Urinary incontinence is a prevalent condition; nevertheless few women seek professional help. One aim of this study was to investigate all women aged 18-70 years in a Swedish community regarding (a) the prevalence rate and risk factors of urine leakage and (b) the quality of life for women with and without urine leakage, for women with stress incontinence versus urge incontinence, and for women with urine leakage who had or had not sought help. A second aim was to study all women aged 18-46 years from the same population four years later regarding (a) the quality of life and natural history of urine leakage, (b) why some women with persistent urine leakage seek help and others do not, and (c) how they deal with their urine leakage. Every fourth woman aged 18-70 years was found to have urine leakage. The number of women with urine leakage increased with increasing age, the number of deliveries, the presence of urinary tract infection, and the use of oestrogen substitutions. Women with urine leakage had a lower quality of life in all eight dimensions of the SF-36 as compared with women without urine leakage. Furthermore, in women with urge incontinence the quality of life was lower compared with women with stress incontinence in all dimensions of the SF-36. Women with urine leakage who had sought help had lower quality of life in seven of eight SF-36 dimensions as compared with women with urine leakage who had not sought help. At the four-year follow-up the quality of life had deteriorated in five of eight SF-36 dimensions in women aged 18-46 years with persistent urine leakage as compared with women with persistent continence. The mean annual incidence and remission rates of urine leakage were on the same low level (4%). Most women with slight or moderate long-term urine leakage had not sought professional help, largely because they considered their leakage a minor problem. Pelvic floor exercises was the most commonly used management method for all participants.

Bakgrund: Urininkontinens är ett stort folkhälsoproblem bland äldre och upplevs som genant. Då många äldre har hemsjukvård är detta ett vanligt problem som distriktssköterskan kommer i kontakt med. Distriktssköterskorna upplever att tyngdpunkten i hemsjukvården ligger på att skriva ut inkontinensskydd och inte på att göra grundliga utredningar. Syfte: Var att belysa distriktssköterskors erfarenheter av att arbeta med urininkontinens bland äldre i hemsjukvården. Metod: En kvalitativ intervjustudie med semistrukturerade frågor genomfördes. Via ett bekvämlighetsurval valdes åtta distriktsköterskor ut att delta. Analysen genomfördes enligt Graneheim's och Lundman's manifesta innehållsanalys. Resultat: Fyra kategorier framkom; att hitta och förstå problemet, att ge rätt inkontinenshjälpmedel, ekonomi och förbrukning samt samarbetet med hemtjänsten. Distriktssköterskorna berörde urininkontinens med ödmjukhet och uttryckte att ämnet inte var svårt då de oftast hade en långvarig kontakt med patienten. Ingen grundlig utredning gjordes gällande orsaken till inkontinensen. Oftast anpassades hjälpmedlen genom att patienten fick prova olika storlekar och sedan berätta vilket som passade bäst. Tidbristen gjorde att de som stod patienten närmast, vanligtvis hemtjänsten, fick bistå med hjälp att bedöma behovet av inkontinenshjälpmedel. Detta kunde resultera i problem då distriktsköterskan upplevde att hemtjänsten ibland använde hjälpmedlen felaktigt. Slutsats: Inkontinensvården bredrivs inte alltid enligt de riktlinjer som finns, vilket kan medföra att den inte alltid är evidensbaserad. Det finns ett behov av bättre utbildning inom inkontinensvård samt en inkontinensansvarig inom varje hemsjukvårdsgrupp. / Background: Urinary incontinence is a major public health problem and cause of embarrassment among the elderly. Since a great many elderly have home health care this is a common problem for the district nurses to encounter. The district nurse experience that the focus within the home health care is on prescribing incontinence aids and not on performing thorough investigations. Aim: Was to illuminating the district nurses’ experiences of working with urinary incontinence among the elderly within home health care. Method: A qualitative interview study was performed using semi-structured questions. Eight district nurses were chosen to participate through a convenience sampling. The analysis was carried out in accordance with the manifest content analysis by Graneheim and Lundman. Results: Four categories emerged; to find and understand the problem, to give the right incontinence aids, economy and consumption, and the collaboration with home care services. The district nurses approached urinary incontinence with humility and claimed that it was not a difficult topic since they usually had a prolonged contact with the patient. No thorough investigation of the reason behind the incontinence was performed. The suitable incontinence aid were determined by letting the patient try out different sizes and give feedback on which aid the patient preferred. Due to lack of time people closest to the patient, usually the home care services, had to provide help with assessing the need for incontinence aids. This could lead to problems since the district nurse felt that the home care services sometimes used the aids erroneously. Conclusion: The incontinence care is not always carried out in accordance with the defined guidelines, which can result in the care not always being evidence-based. There exists a need for better education in incontinence care as well as a person with special competence in this area within each home health care unit.

