Browsing by Subject "Urinary Incontinence"

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    Barriers to urinary incontinence care seeking in White, Black, and Latina women.
    (Female pelvic medicine & reconstructive surgery, 2015-03) Willis-Gray, Marcella G; Sandoval, Juan S; Maynor, Jean; Bosworth, Hayden B; Siddiqui, Nazema Y

    Objective

    We compared barriers to urinary incontinence (UI) healthcare seeking between white, black, and Latina women.

    Methods

    This is a cross-sectional study using a convenience sample of white, black, and Latina women. Women completed the Barriers to Incontinence Care Seeking Questionnaire (BICS-Q), the Incontinence Quality of Life Instrument (I-QOL), the Questionnaire for Urinary Incontinence Diagnosis, and the Incontinence Severity Index (ISI). The primary objective was to assess barriers to UI care seeking among groups, as measured by the BICS-Q. Secondary objectives were to assess factors associated with barriers to incontinence care and to compare specific barriers using BICS-Q subscale scores. Regression analyses were used to further assess for differences among groups while adjusting for potential confounding variables.

    Results

    We included a total of 93 subjects, including 30 white, 33 black, and 30 Latina women. Mean I-QOL, Questionnaire for Urinary Incontinence Diagnosis, and ISI scores were not significantly different among our 3 groups. Barriers, based on BICS-Q scores, were lowest in white women and higher in blacks and Latinas (2.9 vs 7.3 vs 10.9, respectively; P < 0.001). When adjusting for potential confounders such as age, income, education, presence of UI, ISI score, and I-QOL score, Latinas continued to demonstrate higher barriers compared with white or black women (β = 7.4; 95% CI, 2.2-12.7; P = 0.006). There were no significant differences between black women compared with other groups in the adjusted analyses.

    Conclusions

    Latinas experience more barriers to UI healthcare seeking compared with white and black women.
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    Incontinence and gait disturbance after intraventricular extension of intracerebral hemorrhage.
    (Neurology, 2016-03-08) Woo, Daniel; Kruger, Andrew J; Sekar, Padmini; Haverbusch, Mary; Osborne, Jennifer; Moomaw, Charles J; Martini, Sharyl; Hosseini, Shahla M; Ferioli, Simona; Worrall, Bradford B; Elkind, Mitchell SV; Sung, Gene; James, Michael L; Testai, Fernando D; Langefeld, Carl D; Broderick, Joseph P; Koch, Sebastian; Flaherty, Matthew L
    OBJECTIVE: We tested the hypothesis that intraventricular hemorrhage (IVH) is associated with incontinence and gait disturbance among survivors of intracerebral hemorrhage (ICH) at 3-month follow-ups. METHODS: The Genetic and Environmental Risk Factors for Hemorrhagic Stroke study was used as the discovery set. The Ethnic/Racial Variations of Intracerebral Hemorrhage study served as a replication set. Both studies performed prospective hot-pursuit recruitment of ICH cases with 3-month follow-up. Multivariable logistic regression analyses were computed to identify risk factors for incontinence and gait dysmobility at 3 months after ICH. RESULTS: The study population consisted of 307 ICH cases in the discovery set and 1,374 cases in the replication set. In the discovery set, we found that increasing IVH volume was associated with incontinence (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.10-2.06) and dysmobility (OR 1.58; 95% CI 1.17-2.15) after controlling for ICH location, initial ICH volume, age, baseline modified Rankin Scale score, sex, and admission Glasgow Coma Scale score. In the replication set, increasing IVH volume was also associated with both incontinence (OR 1.42; 95% CI 1.27-1.60) and dysmobility (OR 1.40; 95% CI 1.24-1.57) after controlling for the same variables. CONCLUSION: ICH subjects with IVH extension are at an increased risk for developing incontinence and dysmobility after controlling for factors associated with severity and disability. This finding suggests a potential target to prevent or treat long-term disability after ICH with IVH.
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    Prediction models for postpartum urinary and fecal incontinence in primiparous women.
    (Female pelvic medicine & reconstructive surgery, 2013-03) Jelovsek, J Eric; Piccorelli, Annalisa; Barber, Matthew D; Tunitsky-Bitton, Elena; Kattan, Michael W
    OBJECTIVES: This study aimed to develop and internally validate a nomogram that facilitates decision making between patient and physician by predicting a woman's individual probability of developing urinary (UI) or fecal incontinence (FI) after her first delivery. METHODS: This study used Childbirth and Pelvic Symptoms Study data, which estimated the prevalence of postpartum UI and FI in primiparous women after vaginal or cesarean delivery. Two models were developed using antepartum variables, and 2 models were developed using antepartum plus labor and delivery variables. Urinary incontinence was defined by a response of leaking urine "sometimes" or "often" using the Medical, Epidemiological, and Social Aspects of Aging Questionnaire. Fecal incontinence was defined as any involuntary leakage of mucus, liquid, or solid stool using the Fecal Incontinence Severity Index. Logistic regression models allowing nonlinear effects were used and displayed as nomograms. Overall performance was assessed using the Brier score (zero equals perfect model) and concordance index (c-statistic). RESULTS: A total of 921 women enrolled in the Childbirth and Pelvic Symptoms Study, and 759 (82%) were interviewed by telephone 6 months postpartum. Two antepartum models were generated, which discriminated between women who will and will not develop UI (Brier score = 0.19, c-statistic = 0.69) and FI (Brier score = 0.10, c-statistic = 0.67) at 6 months and 2 models were generated (Brier score = 0.18, c-statistic= 0.68 and Brier score = 0.09, c-statistic = 0.68) for predicting UI and FI, respectively, for use after labor and delivery. CONCLUSIONS: These models yielded 4 nomograms that are accurate for generating individualized prognostic estimates of postpartum UI and FI and may facilitate decision making in the prevention of incontinence.
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    Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study.
    (Neurourology and urodynamics, 2023-01) Bretschneider, Carol Emi; Liu, Qian; Smith, Abigail R; Kirkali, Ziya; Amundsen, Cindy L; Lai, Henry; Geynisman-Tan, Juila; Kirby, Anna; Cameron, Anne P; Helmuth, Margaret E; Griffith, James W; Jelovsek, John Eric; Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort Study Group

