Urinary and faecal incontinence among older women and men in relation to other health complaints, quality of life and dependency

Aim: The aim of this thesis was to investigate type, degree and patterns of health complaints, need for help and health-related quality of life across gender among persons aged 75?105 as well as to identify how patterns of health complaints, gender, age and socio-economic factors related to need for help with daily activities and quality of life (Paper I). The aim was also to investigate the prevalence of self-reported symptoms of urinary, faecal and double incontinence among men and women aged 75 and above, and to identify how other health complaints and quality of life relate to incontinence symptoms (Paper II). Furthermore urinary symptoms and their influence on daily life among elderly (75+) women and men were compared in a sample that previously reported having incontinence and/or other urinary symptoms. A further aim was to find underlying structures of urinary symptoms and to identify symptoms which had an impact on seeking medical help and need for help in daily activities (Paper III). The aim of the fourth study was to compare faecal incontinence and related bowel symptoms in relation to gender and being dependent or not (aged 75 and above) and to identify which bowel symptoms predicted help seeking, dependency and low quality of life (Paper IV). Design: A cross-sectional design in a randomly selected sample of 8500 persons 75 years and above in four age groups of five-year intervals. They received a postal questionnaire including questions about health, socio-economy, quality of life and need for help in daily activities. In the follow-up persons received another postal questionnaire with focused questions depending on previous reported health complaints. Those needing help in daily activities once a week or more were visited in their own homes and interviewed face to face. The first sample (Papers I, II) included 4277 persons, mean age for women 84.3 and for men 82.7 years. The second sample (Paper III) included 771 persons who had reported difficulties controlling urine or other urinary problems. The sample in Paper IV included 248 persons who had reported difficulties controlling stool. Result: Coexisting health complaints, i.e. multi-complaints, had impact on QoL as well as on dependency. The patterns of health complaints could be understood from a functional perspective. Problems in communication, mobility and psychosocial functions were those most common and with the highest severity. Women were especially affected as they had more health complaints in functions that were related to help in ADL and to low QoL. Furthermore the prevalence of urinary, faecal and double incontinence was high in all age groups and higher with more advanced age. Incontinence had a negative impact on quality of life and increased need for help in daily activities, and those with double incontinence were the most affected. Among those with urinary problems the character of symptoms differed in storage or voiding symptoms among men and women. However, the influence on social life, avoidance of places and situations and the impact on the whole life seemed equal. Less than 50% had sought medical help for their symptoms and few wore protective aids, especially men. Diarrhoea, constipation, incomplete emptying and laxative use were common among those who reported faecal incontinence, and few had sought medical help or wore protection. Conclusion: Patterns of health complaints indicated problems on a functional level of importance for need for help in daily activities as well as quality of life. Mobility, psychosocial, communication and elimination problems were strongly related to dependency and low health-related QoL. Women seem to be more at risk as they were more often affected in three of these functions and thus more often dependent and had lower QoL. Women also seemed to have more additional negative socio-economic factors. Dysfunctions that were most common should be focused on and interventions aiming to reduce such complaints are of high priority. Overall urinary and bowel functions seem to be equally as important as incontinence per se and therefore a wider perspective when investigating these symptoms would benefit decisions about investigations and help. Men and women have different needs and none of them should be overlooked. There is a risk that men are neglected as incontinence is regarded as a female problem. Urinary, faecal and double incontinence were common conditions but also other urinary and bowel problems, and few had sought help although they reported considerable problems. All urinary problems as well as bowel-related problems seemingly interacted and had equal effect on daily life and quality of life. Therefore those areas should preferably be seen together and not separately

Sexual Function and Depressive Symptoms in Middle-Aged Women with Long-Lasting Type 1 Diabetes : A Cross-Sectional Study

Background & aim: Women and men with diabetes, type 1 (T1D) and type 2 (T2D) develop complications in small and large blood vessels as well as in nerve pathways over time. In men, erectile dysfunction is a well-documented complication. However, sexual dysfunction in women with different types of diabetes is less studied. Sexual dysfunction is associated with lowered health-related quality of life and depression. The aim of the study was to investigate self-reported sexual function and signs of depression in middle-aged women with long-lasting T1D.  Methods: A cross-sectional questionnaire study including the Female Sexual Function Index (FSFI) and the Patient Health Questionnaire (PHQ-9) together with background questions was designed. The sample was women aged 45-66 with T1D for at least 15 years, identified from clinical medical records at four hospitals in southern Sweden. Descriptive statistical analysis of background factors, depression, and self-reported sexual dysfunction, as well as correlation and regression analysis, are presented.  Results: A total of 212 women completed the questionnaire, mean age 54.1 (SD: 5.83), mean years with T1D 36.2 (SD: 11.42). Almost half of the women had sexual dysfunction (45.2%; FSFI < 26.55, max 36) and the mean full score was 23.73 (SD: 10.57). The FSFI domains are desire, arousal, lubrication, orgasm, satisfaction and pain. Symptoms of depression measured by PHQ-9 were reported by 39.8%. A low FSFI was significantly associated with severe depression (p<0.001).  Conclusions: Problems with sexual dysfunction and depression in middle-aged women with long-lasting T1D are common and may be unreported unless addressed in clinical care. Nurses could start asking women about problems with lubrication and vaginal pain in relation to sexual activity. Lubricants or local estrogen therapy could prevent those problems. Routinely assessing depressive status is equally important in improving quality of life for women with T1D.