Syftet med studien var att beskriva det dagliga livet för yngre kvinnor med urininkontinens. Sju stycken kvinnor intervjuades och en öppen fråga ställdes för att få fram studiens syfte. Kvalitativ innehållsanalys genom Lundman & Hällgren Graneheim(2012) användes som analysmetod. Studiens resultat visade att urininkontinens förde med sig en rad konsekvenser för den unga kvinnan. I det dagliga livet innebar det att livet blev mindre aktivt och då var det främst påverkan på den fysiska aktiviteten kvinnorna tog upp och upplevde som ett problem. Upplevelsen att känna sig ensam, okvinnlig och mindre sexuellt attraktiv förekom och rädslan fanns ständigt där att läckaget skulle upptäckas. Kvinnan låg steget före och tänkte förebyggande genom att planlägga vart toaletter fanns, dricka minimalt och anpassa sin klädsel. Urininkontinens upplevdes svårt att prata om och var inget självklart som delades med sin närmaste familj eller vänner. Sammanfattningsvis blev konsekvenserna och anpassningarna att den unga kvinnan med urininkontinens levde i ständig beredskap i vardagen. / The aim of the study was to describe the daily lives of younger women with urinary incontinence. Seven women were interviewed and one open question was asked to produce the study's purpose. Qualitative content analysis by Hällgren Graneheim & Lundman (2012) was used as the analysis method. The study results showed that urinary incontinence entailed a number of consequences for the young woman. In daily life it meant that life became less active and then it was mainly the effect on the physical activity women took up and experienced as a problem. Experience to feel alone, unfeminine and less sexually attractive occurred and the fear was constantly there that the leakage could be detected. The woman thought prevention by designing their everyday lives. Urinary incontinence was experienced hard to talk about and were no obvious shared with their immediate family or friends. In summary, the consequences and the adjustments to the young woman with urinary incontinence lived in constant readiness in everyday life.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Introduction: The purpose of this research was to assess the relationship between the degree of incontinence severity and treatment seeking behavior, healthcare utilization, and work productivity; and to compare overactive bladder (OAB) related disease burden from a global perspective. Methods: A cross-sectional online survey was administered to eligible participants with idiopathic OAB residing in Australia, Canada, France, Germany, Italy, Spain, United Kingdom, and the United States. Participants were categorized into subgroups with dry, mild (1 leak/per day), moderate (2 leaks/day), and severe (3 leaks/day) urinary incontinence (UI) severity groups. Results: A total of 1,334 participants completed the survey. Persons with more severe urinary incontinence symptoms related to OAB consumed more healthcare resources, had a higher occurrence of OAB related clinical consequences, and higher work productivity loss compared to individuals with less severe symptoms. Even though OAB is associated with significant disease burden, many patients do not seek treatment.

Background: Pelvic organ prolapse (POP) can be treated surgically or, more conservatively, with use of a pessary. Objective: To determine if the population of women treated for POP with the use of a pessary in one Nurse Practitioner's (NP) practice demonstrated health outcomes as better, same, or needing improvement through use of a data-based practice model from encounter data extracted from the electronic health record (EHR).Design: The project design was a quality improvement (QI) project, descriptive in nature. One Plan Do Study Act (PDSA) cycle was conducted for this QI project. Setting: NP managed specialty clinic in urban Southwestern Arizona that provides services to women with POP. Patients: Ten randomly selected women who had been treated conservatively for POP with use of a pessary were identified as two subpopulations and evaluated: women who received professional management of the pessary and women who were patient managed. Intervention: The intervention was the development of a data-based practice model, using patient profile data elements derived from the documented EHR encounters of the 10 women. Measurements: Twelve scales were developed to evaluate the patient profile data elements, generating numeric scores for each encounter. Two Decision Rules were then used to evaluate numeric scores by encounter, creating primary and secondary health outcomes. Limitations: Two limitations were identified. The QI project was limited by the small sample size of 10 patients. This is however, true to PDSA guidelines that recommend small scale cycles. The data were limited as only documented data were used. Conclusions: In general, the expected outcome was the outcome observed; the provider was unaware of any women in this QI Project who were not successfully treated with use of a pessary for treatment of POP. The value of this data-based practice model is that outcomes can be aggregated across populations rather than relying on recall of individual outcomes and therefore has potential to be used regularly and systematically as a quality feedback loop, as well as on a larger scale in future PDSA cycles to determine other outcomes beyond a single provider in this or other similar clinical populations.