    Background

    Limited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation.

    Objectives

    To describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year.

    Study design

    The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up.

    Results

    Among 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score.

    Conclusions

    Treatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated.
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    Urinary Incontinence and Health-Seeking Behavior Among White, Black, and Latina Women.
    (Female pelvic medicine & reconstructive surgery, 2016-09) Siddiqui, Nazema Y; Ammarell, Natalie; Wu, Jennifer M; Wu, Jennifer M; Sandoval, Juan S; Bosworth, Hayden B

    Objective

    Fewer than half of women with urinary incontinence (UI) seek care for their condition. Our objective was to qualitatively assess the themes surrounding treatment-seeking behaviors.

    Methods

    We conducted 12 focus groups with women and, using purposive sampling, we stratified by racial or ethnic group (white, black, Latina) and by UI frequency. All sessions were transcribed and coded for common themes. Comparative thematic analysis was used to describe similarities and differences among groups.

    Results

    In total, 113 (39 white, 41 black, and 33 Latina) community-dwelling women participated in focus groups. There were no differences in treatment-seeking themes between groups with different UI frequency. However, certain themes emerged when comparing racial/ethnic groups. Women from all groups shared experiences of embarrassment and isolation because of UI, which were impediments to care seeking. White and black women described discussions with close friends or family that led to normalization of symptoms and prevented care seeking. Latina women maintained more secrecy about UI and reported the longest delays in seeking care. Women articulated a higher likelihood of seeking care if they had knowledge of treatment options, but white women were more likely to seek UI-related knowledge compared with black or Latina women. Physician communication barriers were identified in all groups.

    Conclusions

    Despite similar experiences, there are different perceptions about care seeking among white, black, and Latina women. Culturally relevant educational resources that focus on a range of treatment options may improve knowledge and thus improve care-seeking behaviors in women with UI.