Incontinence in palliative care: assessment to promote dignity.

This article will explore the district nurse (DN) role in caring for palliative service users and their responsibility to prepare them and their family members to understand the trajectory of their prognosis and the possible decline in urinary function and incontinence. Educating DNs to advise service users in appropriate management options and collaborating with the wider multidisciplinary team (MDT) to ensure service users' individual goals and aims are followed as closely as possible. Urinary incontinence (UI) is not a natural part of the ageing process, although the prevalence of UI is increased as people age, through multi-morbidities, polypharmacy, cognitive decline, mobility limitations or life-limiting conditions. UI affects an individual's dignity and can cause a negative impact on self-esteem, and it is often accompanied by a perceived stigma that can lead to anxiety, depression and a reluctance to ask for help and advice.

Brazilian version of the King's Health Questionnaire: assessment of the structural validity and internal consistency in female urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The use of valid patient-reported outcome measurements is essential in clinical and research settings. The structure of the Brazilian version of the King's Health Questionnaire (Br-KHQ) has not been evaluated. Thus, this study sought to evaluate the structural validity and internal consistency of the multi-item domains of the Br-KHQ in women with urinary incontinence (UI). METHODS: A total of 462 Brazilian Portuguese speakers with UI aged 18 years or older were included in this study. Participants answered the Br-KHQ, and a questionnaire containing demographic and personal information. The structure of the Br-KHQ was examined through Exploratory Factor Analysis (EFA) with the implementation of parallel analysis and evaluated using confirmatory factor analysis (CFA). For the latter, several goodness-of-fit indices were considered to evaluate the model fit of the structures tested in this study. Internal consistency was assessed using Cronbach's alpha, composite reliability, and coefficient omega. RESULTS: The EFA showed that the questionnaire has a five-factor structure, i.e., limitations of daily life, personal relationship, emotions, sleep/energy, and severity measures. The CFA demonstrated that this structure presented the most adequate goodness-of-fit indices and the lowest values of Akaike information criterion and Bayesian information criterion, compared with the original and Portuguese structure. High values (>0.70) of internal consistency were found. CONCLUSIONS: The Brazilian version of the KHQ is composed of a five-factor structure. Further studies should evaluate other measurement properties of the Br-KHQ to ensure reliable interpretation of this patient-reported outcome measure in clinical practice.

TRANSLATION AND VALIDATION OF THE BRAZILIAN VERSION OF THE "QUALITY OF LIFE ASSESSMENT IN SPINA BIFIDA" QUESTIONNAIRE FOR CHILDREN AND TEENAGERS.

OBJECTIVE: To assess the reliability and validity of the Quality of Life Assessment in Spina Bifida (QUALAS), children and teenager's versions (QUALAS C and T, respectively). This is the first self-applicable quality of life assessment tool for patients under 13 years of age, which also addresses the issue of urinary and fecal incontinence. METHODS: Two urologists performed the translation of both QUALAS versions. A commission produced a consensus version (Version 2), which was applied as a pilot study to define Version 3. It was then backtranslated into English and compared with the original version for equivalence of concepts. Internal consistency with Cronbach's alpha and the intraclass correlation coefficient (ICC) reproducibility was analyzed after two assessments with an interval from two to four weeks. Convergent and divergent validities between the QUALAS and a generic health-related quality of life questionnaire, the KIDSCREEN-27, were studied through Pearson's correlation. RESULTS: The reliability analysis showed good internal consistency for QUALAS-C (α=0.73) and QUALAS-T (α=0.79) and good reproducibility in both questionnaires (QUALAS-C - ICC=0.86; QUALAS-T - ICC=0.92). For QUALAS-C convergent validity, there was a low correlation between its items (r=0.35). In addition, a low correlation was also found in the divergent validity analysis, when compared to the KIDSCREEN-27 (r≤0.33). Convergent and divergent validities of the QUALAS-T questionnaire had similar results: r=0.46 and r≤0.49, respectively. CONCLUSIONS: After the adaptation and validation process, QUALAS-C and QUALAS-T questionnaires showed to be reliable and valid instruments for measuring the health-related quality of life of children and teenagers with spina bifida aged 8 years or older.

