What Type of Urinary Incontinence Does This Woman Have?

Holroyd‐Leduc, Jayna; Tannenbaum, Cara; Thorpe, Kevin E.; Straus, Sharon E.

doi:10.1001/jama.299.12.1446

Cited by 97 publications

(67 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(for urge UI). In women, these questions are most helpful to diagnose urge UI and slightly less so stress UI; if a woman denies stress leakage, it is highly unlikely that she has physiologic stress UI [18] Physical examination should include cognitive and functional assessments and focus on potential comorbid conditions associated with UI. Rectal exam is used to assess for masses, tone, and prostate nodules or firmness in men (not size).…”

Section: Discussionmentioning

confidence: 99%

“…The patient should have a full bladder and a relaxed perineum and buttocks, and the examiner should be positioned to observe or catch any leakage when the patient gives a single vigorous cough [18] . The test is most sensitive when the patient is upright and insensitive if the patient cannot cooperate, is inhibited, or the bladder volume is low.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Urinary Incontinence in the Elderly

Nerli¹,

Hiremath²

2017

rjms

View full text Add to dashboard Cite

EpidemiologyUrinary incontinence is defined as involuntary loss of urine. The prevalence of UI increases with age. Moderate to severe UI affects 7% of women 20 to 39 yrs of age, 17% of 40 to 59 yrs of age, 23%of 60 to 79 yrs of age , and 32% of ≥80 yrs of age [1] . With global population aging, the absolute numbers of older persons with UI are increasing exponentially. The primary impact of UI is on quality of life, including self-concept, self-esteem, and the burden of coping. Economic costs of UI continue to rise, adding an estimated $26 billion annually to the cost of caring the elderly in USA [2] . AetiologyWhereas UI in younger and middle-aged persons is nearly entirely caused by alteration in the lower urinary tract (LUT) and its innervation, in older persons, UI represents a geriatric syndrome with broadly based, patient level risk factors that include age-related changes in physiology, comorbidity, medications, and especially functional impairments [3,4] . Moreover, in older persons, UI can cause significant morbidity (such as falls and fractures) and functional impairment. Additionally, many older and especially frailer persons require caregivers, and UI can lead to caregiver stress and institutionalization of the frail elder. Risk factors for UI in older persons include impaired mobility, falls, medications, depression, transient ischemic attacks and stroke, dementia, congestive heart failure, fecal incontinence and constipation, and obesity [4] . Age-related Changes in the Lower Urinary TractDetrusor contraction strength declines with age in women as well as men, and there is no detrusor overactivity (DO) associated increase in contractility [5] . Lack of estrogen contributes to, and estrogen replacement reverses, ultrastructural changes of impaired contractility (caveolar depletion and detrusor fibrosis), while low estrogen also may contribute to bladder muscle cell differentiation [6] . In the urethra, closure pressure decreases by an estimated 15 cm H 2 O per decade [7] , possibly related to mucosal changes extending to the bladder trigone, irritating sensory afferent nerves and triggering DO, and decreased urethral vascular density and blood flow (note: these studies did not control for vascular risk factors) [8,9] . Circular smooth muscle mass and fiber counts decrease, with striated muscle loss in the anterior urethra [10] . Little remains known about urethral changes in older men other than prostatic obstruction. Despite evidence for levator denervation and decreased muscle fiber number, type, and diameter, pelvic floor dysfunction whether defined as stress UI (SUI), resting and volitional vaginal closure force, or pelvic organ prolapse is not associated with age after controlling for obesity, parity, menopause, and hormone use [11] . The vagina shortens by a clinically insignificant 0.08 cm per 10 years [12] . Post-menopausal atrophy may cause loss of lactobacillus and colonization with pathogenic organisms (E. coli, enterococci, etc), leading to higher rates of bacteriuria and symptomatic uri...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urinary Incontinence in the Elderly

Nerli¹,

Hiremath²

2017

rjms

View full text Add to dashboard Cite

show abstract

“…Colli et al also found low values of sensitivity and specificity for cases of MUI (51 and 66%, respectively). 14 In a systematic review of the literature, Holroyd-Leduc et al 17 concluded that a positive bladder stress test may be useful for diagnosing SUI. An assessment including clinical history, physical examination, and stress test can only modestly increase the probability of clinical diagnosis of SUI.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of clinical history compared with urodynamic study in 1,179 women

Haddad

Monaco²,

Kwon³

et al. 2016

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

Objective: to determine the positive predictive value of clinical history in comparison with urodynamic study for the diagnosis of urinary incontinence. Methods: retrospective analysis comparing clinical history and urodynamic evaluation of 1,179 women with urinary incontinence. The urodynamic study was considered the gold standard, whereas the clinical history was the new test to be assessed. This was established after analyzing each method as the gold standard through the difference between their positive predictive values. Results: the positive predictive values of clinical history compared with urodynamic study for diagnosis of stress urinary incontinence, overactive bladder and mixed urinary incontinence were, respectively, 37% (95% CI 31-44), 40% (95% CI 33-47) and 16% (95% CI 14-19). Conclusion: we concluded that the positive predictive value of clinical history was low compared with urodynamic study for urinary incontinence diagnosis. The positive predictive value was low even among women with pure stress urinary incontinence.

show abstract

“…TOT, which is applied easily, can be performed simultaneously with other surgeries in cases that have other pelvic pathologies in addition to incontinence. One of the pelvic pathologies that frequently accompany urinary incontinence is pelvic organ prolapse (10) . It was demonstrated that the structure of the connective tissue in cases with pelvic organ prolapse may be different from that of normal women (11) , and, this factor may contribute to the development of urinary incontinence in these cases.…”

Section: Midurethral Sling Surgeries (Mus's) In the Treatmentmentioning

confidence: 99%