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1.
Prevention of Urinary Incontinence in Women.
Swanton, AR, Gormley, EA
Current urology reports. 2020;(10):43
Abstract
PURPOSE OF REVIEW Despite available treatments for urinary incontinence, the data regarding prevention is less established. This review sought to identify prevention measures and discuss their underlying evidence base with an attempt to include the most recent updates in the field. RECENT FINDINGS Urinary incontinence is a prevalent issue among women, particularly surrounding pregnancy and menopause. Interventions regarding pregnancy include not only general health promotion but also potentially interventions such as pelvic floor muscle training and decisions regarding method of delivery. With regard to menopause, the literature suggests avoiding treatments that have adverse effects on continence. Lastly, promoting healthy life style and reducing effects of co-morbid conditions can impact a woman's continence. The literature indicates that preventative strategies exist for urinary incontinence, though the data is limited in this area. Further work is needed to determine the impact of prevention measures and how best to implement them.
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2.
Management of urinary incontinence.
Nightingale, G
Post reproductive health. 2020;(2):63-70
Abstract
Urinary incontinence is a common problem affecting 25-45% women. Effective management can have a huge impact on a patient's quality of life and many treatments are available. Management should be dictated by the degree of bother the symptoms are having, and vary depending on the type on incontinence. Conservative measures should always be initiated, including optimisation of body mass index and smoking cessation. Overactive bladder and urge urinary incontinence can be improved with bladder retraining and avoidance of bladder stimulants. Medical treatment then includes anticholinergic medications or Mirabegron. More invasive options include Botulinum Toxin A (Botox®) injections, sacral nerve stimulation or urological surgery. Stress urinary incontinence should be managed initially with pelvic floor exercises, and input from a specialist nurse or physiotherapist is beneficial. The surgical options for managing stress incontinence have changed considerably over the years, but include bladder neck injections, mid-urethral slings, colposuspension or autologous fascial slings. Mixed urinary incontinence is more challenging to manage, but all conservative measures should be started. Further treatment is directed towards the predominant symptom, but overactivity should be controlled before surgical measures for stress urinary incontinence are performed.
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3.
Multifaceted self-management interventions for older women with urinary incontinence: a systematic review and narrative synthesis.
Fu, Y, Nelson, EA, McGowan, L
BMJ open. 2019;(8):e028626
Abstract
OBJECTIVE To synthesise the evidence for the multifaceted self-management interventions for older women with urinary incontinence (UI) and to understand the outcomes associated with these interventions. DESIGN A systematic review and narrative synthesis to identify randomised controlled trials that investigated the effect of multifaceted self-management interventions for older women with UI. METHODS MEDLINE, PsycINFO, EMBASE, The Cochrane Library, CINAHL and Applied Social Sciences Index and Abstracts databases were searched (January 1990 to May 2019) using a systematic search strategy, complemented by manually screening the reference lists and citation indexes. Study selection, data extraction and risk of bias assessment were undertaken independently. A narrative synthesis was undertaken in which studies, interventions and outcomes were examined based on the intervention components. The effect size and 95% CI were estimated from each study. RESULTS A total of 13 147 citations were identified and 16 studies were included. There was no study rated as of high quality. Three types of multifaceted interventions were found: those that had an element of pelvic floor muscle exercises (PFME), those with bladder retraining and some with combination behavioural interventions. Outcome measures varied across studies. A statistically significant improvement in incontinence symptoms was reported in the intervention group compared with the control in 15 studies. CONCLUSION Multifaceted interventions that included PFME, bladder retraining or combination behavioural techniques appear to be useful in some settings for UI management in older women, but the quality of the evidence was poor and unclear. There was insufficient evidence to determine whether any of the combination of components is superior to others in improving UI symptoms. There is a need for high-quality studies to confirm the effectiveness of these interventions and to identify comparative effectiveness. PROSPERO REGISTRATION NUMBER CRD42018104010.
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4.
