The Association of Physical Activity and Urinary Incontinence in US Women: Results from a Multi-Year National Survey.

OBJECTIVES: To evaluate the relationships between physical activity, both work and recreational, and urinary incontinence among women. METHODS: We assessed women aged 20 years and older in 2008-2018 NHANES (National Health and Nutrition Examination Survey) cycles who answered self-reported urinary incontinence and physical activity questions. Weighted, multivariate logistic regression model was used to determine the association between incontinence and physical activity levels after adjusting for age, body mass index, diabetes, race, parity, menopause and smoking. RESULTS: A total of 30,213 women were included in analysis, of whom 23.15% had stress incontinence, 23.16% had urge incontinence, and 8.42% had mixed incontinence (answered "yes" to both stress and urge incontinence). Women who engaged in moderate recreational activity were less likely to report stress and urge incontinence (OR 0.79, 95% CI 0.62-0.99 and OR 0.66, 95% CI 0.48-0.90, respectively). Similarly, women who engaged in moderate activity work were less likely to report stress, urge and mixed incontinence (OR 0.84, 95% CI 0.70-0.99; OR 0.84, 95% CI 0.72-0.99; and OR 0.66 95% CI 0.45-0.97, respectively). CONCLUSIONS: Moderate physical activity and greater time spent participating in moderate physical activity are associated with a decreased likelihood of stress, urge and mixed incontinence in women. This relationship holds for both recreational and work-related activity. We hypothesize that the mechanism of this relationship is multifactorial, with moderate physical activity improving pelvic floor strength and modifying neurophysiological mediators (such as stress) involved in the pathogenesis of incontinence.

How do urinary incontinence types affect sexual function and quality of life for Turkish women?

OBJECTIVE: Urinary incontinence (UI) subtypes may have some effects on sexual function because of diverse pathophysiological mechanisms. The objective of our study is to compare UI subtypes' effects on women's sexual function and quality of life (QoL). METHODS: In this descriptive and comparative study, a total of 239 women with UI were included (89 with stress urinary incontinence [SUI], 65 with urge urinary incontinence [UUI], and 85 with mixed urinary incontinence [MUI]). Sexual function was assessed with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and QoL was assessed with the Incontinence Impact Questionnaire-7 (IIQ-7). RESULTS: In our study, the mean total PISQ-12 score for the UI subtypes was 29.49 ± 6.38 for SUI, 31.43 ± 5.46 for UUI, and 23.12 ± 5.54 for MUI. Women with MUI had significantly more sexual dysfunctions than the other groups (P < .001). The mean total IIQ-7 score according to UI subtypes was 60.61 ± 31.49 for SUI, 64.40 ± 28.20 for UUI, and 70.51 ± 25.09 for MUI. As regards the scores of the IIQ-7, UI had a negative impact on QoL for women of all groups, especially for women with MUI and UUI, but was not significantly different between the groups (P > .05). CONCLUSION: The sexual function of women with MUI was affected more adversely than the other UI subtypes. There was no statistically significant difference between the UI subtypes according to IIQ-7 scores, but when we examined the scores, MUI and UUI were found to have more negative effects on QoL. Clinicians and continence nurses should make routine evaluations of sexual function and QoL for women according to UI subtypes.

Urinary and faecal incontinence: psychological factors and management recommendations.

BACKGROUND: Urinary and faecal incontinence substantially impacts upon physical health and is associated with significant psychological distress and reduced quality of life. Due to stigma and embarrassment, many patients do not present for management of their incontinence. AIM: The objective of this article is to summarise the forms and causes of urinary and faecal incontinence, highlight the psychological mechanisms and psychopathology associated with incontinence, and provide management recommendations. CONCLUSION: Urinary and faecal incontinence can have a significant impact on an individual's psychological wellbeing and quality of life. Psychological factors may either contribute to or arise from incontinence and should be addressed as part of the overall management plan.

Impact of urinary incontinence on the quality of life of individuals undergoing radical prostatectomy.

OBJECTIVE: to assess the level of urinary incontinence and its impact on the quality of life of patients undergoing radical prostatectomy. METHOD: cross-sectional study carried out with prostatectomized patients. The data were collected from the following instruments: sociodemographic questionnaire, Pad Test, International Consultation on Incontinence Questionnaire - Short Form and King Health Questionnaire. Data were submitted to descriptive and bivariate statistical analysis. The level of significance was set at 0.05. RESULTS: a total of 152 patients participated, with a mean age of 67 years. Among incontinent patients, there was a predominance of mild urinary incontinence. Urinary incontinence had a very severe impact on the general assessment of quality of life in the first months and severe impact after six months of surgery. The greater the urinary loss, the greater the impact on the quality of life domains Physical Limitations, Social Limitations, Impact of Urinary Incontinence and Severity Measures. Most participants reported no erection after surgery and therefore did not respond to the question of the presence of urinary incontinence during sexual intercourse. CONCLUSION: the present study evidenced the occurrence of urinary incontinence after radical prostatectomy at different levels and its significant impact on the quality of life of men, which reveals the need of interventions for controlling it.