Bakgrund: Urininkontinens är ett hälsoproblem som har stor påverkan på det känslomässiga välbefinnandet. Risken att drabbas av problem med urininkontinens ökar med stigande ålder. Urininkontinens innebär ofta ytterligare betydande grad av vårdtyngd för de personalgrupper som vårdar dessa patienter. Det är sjuksköterskans ansvar att utreda och förskriva inkontinenshjälpmedel, därför behöver hon ha kunskaper om olika utrednings-, omvårdnads- och behandlingsalternativ som finns. Syftet var att belysa vilka åtgärder som kan användas för att hantera omvårdnaden av kvinnor över 65 år med urininkontinens, samt resultatet av åtgärderna. Metod: En litteraturstudie gjordes där totalt 16 vetenskapliga artiklar inkluderades. Resultatet visade åtgärder som delades in i sex kategorier; "personalutbildning", "patientinformation", "utredning och bedömning", "fysisk träning", "beteendeträning" och "inkontinenshjälpmedel". Diskussion: Största hindret för att minska urinläckaget är brist på kunskap och engagemang hos patienter och personal. Med små, enkla medel som motion, fasta toalettider och minskat vätskeintag kan urinläckaget och även användandet av blöjor minska, i både antal och storlek. Slutsats: Det finns åtgärder att göra innan blöjor förskrivs. Samtliga åtgärder gjorde att urinläckaget minskade. / Background: Urinary incontinence is a health problem that has great impact on the emotional well-being and increases with age. Urinary incontinence requires higher degree of care givers time. It is the nurse‟s responsibilities to investigate and prescribe incontinence aids. Nurses have to have knowledge in diagnostics, nursing and treatment methods that is used on patients with urinary incontinence. The aim was to illuminate nursing measures that can be used in the care of women over 65 years with urinary incontinence and outcomes of care measures. Method: A literature review was made and 16 scientific articles were included. The results showed measures that was grouped into six categories; "nursing staff education", "patient information", "investigation and assessment", "physical training", "behaviour training" and "incontinence aids". Discussion: The highest obstacle to decrease the urine leakage is lack of knowledge and commitment from patients and care givers. With small, simple measures such as exercise, regular toileting and reduced fluid intake can the urine leakage and pad use decrease in both numbers and size. Conclusion: There are measures that can be used before pads are prescribed and all measures resulted in decreased urine leakage.

Im Zeitraum von 1999 bis 2009 wurde am Universitätsklinikum Göttingen bei 65 Patienten im Rahmen einer Harninkontinenztherapie ein operativer Eingriff mit einem künstlichen Sphinktersystem durchgeführt. Die vorliegende Arbeit untersucht den Erfolg dieser Behandlungsmethode. Dazu wurden sowohl präoperative Befunde aus den Patientenakten erhoben als auch der postoperative Verlauf bewertet. Mit Hilfe zweier validierter Fragebögen sowie selbst formulierter Zusatzfragen, die sich mit der allgemeinen Lebensqualität der behandelten Patienten, mit der Inkontinenzsymptomatik und der die Miktion betreffenden Lebensqualität beschäftigen, sollen sowohl die subjektive Patientenzufriedenheit als auch Veränderungen bezüglich der präoperativen und postoperativen Kontinenzsituation der Betroffenen evaluiert werden. Die Schwerpunkte der Auswertung betreffen die postoperative Kontinenzsituation, die Komplikationsrate und die Zufriedenheit der Patienten mit dem Behandlungserfolg. Die Ergebnisse werden mit bereits veröffentlichten Literaturangaben verglichen und diskutiert.