[Sedentary lifestyle and urinary incontinence in women: A literature review].
Steenstrup, B, Le Rumeur, E, Moreau, S, Cornu, JN
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2018;(17):973-979
Abstract
AIM: The sedentary lifestyle is defined by a lack of regular mobilizing activities in the activities of daily life. The purpose of this work was to gather data related to the potential link between urinary incontinence and sedentary lifestyle in women. METHOD A literature review (Pubmed/MEDLINE databases) based on keywords: women; urinary incontinence; sedentary; sedentary behavior; sedentary lifestyle; physical activity; exercise; sport, over the period 2008-2018 was carried out. RESULTS Five cross-sectional observational studies were analyzed. Overall, the data supported a link between sedentary behavior and urinary incontinence in women. Several potential confounding factors (age, body mass index, comorbidities, lower socio-familial support) have been identified in the literature. Pathophysiological mechanisms remain poorly established, potentially including metabolic factors, postural factors and muscle dysfunctions. Few articles respected the strict definition of sedentary lifestyle, and no prospective study investigating the causal link between meddle or long-term sedentary was highlighted. CONCLUSION The limited data available in the literature suggests that sedentary lifestyle is a risk factor for female urinary incontinence. Many confounding factors have been identified, justifying further studies evaluating more specifically the causal link between sedentary lifestyle and urinary incontinence in women.
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5.
The Urinary Tract Microbiome in Health and Disease.
Aragón, IM, Herrera-Imbroda, B, Queipo-Ortuño, MI, Castillo, E, Del Moral, JS, Gómez-Millán, J, Yucel, G, Lara, MF
European urology focus. 2018;(1):128-138
Abstract
CONTEXT The urinary tract, previously considered a sterile body niche, has emerged as the host of an array of bacteria in healthy individuals, revolutionizing the urology research field. OBJECTIVE To review the literature on microbiome implications in the urinary tract and the usefulness of probiotics/prebiotics and diet as treatment for urologic disorders. EVIDENCE ACQUISITION A systematic review was conducted using PubMed and Medline from inception until July 2016. The initial search identified 1419 studies and 89 were included in this systematic review. EVIDENCE SYNTHESIS Specific bacterial communities have been found in the healthy urinary tract. Changes in this microbiome have been observed in certain urologic disorders such as urinary incontinence, urologic cancers, interstitial cystitis, neurogenic bladder dysfunction, sexually transmitted infections, and chronic prostatitis/chronic pelvic pain syndrome. The role of probiotics, prebiotics, and diet as treatment or preventive agents for urologic disorders requires further investigation. CONCLUSIONS There is a microbiome associated with the healthy urinary tract that can change in urologic disorders. This represents a propitious context to identify new diagnostic, prognostic, and predictive microbiome-based biomarkers that could be used in clinical urology practice. In addition, probiotics, prebiotics, and diet modifications appear to represent an opportunity to regulate the urinary microbiome. PATIENT SUMMARY We review the urinary microbiome of healthy individuals and its changes in relation to urinary disorders. The question to resolve is how we can modulate the microbiome to improve urinary tract health.
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6.
Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis.
