Tag: urinary incontinence

Categories : UrogenitalTags :

A New Intervention for Male Urinary Tract Symptoms

On By ModernMedia
Urinary incontinence. Credit: Scientific Animations CC4.0

A new intervention for men with urinary problems trialled across GP practices has shown a sustained reduction in symptoms. Findings from the University of Bristol-led Treating Urinary Symptoms in Men in Primary Healthcare (TRIUMPH) study, involving over 1000 participants and 30 GP practices, have been published in the BMJ. The study was funded by the National Institute for Health and Care Research (NIHR).

The severity and prevalence of lower urinary tract symptoms [LUTS] in men increases with age (up to 30% in men over 65 years), with greater numbers likely to be affected as the population ages. Symptoms can have a substantial impact on quality of life but can also influenced by lifestyle factors.

Current therapies recommended by NICE (National Institute for Health and Care Excellence) include bladder training, controlling fluid intake and lifestyle advice. However, there is a lack of evidence on their effectiveness, and provision by GP practices varies.

Bristol Medical School researchers sought to trial whether a new intervention, comprising a healthcare professional consultation and an information booklet providing conservative and lifestyle guidance, could be more effective than usual care.

Study findings

The team recruited 1077 adult men, each suffering with troublesome urinary tract symptoms between June 2018 and August 2019. Participants were split with 524 in the intervention arm and 553 in the usual care arm. Participants in the intervention arm were directed to relevant sections of the booklet by general practice nurses/healthcare assistants or research nurses following urinary symptom assessment, with subsequent contacts over 12 weeks to ask how the participant was managing.

Overall, the study’s findings showed a range of troublesome urinary tract symptoms improved over 12 months in a population of men with moderate symptom severity, using a standardised booklet and manualised approach to symptom management. Analyses of symptoms in each trial arm found the intervention achieved a greater reduction in symptoms than usual care, and that the difference was maintained in the longer term

Consultant Urologist, Professor Marcus Drake, the study’s Chief Investigator, said: “The assessment of male lower urinary tract symptoms and use of conservative treatments in primary care are inconsistent. Until now, there was limited evidence that conservative treatments are effective, despite their recommendation in national guidelines. The TRIUMPH study aimed to address this need in primary care.

“Implementation of this intervention as management in primary care, has the potential to improve care and reduce drug prescriptions. Our study also found the intervention can be delivered by practice nurses or healthcare assistants rather than GPs.”

Dr Jon Rees, GP Partner at Tyntesfield Medical Group, and Chair of the Primary Care Urology Society, added: “In primary care we have often traditionally relied upon pharmaceutical management for men with bothersome urinary symptoms – the TRIUMPH study emphasises the importance of discussing conservative measures with all of these patients – for some men, this will be all that is required, for others these measures can act as an adjunct to any medication prescribed.

“Many men will prefer to avoid long-term medication, so an understanding of the potential benefits of the interventions used in the study is a vital part of the toolkit for any clinician managing these patients.”

Professor Matthew Ridd, at University of Bristol, said: “This is a ‘bread-and-butter’ problem seen by GPs every day and it is great to now have evidence for something other than tablets. It has the additional advantage that it can be done by a practice nurse, freeing up GP time.”

Source: University of Bristol

Categories : UrogenitalTags :

Vibrator Use Improves Sexual and Urinary Outcomes

On By ModernMedia
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Studies have demonstrated positive effects of vibrator use on a number of sexual and urinary outcomes in women, according to a review of published literature presented at at the American Urological Association annual meeting.

Though limited in number, the studies induced favourable changes in blood flow and muscle tone of genital tissues, improved multiple aspects of sexual arousal and satisfaction, increased orgasmic response, and decreased sexual distress. In women with pelvic floor dysfunction, vibrator use was associated with decreased urine leakage and urinary symptoms and significantly improved pelvic muscle strength. Vibrator use also decreased pain and improved sexual enjoyment in women with vulvodynia.

“Medical providers, especially gynaecologists, urologists, and FPMRS [female pelvic medicine and reconstructive surgery specialists] need more education on women’s sexual health and vibrators,” said Alexandra Dubinskaya, MD, of Cedars-Sinai Medical Center in Los Angeles. “We need to remove the stigma from vibrators and I do believe this soon will be possible as we are now normalising discussion about women’s sexual health.”

Vibrators should be viewed as another form of technology that can be applied to benefit patients in clinical practice, said Rachel S. Rubin, MD, of Georgetown University in Washington.

“I believe we use technology to make our lives better in almost every way … and the bedroom should not be absent of technology,” she said. “Sex tech is incredible now, from what it used to be. It’s no longer just the seedy stores with newspaper over the windows, but really high-end wonderful devices for couples for all genders. There are so many health benefits to these devices.”

“I believe that if we get male partners interested in devices in the bedroom, everyone’s sexual health will improve,” she stated.