Translation and validation of the brazilian version of the quality of life assessment in spina bifida questionnaire for children and teenagers / Tradução e validação da versão brasileira do questionário quality of life assessment in spina bifida para crianças e adolescentes

ABSTRACT Objective: To assess the reliability and validity of the Quality of Life Assessment in Spina Bifida (QUALAS), children and teenager's versions (QUALAS C and T, respectively). This is the first self-applicable quality of life assessment tool for patients under 13 years of age, which also addresses the issue of urinary and fecal incontinence. Methods: Two urologists performed the translation of both QUALAS versions. A commission produced a consensus version (Version 2), which was applied as a pilot study to define Version 3. It was then backtranslated into English and compared with the original version for equivalence of concepts. Internal consistency with Cronbach's alpha and the intraclass correlation coefficient (ICC) reproducibility was analyzed after two assessments with an interval from two to four weeks. Convergent and divergent validities between the QUALAS and a generic health-related quality of life questionnaire, the KIDSCREEN-27, were studied through Pearson's correlation. Results: The reliability analysis showed good internal consistency for QUALAS-C (α=0.73) and QUALAS-T (α=0.79) and good reproducibility in both questionnaires (QUALAS-C - ICC=0.86; QUALAS-T - ICC=0.92). For QUALAS-C convergent validity, there was a low correlation between its items (r=0.35). In addition, a low correlation was also found in the divergent validity analysis, when compared to the KIDSCREEN-27 (r≤0.33). Convergent and divergent validities of the QUALAS-T questionnaire had similar results: r=0.46 and r≤0.49, respectively. Conclusions: After the adaptation and validation process, QUALAS-C and QUALAS-T questionnaires showed to be reliable and valid instruments for measuring the health-related quality of life of children and teenagers with spina bifida aged 8 years or older.

RESUMO Objetivo: Avaliar a confiabilidade e a validade do questionário QUALAS (Quality of Life Assessment in Spina Bifida) nas versões para crianças e adolescentes (QUALAS-C e QUALAS-T, respectivamente). Este é o primeiro instrumento autoaplicável de avaliação da qualidade de vida para pacientes menores de 13 anos e que também aborda a questão das incontinências urinária e fecal. Métodos: Dois urologistas realizaram a tradução das duas versões do QUALAS. Uma comissão produziu uma versão de consenso (Versão 2), a qual foi aplicada no estudo piloto para definir a Versão 3. Esta foi retrotraduzida para o inglês e comparada à versão original para equivalência de conceitos. Para verificar a confiabilidade, analisou-se a consistência interna com o alfa de Cronbach e a reprodutibilidade com o coeficiente de correlação intraclasse (CCI) após duas aplicações do questionário em intervalo de duas a quatro semanas. As validades convergente e divergente foram estudadas por meio da correlação de Pearson entre o QUALAS e um questionário genérico de qualidade de vida relacionada à saúde, o KIDSCREEN-27. Resultados: A análise de confiabilidade revelou que ambos os questionários apresentaram boa consistência interna (QUALAS-C - α=0,73; QUALAS-T - α=0,79) e boa reprodutibilidade (QUALAS-C - CCI=0,86; QUALAS-T - CCI=0,92). Na análise da validade convergente do QUALAS-C, observou-se baixa correlação entre os itens (r=0,35). Além disso, a análise da validade divergente também demonstrou baixa correlação quando comparada ao KIDSCREEN-27 (r≤0,33). As validades convergente e divergente do questionário QUALAS-T tiveram resultados semelhantes: r=0,46 e r≤0,49, respectivamente. Conclusões: Após o processo de adaptação e validação, pode-se afirmar que os questionários QUALAS-C e QUALAS-T são instrumentos confiáveis e válidos para a mensuração da qualidade de vida relacionada à saúde de crianças e adolescentes com espinha bífida a partir dos 8 anos de idade.