Davenport, MH, Nagpal, TS, Mottola, MF, Skow, RJ, Riske, L, Poitras, VJ, Jaramillo Garcia, A, Gray, CE, Barrowman, N, Meah, VL, et al
British journal of sports medicine. 2018;(21):1397-1404
Abstract
OBJECTIVE To examine the relationships between prenatal physical activity and prenatal and postnatal urinary incontinence (UI). DESIGN Systematic review with random effects meta-analysis and meta-regression. DATA SOURCES Online databases were searched up to 6 January 2017. STUDY ELIGIBILITY CRITERIA Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [e.g., dietary; "exercise + co-intervention"]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal UI). RESULTS 24 studies (n=15 982 women) were included. 'Low' to 'moderate' quality evidence revealed prenatal pelvic floor muscle training (PFMT) with or without aerobic exercise decreased the odds of UI in pregnancy (15 randomised controlled trials (RCTs), n=2764 women; OR 0.50, 95% CI 0.37 to 0.68, I2=60%) and in the postpartum period (10 RCTs, n=1682 women; OR 0.63, 95% CI 0.51, 0.79, I2=0%). When we analysed the data by whether women were continent or incontinent prior to the intervention, exercise was beneficial at preventing the development of UI in women with continence, but not effective in treating UI in women with incontinence. There was 'low' quality evidence that prenatal exercise had a moderate effect in the reduction of UI symptom severity during (five RCTs, standard mean difference (SMD) -0.54, 95% CI -0.88 to -0.20, I2=64%) and following pregnancy (three RCTs, 'moderate' quality evidence; SMD -0.54, 95% CI -0.87 to -0.22, I2=24%). CONCLUSION Prenatal exercise including PFMT reduced the odds and symptom severity of prenatal and postnatal UI. This was the case for women who were continent before the intervention. Among women who were incontinent during pregnancy, exercise training was not therapeutic.
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7.
A decade of research on Incontinence-Associated Dermatitis (IAD): Evidence, knowledge gaps and next steps.
Beeckman, D
Journal of tissue viability. 2017;(1):47-56
Abstract
BACKGROUND Incontinence-Associated Dermatitis (IAD) is one of the clinical manifestations of Moisture- Associated Skin Damage (MASD). IAD is a common problem in aged patients with fecal and/or urinary incontinence. AIM: Update about IAD terminology, etiology, epidemiology, observation, prevention, and treatment. METHODS Integrative review. RESULTS The lack of an ICD-10 code and an internationally validated and standardized method for IAD data collection contribute to a variation in epidemiological data. Frequent episodes of incontinence (especially fecal), occlusive containment products, poor skin condition, reduced mobility, diminished cognitive awareness, inability to perform personal hygiene, pain, pyrexia, certain medications (antibiotics, immunosuppressants), poor nutritional status, and critical illness are associated with IAD. Correctly diagnosing IAD and distinguish it from pressure ulcers is difficult. Even though the clinical presentation of partial thickness pressure ulcers and IAD is similar, the underlying etiologic factors differ. However, incontinence and IAD were found to be risk factors for pressure ulcer development. IAD management should essentially focus on skin cleansing to remove dirt, debris and microorganisms; skin moisturization to repair or augment the skin's barrier; and the application of a skin barrier product to prevent skin breakdown by providing an impermeable or semi-permeable barrier on the skin. The body of evidence is still limited, but growing since the last decade. CONCLUSION Incontinence causes disruptions of the skin barrier function and leads to superficial skin damage. Macerated skin and superficial skin changes due to incontinence are associated with pressure ulcer development. Skin maceration, chemical irritation, and physical irritation should be targeted to effectively prevent and treat IAD.
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8.
Effectiveness of topical skin products in the treatment and prevention of incontinence-associated dermatitis: a systematic review.
