A novel research definition of bladder health in women and girls: Implications for research and public health promotion

BACKGROUND:Bladder health in women and girls is poorly understood, in part, due to absence of a definition for clinical or research purposes. This article describes the process used by a National Institutes of Health funded transdisciplinary research team (The Prevention of Lower Urinary Tract Symptoms [PLUS] Consortium) to develop a definition of bladder health. METHODS:The PLUS Consortium identified currently accepted lower urinary tract symptoms (LUTS) and outlined elements of storage and emptying functions of the bladder. Consistent with the World Health Organization's definition of health, PLUS concluded that absence of LUTS was insufficient and emphasizes the bladder's ability to adapt to short-term physical, psychosocial, and environmental challenges for the final definition. Definitions for subjective experiences and objective measures of bladder dysfunction and health were drafted. An additional bioregulatory function to protect against infection, neoplasia, chemical, or biologic threats was proposed. RESULTS:PLUS proposes that bladder health be defined as: "A complete state of physical, mental, and social well-being related to bladder function and not merely the absence of LUTS. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational, or other activities)." Definitions for each element of bladder function are reported with suggested subjective and objective measures. CONCLUSIONS:PLUS used a comprehensive transdisciplinary process to develop a bladder health definition. This will inform instrument development for evaluation of bladder health promotion and prevention of LUTS in research and public health initiatives

Does urethral competence affect urodynamic voiding parameters in women with prolapse?

Aims To (1) compare voiding parameters and (2) correlate symptoms and urodynamic findings in women with pelvic organ prolapse (POP) and varying degrees of urethral competence. Methods We compared three groups of women with stages II–IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the Colpopexy and Urinary Reduction Efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n = 67) did not have and Group 2 (n = 84) had urodynamic stress incontinence (USI) during prolapse reduction. Group 3 participants (n = 74), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms and planned sacrocolpopexy. Participants completed standardized uroflowmetry, pressure voiding studies, and validated symptom questionnaires. Results Subjects' median age was 61 years, median parity 3 and 87% had stage III or IV POP. Fourteen percent of women in Group 3 demonstrated USI without, and 70% with, prolapse reduction. Women in Groups 2 and 3 had more detrusor overactivity (DO) than Group 1 (17 and 24% vs. 6%, P  = 0.02) and detrusor overactivity incontinence (DOI) (15 and 8% vs. 0%, P  = 0.004). Based on the Blaivis–Groutz nomogram, 60% of all women were obstructed. Post-void residual volume (PVR), peak flow rate, detrusor pressure at peak flow, voiding mechanisms, voiding patterns, obstruction and urinary retention did not differ among groups. Women in Group 3 had higher irritative and obstructive symptom scores than Group 1 or 2; neither score differed by presence of DO nor obstruction, respectively. Conclusion Women with POP have significant rates of urodynamic obstruction and retention, independent of their continence status. Symptoms of obstruction and retention correlate poorly with urodynamic findings. Neurourol. Urodynam. 26:1030–1035, 2007. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57365/1/20436_ftp.pd

Association of Low Dietary Intake of Fiber and Liquids with Constipation: Evidence from the National Health and Nutrition Examination Survey (NHANES)

Epidemiological studies support an association of self-defined constipation with fiber and physical activity, but not liquid intake. The aims of this study were to assess the prevalence and associations of dietary fiber and liquid intake to constipation

The Prevention of Lower Urinary Tract Symptoms (PLUS) in girls and women: Developing a conceptual framework for a prevention research agenda

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146323/1/nau23787_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146323/2/nau23787.pd

Likelihood of Nursing Home Referral for Fecally Incontinent Elderly Patients is Influenced by Physician Views on Nursing Home Care and Outpatient Management of Fecal Incontinence

(1) Characterize physicians’ management practices for fecal incontinence (FI) among elderly patients, (2) describe physician perceptions of the quality of care for FI provided in nursing homes (NH), and (3) identify physician views and attributes associated with referral of elderly patients with FI to a NH

Survey of Geriatricians on the Effect of Fecal Incontinence on Nursing Home Referral: FECAL INCONTINENCE AND NURSING HOME REFERRAL

Determine the impact of fecal incontinence (FI) in health care providers’ decisions to refer patients for nursing home (NH) placement

Fecal Incontinence in US Adults: Epidemiology and Risk Factors

The study aims were to estimate the prevalence of different types and frequencies of fecal incontinence (FI), describe demographic factors, and identify risk factors

Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women

To estimate the prevalence and trends of these pelvic floor disorders in U.S. women from 2005–2010

Enhancing Participation of Older Women in Surgical Trials

Older participants are often excluded from clinical trials, precluding a representative sample

Association of diuretic use and overactive bladder syndrome in older adults: A propensity score analysis

Diuretics use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n = 172) had a mean age of 79 ± 7.5 (± S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients respectively reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio = OR = 3.48; 95% confidence interval = CI = 1.73–7.03) and urgency (74% versus 57% non-diuretic; OR = 2.17; 95% CI = 1.11–4.24) but not with incontinence (OR = 1.74; 95% CI = 0.87–3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR = 3.09; 95% CI = 1.20–7.97) and urgency (adjusted OR = 2.50; 95% CI = 1.00–6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR = 2.54; 95% CI = 1.09–5.91), which lost significance after propensity adjustment (adjusted OR = 1.88; 95% CI = 0.57–6.17). Overall summary mean Urge-IIQ score was 1.83 ± 0.85 (±S.D.) with 1.75 ± 0.86, 1.68 ± 0.76, and 2.03 ± 0.88, respectively for no-diuretic, non-loop, and loop-diuretic patients (one-way ANOVA p = 0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use