Reasons Behind Preferences for Community-Based Continence Promotion.

OBJECTIVES: This study aimed to understand the potential reach of continence promotion intervention formats among incontinent women. METHODS: The Survey of the Health of Wisconsin conducts household interviews on a population-based sample. In 2016, 399 adult women were asked about incontinence and likelihood of participation in continence promotion via 3 formats: single lecture, interactive 3-session workshop, or online. Descriptive analyses compared women likely versus unlikely to participate in continence promotion. To understand format preferences, modified grounded theory was used to conduct and analyze telephone interviews. RESULTS: One hundred eighty-seven (76%) of 246 incontinent women reported being likely to attend continence promotion: 111 (45%) for a single lecture, 43 (17%) for an interactive 3-session workshop, and 156 (64%) for an online program. Obesity, older age, nonwhite race, prior health program participation, and Internet use for health information were associated with reported continence promotion participation. Cited advantages of a single lecture included convenience and ability to ask questions. A workshop offered accountability, hands-on learning, and opportunity to learn from others; online format offered privacy, convenience, and self-directed learning. CONCLUSIONS: Most incontinent women are willing to participate in continence promotion, especially online.

Managing Urinary Incontinence.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers. This article is the second of two that provide an update on urinary incontinence and its management in older adults. It includes an informational tear sheet-Information for Family Caregivers-that contains links to the instructional videos. To use this series, nurses should read the articles first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Social position and geriatric syndromes among Swedish older people: a population-based study.

BACKGROUND: Older people with a low social position are at higher risk of poor health outcomes compared to those with a higher social position. Whether lower social position also increases the risk of geriatric syndromes (GSs) remains to be determined. This study investigates the association of social position with GSs among older community-dwellers. METHODS: Three consecutive population-based health surveys in 2006, 2010 and 2014 among older community-dwellers (age 65-84 years) in Stockholm County were combined (n = 17,612) and linked with Swedish administrative registry information. Social position was assessed using registry information (i.e. education, country of origin and civil status) and by self-reports (i.e. type of housing and financial stress). GSs were assessed by self-reports of the following conditions: insomnia, urinary incontinence, functional decline, falls, depressive disorder, hearing or vision problems. Binomial logistic regression analyses were used to estimate the association between social position and GSs after adjusting for age, sex, health status, health behavior and social stress. RESULTS: The prevalence of GSs was 70.0%, but varied across GSs and ranged from 1.9% for depression to 39.1% for insomnia. Living in rented accommodation, being born outside the Nordic countries, being widowed or divorced were associated with GS presence. Financial stress was most strongly associated with GSs (adjusted odds ratio, 2.59; 95% CI, 2.13-3.15). CONCLUSION: GSs are highly prevalent among older Swedish community-dwellers with wide variations across syndromes and strong association with all measures of social position, most strikingly that of experiencing financial stress.

Functioning and disability of premenopausal women with urinary incontinence: An assessment by using the World Health Organization Disability Assessment Schedule-WHODAS 2.0.