Pather, P, Hines, S, Kynoch, K, Coyer, F
JBI database of systematic reviews and implementation reports. 2017;(5):1473-1496
Abstract
BACKGROUND Incontinence-associated dermatitis (IAD) is inflammation of the skin resulting from repeated contact with urine and/or feces. It causes pain, redness, swelling and excoriation, and may lead to complications such as fungal skin infections and pressure injuries. It is important to prevent and treat IAD to avoid complications and improve patient outcomes. A number of products are available for protecting skin, but evidence on their effectiveness is limited. OBJECTIVES The current review aimed to establish the effectiveness of topical skin products in reducing the occurrence and/or severity of IAD. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adult patients over the age of 18 years with incontinence and/or diarrhea. TYPES OF INTERVENTION Topical skin products as individual interventions or part of a skin care regimen. TYPES OF STUDIES Both published and unpublished study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after, prospective and retrospective cohort, case-control, analytical cross-sectional, descriptive study designs including case series, individual case reports and descriptive cross-sectional studies across all care settings for inclusion. OUTCOMES The primary outcome of interest was the absence or non-development, reduction or resolution, new development or increase in the occurrence of IAD or the increase in severity of IAD. The secondary outcome was any adverse effect caused by the skin care products used. SEARCH STRATEGY A three-step search strategy to find both published and unpublished papers was utilized in this review. Studies were limited to those published in English from 1980 to 2016. METHODOLOGICAL QUALITY Papers selected were assessed by two independent reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Data were extracted using the standardized data extraction tool in JBI-MAStARI. The data extracted included specific details about the interventions, populations, study methods and outcomes. DATA SYNTHESIS Studies were assessed for methodological quality and statistical significance to determine validity and generalizability of study results. It was not possible to pool studies to conduct meta-analysis or test for heterogeneity. RESULTS There were a limited number of clinical trials that compared products for efficacy in preventing and treating IAD. Assessment tools and severity scores used to measure skin damage outcomes were dissimilar and prone to subjectivity. It was difficult to ascertain superiority of any individual product. CONCLUSION Information on barrier protective efficacy, side effects and cost can be valuable to both clinicians and care providers. More randomized controlled trials on product effectiveness for prevention and treatment of IAD are highly recommended.
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9.
Genitourinary Syndrome of Menopause: Management Strategies for the Clinician.
Faubion, SS, Sood, R, Kapoor, E
Mayo Clinic proceedings. 2017;(12):1842-1849
Abstract
Genitourinary syndrome of menopause (GSM), previously known as atrophic vaginitis or vulvovaginal atrophy, affects more than half of postmenopausal women. Caused by low estrogen levels after menopause, it results in bothersome symptoms, including vaginal dryness, itching, dyspareunia, urinary urgency and increased frequency, and urinary tract infections. Even though women with GSM can have sexual dysfunction that interferes with partner relationships, women are often embarrassed to seek treatment, and health care professionals do not always actively screen for GSM. As a result, GSM remains underdiagnosed and undertreated. Several effective treatments exist, but low-dose vaginal estrogen therapy is the criterion standard. It is effective and safe for most patients, but caution is suggested for survivors of hormone-sensitive cancers. Newer treatment options include selective estrogen receptor modulators, vaginal dehydroepiandrosterone, and laser therapy. Nonprescription treatments include vaginal lubricants, moisturizers, and dilators. Pelvic floor physical therapy may be indicated for some women with concomitant pelvic floor muscle dysfunction. Sex therapy may be helpful for women with sexual dysfunction. This concise review presents a practical approach to the evaluation and management of GSM for the primary care physician.
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10.
Management of Moisture-Associated Skin Damage: A Scoping Review.
Woo, KY, Beeckman, D, Chakravarthy, D
Advances in skin & wound care. 2017;(11):494-501
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Abstract
BACKGROUND Protecting the skin against moisture-associated damage is an important component of comprehensive skin and wound care. Based on a review of literature, the authors propose key interventions to protect and prevent damage in the skin folds, perineum, and areas surrounding a wound or stoma. OBJECTIVE The aim of this scoping review is to identify and provide a narrative integration of the existing evidence related to the management and prevention of moisture-associated skin damage (MASD). METHODS Study authors searched several databases for a broad spectrum of published and unpublished studies in English, published between 2000 and July 2015. Selected study information was collated in several different formats; ultimately, key findings were aggregated into a thematic description of the evidence to help generate a set of summative statements or recommendations. RESULTS Based on inclusion criteria, 37 articles were considered appropriate for this review. Findings included functional definitions and prevalence rates of the 4 types of MASD, assessment scales for each, and 7 evidence-based strategies for the management of MASD. CONCLUSIONS Based on this scoping review of literature, the authors propose key interventions to protect and prevent MASD including the use of barrier ointments, liquid polymers, and cyanoacrylates to create a protective layer that simultaneously maintains hydration levels while blocking external moisture and irritants.