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Urogynaecology and pelvic floor problems
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
Urinary symptoms can be divided into those relating to urine storage and those relating to voiding. The symptom of stress incontinence (leaking with cough, straining, exercise, etc) may be isolated, but most patients present with mixed incontinence, which is where stress incontinence occurs with frequency, urgency and urge incontinence. The combination of frequency, urgency and/or urge incontinence is given the term overactive bladder (OAB). Voiding symptoms are uncommon in women who have not had previous continence surgery.
Cerebrovascular accidents, intracranial tumors, and urologic consequences
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
David J. Osborn, W. Stuart Reynolds, Roger R. Dmochowski
Medical management of symptoms can be difficult in this patient population, and surgical management can be fraught with complications.13 α-Blockers have the unfortunate side effects of dizziness and hypotension, which is especially detrimental to functioning and rehabilitation of these patients. Additionally, especially when there is baseline impairment, anticholinergic medications have negative effects on cognitive functioning.70 Imipramine is another drug that can be used for patients with urge and/or mixed incontinence. It has anticholinergic properties and it also prevents reuptake of norepinephrine, which will increase bladder outlet resistance.71 Duloxetine may have benefit for women with mixed symptoms, but it remains unavailable for this indication in the United States (Figure 21.6).
Tension-Free Vaginal Tape Procedure for Treatment of Female Urinary Stress Incontinence
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
significAnt (p = 0.0005) 30% lower cure rAte thAn in controls, A finding thAt might indicAte thAt over time the obese women hAve A declining cure rAte After tvt surgery [53]. Mixed Urinary incontinence is A condition when A pAtient suffers simultAneously of both stress And urgency incontinence. Mixed incontinence cAn be divided into cAses with either predominAnt stress or predominAnt urgency incontinence Assessed by subjective pArAmeters or into urodynAmicAlly proven mixed incontinence with signs of leAkAge At stress And detrusor Activity. surgery for mixed incontinence is mostly recommended for cAses with stress incontinence predominAting mixed incontinence, with or without urodynAmicAlly proven detrusor overActivity. study reports on the outcome of tvt surgery in cAses of mixed incontinence Are difficult to compAre And interpret As the definition of mixed incontinence vAries greAtly And cure rAtes Are expressed As overAll cure, cure of the stress component, or cure of the urgency component. tAble 73.6 gives the overAll cure rAtes After tvt in subjects with mixed incontinence of the few reports from which these pArAmeters could be extrActed. A rAther recent metA-AnAlysis looking At the cure rAte After Mus surgery indicAtes thAt there is A persistent And good cure of the stress component, while the cure of the urgency component is vAriAble And less thAn the stress component between 30% And 85% At A follow-up of A few months up to 5 yeArs [61]. From the studies with A longer follow-up, it seems As if cure rAtes decline with time [57,59]. This decline is not necessArily cAused by the fAilure of the tvt procedure As the stress component does not show tendencies of recurrency. It is mostly the symptoms of urgency thAt increAse, which in turn might be the consequence of concomitAnt illnesses evolving during follow-up. quality of life hAs become An importAnt concept when discussing the outcome of incontinence surgery. The quality of life of the incontinent women is not solely reigned by the Absence of Urinary leAkAge, but As much by the Absence of voiding difficulties, Urinary trAct infections (utIs), And other Adverse symptoms cAused by complicAtions AssociAted with the surgicAl procedure. MinimAl invAsiveness And stAndArdizAtion of A TAble 73.6 Cure rAtes After tension-Free vAginAl tApe in Women with Mixed Incontinence
Does the climacteric influence the prevalence, incidence and type of urinary incontinence?
Published in Climacteric, 2023
Several studies [1,26–30] have added important information regarding the prevalence of different types of urinary incontinence (i.e. stress urinary leakage, urge urinary leakage and mixed urinary leakage). Based on our current knowledge, stress urinary leakage tends to dominate among younger women while the number of women with urge incontinence and mixed incontinence increases with age. Studies have reported that older women are more likely to have mixed and urge incontinence while young and middle-aged women generally report stress incontinence. Overall, approximately half of all incontinent women are classified as stress incontinent. A smaller proportion is classified as mixed incontinent and the smallest fraction as urge incontinent. Hannestad et al. [5] demonstrated a fairly regular increase in prevalence of mixed incontinence across the age range, and a decrease in the prevalence of stress incontinence from the age group of 40–49 years through the group of 60–69 years.
Genitourinary syndrome of menopause in Chinese perimenopausal and postmenopausal women
Published in Climacteric, 2021
X. Ruan, L. Zhang, Y. Cui, M. Gu, A. O. Mueck
Regarding the second most common symptom, urinary incontinence (at 91.65% almost the same high prevalence as low sexual desire), we could not make a clear distinction between the three main types of stress, urge and mixed incontinence. Up to 70% of women in western countries relate the onset of urinary incontinence to their final menstrual period, with 15–20% complaining of severe urgency and almost 50% complaining of stress incontinence [26,27]. Urge incontinence, in particular, is more prevalent in the later postmenopause, and the prevalence appears to rise with an increasing number of years of estrogen deficiency [28]. Our study found that, independent of age and menopausal status, urinary incontinence was higher than in western studies, possibly due to two reasons: firstly, no distinction between the three types of incontinence; and, secondly, race, ethnicity and lifestyle certainly are all different.
Hip exercises improve intravaginal squeeze pressure in older women
Published in Physiotherapy Theory and Practice, 2020
Lori J. Tuttle, Taylor Autry, Caitlin Kemp, Monique Lassaga-Bishop, Michaela Mettenleiter, Haley Shetter, Janelle Zukowski
The pelvic floor muscles (PFM) are partly responsible for controlling urinary and bowel functions of both males and females. The PFM consist of pubovisceral, puborectalis, and iliococcygeus, which originate on the pubis and the tendinous arch of the levator ani and insert on the perineal body, vaginal wall, between the internal and external anal sphincter, behind the rectum and in the iliococcygeal raphe (Kearney, Sawhney, and Delancey, 2004). These muscles work together to support internal organs and assist in maintaining posture and urinary and fecal continence (Raizada and Mittal, 2008; Rocca Rossetti, 2016). Pelvic Floor Dysfunction (PFD) is most often seen in postmenopausal women but affects both sexes and people of all ages (Milsom et al., 2014; Pierce, Perry, Chiarelli, and Gallagher, 2016; Shamliyan, Kane, Wyman, and Wilt, 2008). Nearly 26–30% of women report experiencing symptoms of PFD at some point in their lifetime, demonstrating its high prevalence in society (Nygaard et al., 2008; Wu et al., 2014). Symptoms may include: urinary and/or fecal incontinence (e.g. stress, urge, or mixed incontinence); frequent urination; and pelvic pain during urination or intercourse. A myriad of factors has been implicated in the development of PFD including, but not limited to: vaginal childbirth; constipation; diabetes; aging; injury; pelvic trauma; and obesity (Delancey et al., 2008; Pierce, Perry, Chiarelli, and Gallagher, 2016; Tinelli et al., 2010).