Palliativ cancervård är en betydande del av urologin. Studie av det sista levnadsåret för patienter som dog av urologisk cancer

A total of 330 in-patient episodes at the urology ward, with a mean duration of 9.8 days, were registered in a study of 100 patients who died from urological cancer. Twelve patients spent more than two months of their last year of life at the urology ward. As many as 82% of the admittances were on an emergency basis. A total of 101 operations were performed on 84 patients; 47 patients received palliative radiotherapy. This patient category needs a great deal of palliative care--at short notice--in order to get an optimal quality of life. Although many symptoms could have been alleviated outside hospital, the majority of patients needed specialised urological hospital care during their last year of life

Toileting behavior and urinary tract symptoms among younger women

Introduction and hypothesis: Irregular or infrequent voiding due to avoiding school toilets can contribute to a number of urinary problems among school children. There is, however, a lack of studies on younger women. The aim of this study was to investigate toileting behavior and the correlation to lower urinary tract symptoms (LUTS) among young women (age 18–25 years). A further aim was to validate the Swedish version of the Toileting Behavior scale (TB scale). Methods: Quantitative descriptive design was used with two questionnaires: the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and the TB scale, together with six background questions. The questionnaires were distributed in November 2014 to 550 women aged 18–25 years randomly selected from the population register in southern Sweden. Results: A total of 173 (33%) women responded. Mean age was 21.6 years (range 18–25). The Swedish version of TB scale showed good construct validity and reliability, similar to the original. Most toileting behavior was significantly correlated with LUTS, which were common, as 34.2% reported urgency and 35.9% urine leakage at least sometimes or more often. Conclusions: LUTS were quite common in this group of young women. Toileting behaviors were also significantly related to urinary tract symptoms. Thus, TB scale was useful in this population, and the translated Swedish version showed good construct validity and reliability

Patient-reported outcome after radical cystectomy : translation and psychometric validation of the Swedish version of the Functional Assessment of Cancer Therapy Scale Vanderbilt Cystectomy Index

Objective: The aim of this study was to translate and validate the Swedish version of the Functional Assessment of Cancer Therapy Scale – Vanderbilt Cystectomy Index (FACT-VCI). Materials and methods: For adaptation into Swedish, a multiprofessional team was used for translation including cultural adjustment, followed by back-translation. Test and retest in 10 individuals was followed by assessing metric properties in 75 consecutive patients with bladder cancer treated with radical cystectomy. Reliability and internal consistency were measured by Cronbach’s alpha. Face validity was tested with two laypersons and construct validity was tested by correlation to the dimensions in the Functional Assessment of Cancer Therapy Scale – General (FACT-G). Results: The translated Swedish instrument showed validity and reliability similar to the original, and the results were comparable to published studies using FACT-VCI. The correlation between the VCI sum score and FACT-G dimensions was significant in all dimensions and the item-total correlation was over 0.3; therefore, the construct validity was acceptable. In addition, it was possible to detect differences in separate items in the translated version of FACT-VCI between age groups, type of diversion and those treated with chemotherapy, even though the samples were small. Conclusions: The Swedish version of FACT-VCI is a valid and reliable instrument for use in the follow-up of patients with bladder cancer treated with urinary diversion. To measure changes after surgery, preoperative assessment with the related FACT-G instrument is advisable

Pelvic Floor Muscle Exercise after Delivery with or without the Biofeedback Method : An Intervention Study

Objective: The aim of this study was to explore the strength of the pelvic floor muscles after delivery by performing pelvic floor muscle exercises using the biofeedback method, with and without supporting visits and to compare with a conventional method. Further, to explore the objective measurement by EMG (electromyography) of the contracting ability of those with weakest pelvic floor muscle strength and compare the effect of the intervention. Methods: An intervention study, where 150 recently delivered women were consecutively selected, at their first postpartum visit, into one of three groups. Results: There was no significant difference between the three groups in pelvic floor muscle (PFM) contraction at 6-months. Analysis of a subgroup of women (n = 42), who had the poorest ability to contract their PFM with Periform®, controlled by EMG (<17.5 μV) at the first visit postpartum, showed that there was a statistical difference between group I (n = 15) and group III (n = 15) at the six month control (p = 0.010), where group III had significantly better objective results of the strength in their PFM. Significantly more women in groups II (n = 11 of 12) and III (n = 14 of 15) increased their PFM strength (p = 0.005 and 0.001), respectively. Conclusion: Women with a poor ability to contract their PFM had better results regarding the strength of their PFM when they exercised using the biofeedback method with the Periform® instrument compared to those who exercised without it. Motivation and support from the midwife had a positive impact on the results

Validation of the Swedish short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic floor distress inventory (PFDI-20) and Pelvic organ prolapse/Urinary incontinence sexual questionnaire (PISQ-12).

Objective. To psychometrically evaluate the Swedish translations of the short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic organ prolapse/Urinary incontinence Sexual questionnaire (PISQ-12). Design and setting. University hospital. Sample. Forty-four patients awaiting prolapse surgery. Methods. The dual panel translation method followed by an evaluation of validity and reliability in prolapse patients. Main outcome measures. Construct, convergent and discriminant validity, reliability via test-retest and internal consistency. Results. Item response rates were high (range: 95.5-100%) for PFIQ-7 and PFDI-20. The corrected item-total correlations showed acceptable construct validity for PFIQ-7 (r= 0.338-0.826) but low for PFDI-20 (r= 0.116-0.581) and PISQ-12 (r= 0.024-0.735). Acceptable convergent validity was found in all three instruments with a negative correlation with the SF-12. There were no floor- or ceiling effects in the three instruments. In the test-retest analysis intraclass correlation coefficients (ICC) were significant (r= 0.888 - 0.943). Cronbach´s alpha varied between 0.57 and 0.94. Conclusion. This is the first validated translation of the PFIQ-7, PFDI-20 and PISQ-12 in Swedish. All three instruments indicated acceptable psychometric properties