AIMS: To analyze the association between urinary incontinence and disability status in premenopausal women. MATERIALS AND METHODS: The study included 120 premenopausal women recruited from six Basic Family Health Units to participate in this study. We assessed sociodemographic, gynecological, and obstetric data by using specific questions. The International Continence Society's definitions were applied to determine the presence and type of urinary incontinence, and the disability was assessed by using the 36-item version of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. RESULTS: The WHODAS scores showed that women with urinary incontinence had a worse disability in cognition (P = .023) and mobility (P = .020) domains, in addition to the total score (P = .23). Women with mixed urinary incontinence had a worse disability in mobility domain (P = .039) than those with stress or urgency incontinence. Qualitative analyses of disability showed a significant difference between women with and without urinary incontinence (P = .033), with higher percentages of incontinent women with moderate and severe disability. Women who reported urinary incontinence had 7.69 more points on the final score of WHODAS than those who did not report this outcome. CONCLUSIONS: Urinary incontinence in women of reproductive age is associated with disability and worse scores of WHODAS when we compare them to women without urine leakage. The results presented can be useful for designing and adapting strategies for comprehensive care of women with urinary incontinence and disability, and developing rehabilitation programs based on functioning.

What are the concerns and goals of women attending a urogynaecology clinic? Content analysis of free-text data from an electronic pelvic floor assessment questionnaire (ePAQ-PF).

INTRODUCTION AND HYPOTHESIS: Understanding patients' concerns and goals is essential for providing individualised care in urogynaecology. The study objectives were to undertake a content analysis of free-text concerns and goals recorded by patients using an electronic pelvic-floor questionnaire (ePAQ-PF) and measure how these related to self-reported symptom and health-related quality-of-life (HRQOL) data also recorded using ePAQ-PF. METHODS: A total of 1996 consenting patients completed ePAQ-PF. Content analysis was undertaken of free-text responses to the item: 'Considering the issues that currently concern you the most, what do you hope to achieve from any help, advice or treatment?' Key content themes were identified by the lead researcher, and three researchers read and coded all recorded responses. Student's t test was used to compare ePAQ-PF domain scores for patients reporting concerns in the relevant domain with those who did not. RESULTS: In total, 63% of participants who completed the questionnaire, recorded at least one free-text item. Content analysis identified 1560 individual concerns coding into the 19 ePAQ-PF domains. Symptom scores were significantly higher for patients reporting free-text concerns in 18 domains (p < 0.05). Additional concerns relating specifically to body image were recorded by 11% of patients. Key areas of importance emerging for personal goals included cure/improvement, better understanding, incontinence pad use, sexual function and surgery. CONCLUSIONS: Free-text reporting in ePAQ-PF is utilised by patients and facilitates self-expression and discussion of issues impacting on HRQOL. The significant relationship between recorded free-text concerns and ePAQ-PF domain scores suggests convergent validity for the instrument. Development and psychometric testing of a domain to assess body image is proposed.

[Absorbent products for urinary incontinence management]. / Place des protections dans la prise en charge de l'incontinence urinaire.

INTRODUCTION: Despite therapeutic strategies of female and male urinary incontinence (UI) are currently well defined, there is no precise indication of the real place or strategy use of absorbent products regardless of the etiology of the incontinence or the clinical context. METHODS: We performed a research from the PubMed database using the following keywords: (urinary incontinence [MESH Terms]) AND absorbent pad [MeSH Terms]; allowing us to isolate 362 articles. RESULTS: Many protections designs are available over-the-counter without prescription and without reimbursement in France. For "light UI", disposable insert pads are the design that seems to be the most suitable for women, compared to disposable menstrual pads, OR=0.27 [0.14, 0.52], washable pants with integral pad OR=0.12 [0.06, 0.26] or washable insert pads OR=0.05 [0.02, 0.26]. For moderate to severe UI, there is no "best universal product". There are differences between the gender and the use of a panel of protections seems the most appropriate. Both women and men prefer pull-ups to disposable insert pads, OR=0.41 [0.20, 0.87] and OR=0.39 [0.22, 0.68] respectively. In men, a preference in 70 % of subjects for urisheats is observed compared to the protections they usually use (P=0.02). The use of protections improves independence in daily OR activities=0.102 [0.046, 0.158] and quality of life related to UI OR=4.40 [1.74, 7.07] compared to patients not using protections. Despite this, their use must remain cautious because of the potential infectious urinary complications, more frequent in particular in institutional people, with 41 % of users developing at least one urinary infection over an evaluation period of 12 months vs. 11 % of non-users (P=0.001), or immuno-allergic with the "dermatitis associated incontinence" whose prevalence can reach a rate of 50 %. CONCLUSION: Comparative analyzes of risk-benefit, economic costs, patient satisfaction, protections vs. other measures are lacking. It is necessary to continue the development of these products and to compare more precisely their intrinsic characteristics, to best support patients choices.