Evaluation of Validity and Reliability of a Revised Incontinence-Associated Skin Damage Severity Instrument (IASD.D.2) by 3 Groups of Nursing Staff.

PURPOSE: The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas. DESIGN: Observational, evaluative design. SAMPLE AND SETTING: Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female. METHODS: Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a "gold standard" in this study) was analyzed. RESULTS: The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience. CONCLUSION: The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.

Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review.

Background: Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health. Objective: The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions. Data Sources: Data sources include PUBMED, CINAHL, LILACS, and SCIELO. Study Selection: Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered. Data Extraction: The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF. Data Synthesis: Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature. Limitations: A limitation in the study was that only observational studies were included. Conclusions: A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.

Construção de instrumento para consulta de enfermagem à idosa com incontinência urinária de um serviço ambulatorial / Construction of an instrument for nursing consultation for older women with urinary incontinence of an outpatient service

A presente proposta decorre de uma pesquisa que tem como objetivo construir um instrumento para consulta de Enfermagem a idosa com incontinência urinária assistida em um serviço ambulatorial. Essa pesquisa foi motivada pela necessidade de uma ferramenta que facilite o registro da prática profissional, evidenciando desta forma a contribuição da enfermagem no cuidar da paciente com incontinência urinaria. Acredita-se que a elaboração do instrumento pode fomentar futuras investigações e ser utilizado na prática assistencial em caráter experimental, bem como agregar conhecimento acerca da documentação profissional, evidenciando a Enfermagem enquanto profissão e ciência

Therapeutic effect of propiverine hydrochloride on mixed-type urinary incontinence in women: The Female Urgency and Stress Urinary Incontinence Study of Propiverine Hydrochloride trial.

OBJECTIVES: To show the efficacy of propiverine hydrochloride in the management of symptoms of stress urinary incontinence in female patients with mixed-type urinary incontinence. METHODS: The study was carried out as a multicenter single-arm clinical trial at 64 institutions in Japan. The participants were female patients aged ≥20 years with mixed-type urinary incontinence. The frequency of stress urinary incontinence and urgency urinary incontinence was evaluated at baseline and 4, 8 and 12 weeks after treatment with propiverine hydrochloride. Subjective symptoms were evaluated using the Overactive Bladder Symptom Score and the International Consultation on Incontinence Questionnaire-Short Form. Functional urethral length and maximum urethral closing pressure were also measured at baseline and 12 weeks after treatment at the institutions where the urethral pressure profile was taken. RESULTS: In total, 49 mixed-type urinary incontinence patients were enrolled in the present study. The number of cases of urgency urinary incontinence was reduced time-dependently, which showed statistically significant differences between baseline and 4, 8 and 12 weeks after treatment. A similar statistically different reduction was also observed for stress urinary incontinence. The mean reduction rates of urgency urinary incontinence and stress urinary incontinence at 12 weeks after treatment were 63.9% and 44.3%, respectively. The total scores of International Consultation on Incontinence Questionnaire-Short Form and Overactive Bladder Symptom Score were gradually reduced, and the differences were statistically significant. Functional urethral length and maximum urethral closing pressure at 12 weeks after treatment did not show any statistical differences compared with those at baseline. CONCLUSIONS: Propiverine hydrochloride can be an effective therapeutic option for stress urinary incontinence in patients with mixed-type urinary incontinence.

Impact of urinary incontinence types on women's quality of life. / Impacto dos tipos de incontinência urinária na qualidade de vida de mulheres.

OBJECTIVE: To identify the most frequent type of urinary incontinence in women assisted in two outpatient clinics of urogynecology, and to compare general and specific quality of life among the different types of incontinence measured through validated questionnaires. METHOD: Cross-sectional study conducted at the urogynecology outpatient clinic. The following questionnaires were used for quality of life assessment: Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF), King's Health Questionnaire (KHQ), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). RESULTS: The study included 556 women. Mixed Urinary Incontinence was the most frequent type (n=348/62.6%), followed by Stress Urinary Incontinence (n=173/31.1%) and Urge Urinary Incontinence (n=35/6.3%). Women with mixed urinary incontinence had greater impact on the general (SF-36) and specific quality of life (KHQ and ICIQ-SF) compared to the others (p<0.05). In the evaluation of sexual function (PISQ-12), there was no difference between groups (p=0.28). CONCLUSION: All types of urinary incontinence interfere both in the general and specific quality of life, but women with mixed urinary incontinence are the most affected.