Object of the study. Pelvic floor muscles strength and endurance of women with stress urinary incontinence. Problem of the study. The actuality of urinary incontinence remains in Lithuania, not only because of it’s prevalance, but also because women are not able to find appropriate help and incorrect treatment methods are applied. Aim of the study. To evaluate the efficiency of physical therapy methods for the pelvic floor muscle re-education in women with stress urinary incontinence. Objectives. To evaluate the efficiency of Kegel and combined methods for the pelvic floor muscle re-education in women with stress urinary incontinence, to compare the efficiency of Kegel and combined methods for the pelvic floor muscle re-education in women with stress urinary incontinence. Methods. The objective pelvic floor muscle maximum strenght and endurance in 24 female were measured using pelvic floor muscle function measurement apparatus „Pelvexiser“ and chronometer. The subjects were interviewed about urinary incontinence symptoms‘ severity and urinary incontinence occurrence during provocative tests. Research data was analysed using SPSS 10,0 for Windows. Results. Muscle function assessment after treatment showed that in both groups pelvic muscles strenght and endurance improved significantly. After treatment a majority of women in Kegel group indicated the severity of their symptoms as moderatley problematic, the majority of women in combined method group reported only minor symptoms... [to full text]

Mokslinis konsultantas: doc. dr. Vidmantas Alekna (Vilniaus universiteto Eksperimentinės ir klinikinės medicinos institutas, biomedicinos mokslai, medicina – 07 B). Darbo tikslas: ištirti Vilniaus mieste gyvenančių senyvo amžiaus vyrų šlapimo nelaikymo ir erekcijos sutrikimų ypatumus bei gyvenimo kokybę. Tyrimo objektas ir metodai. Tiriamųjų grupė sudaryta sluoksninės imties metodu. Apklausti 788 asmenys, gyvenantys Vilniaus m. bendruomenėje ir 168 vyrai – globos įstaigose. Respondentai buvo tiriami interviu metodu, naudojant specifinius ir bendrus klausimynus. Statistinė duomenų analizė atlikta „SPSS 12.0 for Windows“. Pagrindinės išvados. Šlapimo nelaikymo dažnumas tarp Vilniaus m. bendruomenėje gyvenančių 55 metų amžiaus ir vyresnių vyrų yra 17,8 proc., o tarp globos įstaigose gyvenančių vyrų – 38,1 proc. Su amžiumi šlapimo nelaikymo dažnumas didėja. Šlapimo nelaikymo riziką didina gerybinė prostatos hiperplazija, patirtas insultas, depresija, pažinimo sutrikimas, Parkinsono liga, obstipacija ir kai kurių vaistų vartojimas. Erekcijos sutrikimai nustatyti 79,2 proc. šlapimo nelaikančių 55 metų amžiaus ir vyresnių vyrų ir 36,7 proc. sveikų vyrų, gyvenančių Vilniaus m. bendruomenėje. Esant šlapimo nelaikymui yra blogesnės šios gyvenimo kokybės sritys: fizinė sveikata, psichologinė būsena, socialiniai santykiai ir aplinka. Po 2 metų gyvenimo kokybė pablogėjo fizinės sveikatos bei socialinių santykių srityse. / Scientific adviser: Assoc. Prof. Dr. Vidmantas Alekna (Institute of Experimental and Clinical Medicine at Vilnius University, Biomedical sciences, Medicine - 07 B). The aim: To estimate the frequency of urinary incontinence (UI) in men residing in Vilnius city community and nursing institutions, to assess risk factors for UI, to determine the frequency of erectile dysfunction in men with UI, and to analyse their quality of life. Object and methods: 788 elderly men residing in Vilnius city community and 168 - in nursing institutions were interviewed. The respondents were interviewed with the specific and general questionnaires for UI and quality of life. Statistical data analysis was performed by applying SPSS 12.0 for Windows. Conclusions: Frequency of UI among the men living in Vilnius city community amounts to 17.8% and 38.1% - in nursing institutions. The benign prostatic hyperplasia, stroke, senile cognition disorder, Parkinson’s disease, depression, constipation and use of the some medications increase the risk of UI among elderly men. Erectile dysfunction was diagnosed in 79.2% of the men with UI aged 55 and over and in 36.7% of the healthy men of the same age. In men with UI the physical health, psychological state, social relations and the environment domains of quality of life were disturbed. After two years the quality of life of the men with UI became lower in the areas of physical health and social relations.