From stigma to the spotlight: A need for patient-centred incontinence care.

Incontinence is not a single disorder but a family of related conditions with different etiologies and treatments; it is a chronic disability that carries an enormous stigma. In few disorder/treatment pairings, there is the need to reinvent care more urgent and clear than in the area of incontinence. Patient-centred care has been realized to improve outcomes, quality of care, and patient satisfaction while concurrently reducing healthcare costs. To improve continence care and move it away from "cleaning up accidents" to a patient-centred care model, in which the disorder is managed to best practice guidelines, does not require investigative or developmental prowess but a simple, concentrated effort to diffuse existing knowledge to close the knowledge gaps, both at the clinical language level for clinical nurses and family physicians, as the gatekeepers to specialist care, and in simplified layperson's language for the healthcare worker, family carer, and person living with incontinence.

Urological symptoms among 23,240 men in the general danish population - concerns about symptoms, their persistence and influence on primary care contacts.

OBJECTIVE: To analyse possible associations between men's likelihood of contacting a general practitioner (GP) for urological symptoms and the persistence of the symptoms, the influence on daily activities and the level of concern about the symptoms. DESIGN: Web-based nationwide cross-sectional questionnaire study. SETTING: The general population in Denmark. SUBJECTS: 48,910 randomly selected men aged 20+ years. MAIN OUTCOME MEASURES: Urological symptom prevalence and odds ratios for GP contact with urological symptoms in regard to concern for the symptom, influence on daily activities and the persistence of the symptom. RESULTS: Some 23,240 men responded to the questionnaire, yielding a response rate of 49.8%. The prevalence of at least one urological symptom was 59.9%. Among men experiencing at least one urological symptom almost one-fourth reported contact to general practice regarding the symptom. Approximately half of the symptoms reported to be extremely concerning were discussed with a GP. CONCLUSION: Increased symptom concern, influence on daily activities and long-term persistence increased the likelihood of contacting a GP with urological symptoms. This research points out that guidelines for PSA testing might be challenged by the high prevalence of urological symptoms. Key points The decision process of whether to contact the general practitioner (GP) is influenced by different factors, but contradictory results has been found in triggers and barriers for help-seeking with urological symptoms. • Increased symptom concern, influence on daily activities and long-term persistence consistently increased the likelihood of contacting a general practitioner with urological symptoms in men. • Only 50% of the symptoms reported to be extremely concerning were however discussed with the GP. • Guidelines for PSA testing might be challenged by the high prevalence of urological symptoms.

Urinary Incontinence in a National Cohort of Older Women: Implications for Caregiving and Care Dependence.

BACKGROUND: Urinary incontinence (UI) can interfere with older women's ability to perform activities of daily living (ADLs), but little is known about factors that predispose incontinent women to become functionally dependent or compromise their ability to serve as caregivers to others. STUDY DESIGN: UI, caregiving, and care-receiving behaviors were assessed by questionnaire in a national sample of community-dwelling older women. Multivariable models evaluated associations between incontinence and care dependence, assessed factors associated with care dependence among incontinent women, and compared health among female caregivers with and without incontinence. RESULTS: Of the 1703 women, 27% reported weekly or more incontinence and 13% monthly incontinence. Women with weekly or more incontinence were more likely than women without incontinence to report receiving care for ADLs (AOR = 2.39, CI = 1.61-3.56) or instrumental ADLs (AOR = 1.94, CI = 1.42-2.63). Compared to 46% of women without incontinence, 60% of women with monthly or weekly incontinence reported unmet care needs (p = 0.0002). Factors associated with care dependence included more frequent incontinence, older age, marital status, and fair/poor health (p < 0.05 for all). Overall, 15% of women served as a caregiver for another adult, which did not differ by incontinence status (p = 0.84), but female caregivers with incontinence reported worse health than those without incontinence (p = 0.0004). CONCLUSIONS: In this national cohort, older women with incontinence were more likely to be functionally dependent and have unmet care needs than those without incontinence, after adjustment for other factors. At least one in ten incontinent women served as caregivers, despite having worse health than female caregivers without incontinence.