Effects of Urinary Incontinence Subtypes on Women's Sexual Function and Quality of Life.

OBJECTIVE: To evaluate the effects of different subtypes of urinary incontinence (UI) on sexual function and quality of life (QoL). MATERIALS AND METHODS: Ninety-three women with UI were enrolled in the observational study. By the urodynamic findings, 32 women (34.5 %) were diagnosed with stress urinary incontinence (SUI), 35 (37.6%) with urgency urinary incontinence (UUI), and 26 (27.9%) with mixed urinary incontinence (MUI). The Short Form-36 questionnaire was used to investigate the QoL, and the Female Sexual Function Index and Female Sexual Distress Scale questionnaires were used to study sexual function and sexual distress, respectively. RESULTS: Low mean total Female Sexual Function Index scores and high mean Female Sexual Distress Scale total scores were obtained for each group. However, women with MUI showed a significantly higher impairment of female sexual function (P <.05) compared with others. Women with MUI and UUI had more orgasmic disorder than those with SUI, and women with MUI and SUI had mainly lower sexual desire than those with UUI. QoL was worse in women of all groups, particularly in those with UUI and MUI. CONCLUSION: UI, whatever its nature, has a significant impact on sexual function; notwithstanding, the subgroups of UI, namely SUI, UUI, and MUI, may have their sexual function affected in different ways. All subtypes of UI can have severe consequences on perception of QoL, but when compared, a significantly high impairment of QoL was observed in the MUI and the UUI groups.

Adult women's experiences of urinary incontinence: a systematic review of qualitative evidence.

BACKGROUND: Women are affected dramatically by urinary incontinence (UI). This disease is currently considered as epidemic. OBJECTIVE: The objective of this review is to identify, through the best available evidence, how women experience UI worldwide. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review included studies of adult women who had experienced UI. PHENOMENA OF INTEREST: Women with UI from various social and cultural settings were included in this review. TYPES OF STUDIES: Qualitative data including, but not limited to, study designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included in this review. OUTCOMES: All aspects related to the experience of UI endured by women were considered. SEARCH STRATEGY: An initial search of MEDLINE (PubMed) and CINAHL was done, followed by the exploration of all the databases and all identified studies, published in English, Spanish, French and Portuguese. The databases searched were CINAHL, PubMed, PsycINFO, Lilacs, Scielo, BVS, BVS-Psi, Scopus, Embase, Sociological Abstracts, Dissertation Abstracts International and the University of São Paulo Dissertations and Thesis bank and gray literature. METHODOLOGICAL QUALITY: Each primary study was assessed by two independent reviewers for methodological quality. The Joanna Briggs Institute Qualitative Appraisal and Review Instrument (JBI-QARI) data extraction form for interpretive and critical research was used to appraise the methodological quality of all papers. DATA EXTRACTION: Qualitative data were extracted using the JBI-QARI. DATA SYNTHESIS: Qualitative research findings were synthesized using the JBI-QARI. RESULTS: From the 28 studies were included, 189 findings were extracted and they were grouped into 25 categories and eight synthesized findings: (i) cultural and religious backgrounds and personal reluctance contribute to delays in seeking UI treatment; (ii) the inevitable and regrettable problem of UI endured silently and alone affects women's daily activities and their social roles; (iii) poor knowledge and the vague nature of the symptoms mask the fact that UI is a disease; (iv) the experiences provoked by UI and the sense of shame regarding the condition have contributed to impair women's lives; (v) UI has provoked negative effects on women's intimacy and sexual satisfaction and provoked changes in the ways they experience their sexuality and sexual function; (vi) UI is considered a consequence of pregnancy and childbirth, inherent to aging or a religious punishment; (vii) the women affected by UI adopt several strategies to improve their health status; and (viii) women have personal preferences toward care providers and treatments; they confront difficulties through UI treatment and some care needs are not met. CONCLUSION: Personal and tailored health care should be provided, and preferences and expectations should be taken into consideration in the provision of health care to the people affected by UI.

The Correlation of Urethral Pressure Profilometry Data in Women with Different Types of Urinary Incontinence.