According to Dr Dubiskaya, therapeutic vibratory stimulation has its origin in the now-disproven condition known as female hysteria, associated with excessive emotions and thought to be related to marital relationships, orgasm, and pregnancy. Practitioners were said to have to turned to vibrators to relieve hysteria by stimulating the female patients to orgasms, referred to as “paroxysms”, and turned to vibrators when the practice started to take a toll on their hands and wrists. It’s a now-familiar idea that was popularised by Rachel Maines in her 1998 book “The Technology of Orgasm”, which even inspired a movie.

However, there is no actual evidence in support of this supposed practice as Dubisankya claims. Hallie Lieberman and Eric Schatzberg, the chair of the School of History and Sociology at Georgia Tech, were some of the few who actually bothered to check Maines’s 465 citations. “Maines fails to cite a single source that openly describes use of the vibrator to massage the clitoral area,” they wrote in a contentious paper. “None of her English-language sources even mentions production of ‘paroxysms’ by massage or anything else that could remotely suggest an orgasm.”

Nevertheless, vibrator use is now widespread despite its seedy reputation it had acquired in modern times. In a survey conducted over a decade ago, a majority of women and more than 40% of men reported the use of a vibrator at some point in their lives.

To assess the evidence supporting vibrators’ medical benefits in women, the researchers conducted a systematic literature review, focusing on studies related to sexual health, pelvic floor function, and vulvar health. They found 21 meeting the inclusion criteria, 11 of which were studies of female sexual dysfunction, nine on pelvic floor dysfunction, and one on vulvodynia.

The sexual dysfunction studies showed that vibratory stimulation facilitated vasodilation and blood flow, improved tissue perfusion and metabolism, decreased muscle tone, and increased relaxation. Clinically, use of vibrators was found to be associated with improvement in the Female Sexual Function Index score, as well as increased arousal, orgasm, and genital sensation.

Patients who used vibrators reported increased sexual desire, satisfaction, and overall sexual function, as well as reduced time to orgasm, achievement of multiple orgasms, and reduced distress.

The pelvic floor dysfunction studies showed that vibratory stimulation was linked to a reduction in use of hygienic pads among women with stress urinary incontinence and urine leakage, as well as urinary symptoms. There was improvement in pelvic-floor muscle tone, QoL and patient satisfaction with the treatment.

The vulvodynia study focused on vibratory stimulation for relief of pain and associated symptoms. Dr Dubinskaya said that after 4 to 6 weeks of vibrator use, women reported antinociceptive and desensitising effects, reduced pain, and increased sexual enjoyment. More than 80% of the study participants expressed satisfaction with the treatment, and 90% said they were comfortable with their doctor offering a vibrator as a form of therapy.

Dr Dubisankya is recruiting for a clinical trial to identify which conditions can be most effectively treated with vibrator use.

Source: MedPage Today

Categories : Ageing GenderTags :

Urinary Incontinence Worsens as Women Age

On By ModernMedia
Photo by Tim Mossholder on Unsplash

A new study published in Menopause suggests postmenopausal women aged 45 to 54 years are more likely to have overactive bladder (OAB) syndrome. Additionally, obesity and multiple births put a woman at greater risk for stress urinary incontinence (SUI). 

Urinary incontinence symptoms are common in women and typically worsen as women age. In the United States, the prevalence of urinary incontinence is 17.1% in women aged 20 years or older and 38% in women aged 60 years and older.

There are two main types of urinary incontinence: urinary urge incontinence (UUI) and SUI. Urinary urge incontinence is defined as the involuntary loss of urine associated with the urge to urinate. Stress urinary incontinence, which women are more likely to be diagnosed with, is the involuntary loss of urine because of effort or physical exertion, including sporting activities, sneezing, and coughing. Overactive bladder syndrome is characterised by urinary urgency and is usually accompanied by increased daytime frequency and/or nocturia, with urinary incontinence.

This is the largest known study, with data from more than 12 000 women. Its goal was to investigate the prevalence and factors associated with urinary symptoms.

While the study showed a significant association of OAB in women aged 45 to 54 years and postmenopausal status, it also demonstrated that SUI symptoms may likely become less frequent after menopause. However, high body mass index and the number of times a woman has given birth were shown to increase SUI symptoms.
Other factors studied included smoking status, history of diabetes, hysterectomy, and the use of hormone therapy. The researchers suggest that additional studies should be conducted to consider the association between time since menopause and OAB symptoms in the perimenopause period.

“This study underscores how common urinary incontinence is in women, with nearly one in five Japanese women reporting urinary incontinence related to OAB or SUI in the last month. Midlife women were particularly affected by SUI (18.2% in women aged 50 to 54 years). Given the significant negative effect on quality of life and the presence of effective strategies for management of these burdensome symptoms, clinicians should routinely ask women about urinary incontinence,” said Dr Stephanie Faubion, The North American Menopause Society medical director.

Source: EurekAlert!