Development and initial psychometric properties of the 'ICIQ-Cog': a new assessment tool to measure the disease-related impact and care effort associated with incontinence in cognitively impaired adults.

OBJECTIVES: To develop a new assessment tool, the ICIQ-Cog, to measure the disease-related impact of incontinence in cognitively impaired adults and the effort associated with the care of this population, and to present the initial psychometric properties of this tool and outline the possible clinical implications. PARTICIPANTS AND METHODS: The ICIQ-Cog consists of two scales: a 12-item scale measuring disease-specific bother (ICIQ-Cog-P) and a four-item scale assessing efforts associated with care of people with incontinence and cognitive impairment (ICIQ-Cog-C). Data on 60 nursing home residents with incontinence and cognitive impairment were obtained in a test-retest research design. The psychometric properties of the ICIQ-Cog were examined using a combination of classic and item response theory methods. RESULTS: Factor analyses resulted in a three-factor solution for the ICIQ-Cog-P, with interrelated factors. Rasch analysis showed a good model fit when collapsing response categories. The ICIQ-Cog-C fitted to one dimension. The ICIQ-Cog tool provided reliable measures in terms of internal consistency (0.69-0.82) and retest reliability (0.71-0.83). The preliminary results on external validity showed that the ICIQ-Cog assessed disease-specific aspects linked to the group of cognitively impaired people with incontinence. CONCLUSION: The ICIQ-Cog tool has appropriate psychometric and clinometric properties and is therefore useful for making decisions about treatment in cognitively impaired adults with incontinence.

Barriers to seeking care for urinary incontinence in Mexican American women.

INTRODUCTION AND HYPOTHESIS: The majority of epidemiologic studies of urinary incontinence (UI) have been conducted in non-Hispanic populations. We conducted a case-control study to identify factors associated with delayed care-seeking behavior in adult Mexican American women with UI. METHODS: Cases were women with UI who sought care >2 years after the onset of symptoms (delayed care group). Controls were women with UI who sought care ≤2 years after the onset of symptoms. Participants were women who self-identified as Mexican American, Hispanic, Chicana or Latina, and were 18 years of age or older. RESULTS: A total of 209 records (107 cases and 102 controls) were available for analysis. Of the women in the delayed care and control groups, 32% and 23%, respectively, were ≥66 years of age (P = 0.12). Women in the delayed care group were less likely than those in the control group to report that the following item was a barrier (adjusted OR = 0.54, P = 0.06): "The wait is too long to the appointment". Women in the delayed care group were twice as likely as those in the control group (adjusted OR = 2.17, P = 0.03) to agree that lack of interest on the part of the health-care practitioner and staff was a barrier. In addition to standardized responses, open-ended responses were solicited and the most frequent barrier was lack of knowledge. CONCLUSIONS: Among Mexican American women with UI, those who delayed seeking care for their UI were more likely than those who sought care promptly to cite lack of interest on the part of a health-care provider as a barrier to seeking care in a timely fashion.

Male Incontinence: The Etiology or Basis of Treatment.