INTRODUCTION: The aim of the study was to analyse the correlation of subjective complaints and urethral pressure profilometry (UPP) data in women with different types of urinary incontinence (UI): stress UI (SUI), urgency UI (UUI), and mixed UI (MixUI). METHODS: A study group of 405 women with complaints about UI were surveyed (UDI-6; ICIQ-UI) to determine the subjectively dominant type of UI, and UPP was performed for all these women. The variables analysed by UPP were the maximum urethral closure pressure at rest (MUCPrest), maximum urethral closure pressure at cough stress (MUCPstress), functional urethral length at rest (FULrest), functional urethral length during cough stress (FULstress) test and pressure transmission ratio (PTR). The statistical variation between different groups of UI patients was calculated for all the analysed variables. RESULTS: The value of PTR was statistically and significantly higher in the group of patients with isolated UUI, compared to the SUI and MixUI groups. The MUCPrest and MUCPstress values were consistently lower in women with isolated SUI, compared to isolated UUI. The FULrest and FULstress values showed no statistically significant difference between the groups with different types of UI. CONCLUSIONS: The PTR value is a result of UPP test that helps in distinguishing objectively between UUI, SUI, and MixUI. The PTR value can be used to characterise the hypermobility of urethra. The MUCPrest and MUCPstress values are consistently lower in women with isolated SUI, compared to those with isolated UUI. MUCP can be used as an objective criterion for differentiation of these 2 groups of patients.

[Male Urinary Incontinence--a Taboo Issue]. / Urininkontinenz beim Mann--ein Tabuthema.

Male urinary incontinence is an underestimated and frequently not broached issue. The urinary incontinence is divided into stress-, urge incontinence and hybrid forms as well as overflow incontinence. The fact that there are increasingly more men over 60 means that the prevalence of the urinary incontinence is up to 40%, and urinary incontinence will increasingly gain importance in daily routine practice. Many investigations and therapies can be realized by the general practitioner. Already simple therapy approaches can lead to a considerable clinical improvement of male urinary incontinence. If the initial therapy fails or pathological results (i. e. microhaematuria, recurrent urinary tract infections, raised residual urine and so on) are found, the patient should be referred to a urologist.

Urinary Incontinence in Women.

Urinary incontinence, the involuntary leakage of urine, is caused by a variety of factors and may result in a wide range of urinary symptoms that can affect women's physical, psychological, and social well-being and sometimes can impose significant lifestyle restrictions. Identifying the etiology of each woman's urinary incontinence symptoms and developing an individualized treatment plan is essential for improving her quality of life. The purpose of this joint document of the American College of Obstetricians and Gynecologists and the American Urogynecologic Society is to review information on the current understanding of urinary incontinence in women and to outline guidelines for diagnosis and management that are consistent with the best available scientific evidence.

[Effect of the type of urinary incontinence on the quality of life of patients in the public healthcare system in Southeastern Brazil]. / Impacto do tipo de incontinência urinária sobre a qualidade de vida de usuárias do Sistema Único de Saúde no Sudeste do Brasil.

PURPOSE: To identify the impact of urinary incontinence (UI) on quality of life (QoL), to compare the scores of QoL domains in women with stress urinary incontinence (SUI), overactive bladder (OAB) and mixed incontinence (MUI) and to establish the association between the clinical type of UI and the impact on QoL. METHODS: Data of 181 incontinent women attended at a public hospital were collected regarding age, body mass index (BMI) and co-morbidities. King's Health Questionnaire (KHQ) was applied and patients were classified into two groups according to the self-assessment of incontinence impact. KHQ scores were compared by the Mann-Whitney test. Depending on their urinary symptoms, women were divided into SUI, OAB and MUI groups and their scores in the KHQ domains were compared by the Kruskal-Wallis and Dunn tests. The odds ratio (OR) of a woman reporting a worse effect of UI on QoL was estimated using the binary logistic model. The control variables were: age, BMI and number of co-morbidities. RESULTS: A significant difference was found between the two groups of self-assessment of UI impact for all KHQ domains. The MUI group showed worse scores than the SUI group for all domains, and OAB group, for limitation of physical and daily activities. There was a significant difference between the odds of the women in the SUI and MUI groups reporting worse effects of UI on QoL (OR=2.9; p=0.02). CONCLUSION: As reported at other reference services, MUI was the most commom type, and urinary loss had a moderate/major impact on QoL, affecting mainly role limitations domain. The adjusted analysis showed that women with MUI had almost three times greater odds of reporting worse impact on QoL than women with SUI.

Impacto do tipo de incontinência urinária sobre a qualidade de vida de usuárias do Sistema Único de Saúde no Sudeste do Brasil / Effect of the type of urinary incontinence on the quality of life of patients in the public healthcare system in Southeastern Brazil

Identificar o impacto da incontinência urinária (IU) sobre a qualidade de vida (QV), comparar os escores dos domínios de QV em mulheres com incontinência de esforço (IUE), bexiga hiperativa (BH) e incontinência mista (IUM) e estabelecer a associação entre o tipo clínico de IU e o impacto sobre a QV.