CONTEXT: Elderly men are an increasing proportion of the aging population in the 21st century. Urinary incontinence reduces the quality of life and increases the burden of care for the aging population. OBJECTIVE: The primary objective of this review is to explore the etiopathology of common causes of incontinence in aging male patients. The focus is on the algorithm of the initial evaluation of these patients from both a primary care and a urologic standpoint. EVIDENCE ACQUISITION: A nonsystematic review of the literature was performed in September 2017. The data and evidence of this paper have been obtained by a PubMed search, and through official statements and recommendations from the International Consultation on Incontinence. Our search incorporated terms such as elderly, urinary incontinence, male, urodynamics, bladder outlet obstruction, BPH, neurologic, urethral stricture, spinal shock, and urethral sphincter injury. EVIDENCE SYNTHESIS: A total of 7204 papers were identified; 6838 were excluded for female populations and populations <65 yr. A broad differential diagnosis exists for urinary incontinence in aging male patients, and many patients will be found to have multifactorial incontinence, compounding the issue. Neurologic etiologies common in this population include cerebrovascular accidents, Parkinson's disease, and dementia. Spinal cord injuries and multiple sclerosis are less common. In this analysis, non-neurologic etiologies leading to incontinence are broadly grouped under bladder outlet obstruction, sphincter injury, overactive bladder, underactive bladder, polypharmacy, and urinary tract infections. CONCLUSIONS: We provide a review of the differential diagnosis of incontinence in an elderly male patient. There is a need for understanding etiopathology and recognizing that many patients may have a combination of the above. The assessment algorithm, modified from the International Continence Society, provides a pathway for the provider in evaluating and treating elderly patients. PATIENT SUMMARY: In this review, we have identified the sources of urinary incontinence in elderly male patients by neurologic and non-neurologic causes. We also discuss the basic evaluation and workup of an incontinent patient.

Qualitative Exploration of the Patient Experience of Underactive Bladder.

BACKGROUND: Underactive bladder (UAB) is considered the symptom complex associated with the urodynamic diagnosis of detrusor underactivity. OBJECTIVE: The aim of this research was to investigate the patient reported experience of the symptoms, signs, and impact of UAB. This research is also part of the initial qualitative phase for the development of a new patient reported outcome measure for the assessment of UAB. DESIGN, SETTING, AND PARTICIPANTS: Qualitative methods were used to understand the experience of UAB from a patient perspective, in a purposive sample of male (n=29) and female (n=15) patients aged 27-88 yr (mean: 64 yr), diagnosed with a primary diagnosis of detrusor underactivity, with or without coexisting urological conditions. Semistructured interviews were conducted in Bristol, UK. RESULTS: Male and female patients reported a variety of lower urinary tract symptoms and associated impact on quality of life. Storage symptoms of nocturia, increased daytime frequency, and urgency, and the voiding symptoms of slow stream, hesitancy, and straining were reported by over half of the patients. A sensation of incomplete emptying and postmicturition dribble were also frequently described. Most had a post void residual >30ml (n=34, 77%, median: 199ml) with many reporting urinary tract infections, a history of self-catheterisation, and some experiencing occasional acute retention episodes. These symptoms and signs can have a broad impact on quality of life including having to plan their daily activities around the location of toilets, disruption to sleep, social life, and associated effect on family and friends. CONCLUSIONS: Knowledge of the lived experience of UAB obtained in the current study will be used for the development of a new patient reported outcome measure and help inform the current working definition of UAB. PATIENT SUMMARY: The symptoms, signs, and impact on quality of life of underactive bladder are described by patients with the condition.

Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study.

INTRODUCTION AND HYPOTHESIS: The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD. METHODS: Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities. RESULTS: The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25 kg/m2 was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42 %. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level. CONCLUSIONS: In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.

Urinary Incontinence in Women.

Urinary incontinence, the involuntary loss of urine, can result from a multitude of etiologies and can have a significant negative impact on a woman's physical, social, economic, and psychological well-being. This commentary will review the current evidence regarding the screening, diagnosis, and treatment options for urinary incontinence in women.