Urinary Incontinence in Women

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Urinary Incontinence (UI) is a loss of bladder control. It is a common and sometimes embarrassing issue. The severity of UI can range from occasionally leaking urine when coughing or sneezing to having an urge to urinate that one does not get to the toilet (Aoki et al., 2017). UI can have causes that are not due to underlying health issues like intoxication, coughing and sneezing, unavailability of bathrooms and extreme anxiety and intense laughter. Urinary Incontinence is a common problem among women. This paper will be addressing the issue UI, including the use of specialized diagnostic approaches for appropriate prescription of treatment.

The Spirit of Inquiry Ignited

Urinary incontinence is a common health issue among women. In the US, it is approximated that about 20 million individuals are affected by this issue. Ditah et al. (2014), reported that women are likely to be susceptible to urinary incontinence two to three times more than men. Women aged 50 years or older are affected more by this condition. UI has a significant impact on people and their quality of life. Many women are unaware of the several options for help available. There are many women whose lives have been ruined by this condition. Urinary Incontinence (UI) is a condition that affects women more than it does men.

The PICOT Question Formulated

Definition

Urinary Incontinence is lack of bladder control, and its severity varies from leaking urine after sneezing, coughing or laughing to complete incapacity to control urine.

Epidemiology

The risk factor of UI is increased significantly in women who have had childbirth. Women at post-menopausal are greatly affected by UI as compared to their younger counterparts (Drake, 2017). Women aged 50 years or older are affected more by this condition. Research also reveals that women are two or three times likely to be affected by this condition as compared to men (Ditah et al., 2014). In the US, it is approximated that about 20 million individuals are affected by this issue.

Clinical Presentation

Many persons experience irregular, slight drips of urine. Other people may drop small to moderate amounts of urine more regularly. In stress incontinence, urine leaks when one exerts pressure on the bladder by sneezing, coughing, laughing or by lifting something heavy. In urge incontinence, one has a sudden urge to urinate, followed by uncontrollable loss of urine. In overflow incontinence type, a person experiences frequent dribbling of urine as a result of a bladder that failed to empty. On the other incontinence type known as functional incontinence, a physical or psychological impairment prevents one from making it to the toilet in time. Lastly, in mixed incontinence, one experiences several incontinences.

Complications

A person experiencing urinary incontinence can develop skin problems such as skin infections, rashes and sores due to always wet skin. Also, incontinence increases the risk of repeated urinary tract infections. UI affects social, work and personal relations.

Diagnosis

Appropriate diagnosis is crucial to ensure that the correct type of UI is treated to enhance the patients’ health outcomes. The appropriate diagnosis approach must be used to ensure that the right UI type is pinpointed the proper treatment prescribed (LaBossiere & Herschorn, 2017). The PICOT will aid analyze the effectiveness of appropriate diagnosis of UI in ensuring proper treatment to improve the health outcomes.

Picot Question

In women with Urinary Incontinence (UI) aged 55 and above (P), do specialized diagnostic methods (I) compared to general diagnostics approaches (C) result in the appropriate prescription of treatment of different types incontinence (O) in a six month (T)?

Search Strategy Conducted

Literature search allowed exploration of various databases in the medical arena and access, navigate and filter information (Grewal, Kataria & Dhawan, 2016). The PICOT question was used as a guide when searching in various databases. Majority of the search engines are helpful and yielded numerous articles that were relevant to the topic. Nevertheless, Cochrane disappointed because it produced very few materials. SU online library also yielded only seven pertinent articles which were very few. I am familiar with this database as I use it in all my research, and it has proven to be useful as it produces a variety of articles for one to choose from. The search engine is also straightforward to use. Of all the databases, I found PubMed, CNAHL and Trip databases to be quite helpful. The CINAHL database yielded 1061articles that were appropriate for the topic. PubMed database yielded 1078 search results that were also relevant to the problem. SU online library produced 15 search results out of which seven were relevant. There were no results yielded using Dynamed database. Trip databases turned out to be very useful as a variety of articles were yielded.

Critical Appraisal of the Evidence Performed

UI is hardly given attention despite its significant incidence and diverse health effects. On a study by Nelson, Cantor, Pappas, and Miller (2018) assessing whether screening for UI in women not formally diagnosed improved results and to determine the accuracy of screening strategies and the probable predicaments of screening. The findings showed that the evidence is insufficient on the overall effectiveness and difficulties of screening for UI in women (Nelson et al., 2018). Inadequate evidence in the total population indicates that reasonably high correctness of some screening methods.

Another study was aiming as emphasizing on the efficacy of vaginal cone (VC) therapy in Stress Incontinence (SUI) as compared to a transobturator tape (TOT) (Dur et al., 2019). The study involved forty women who were assigned into two groups. One group included women who underwent through VC for three months, and the other group involved women treated using TOT. The follow up was done at six weeks and six months after treatment. The assessment of actual cure was conducted by cough stress and pad test results. The findings revealed that SUI vital treatment is surgery; however, VC can be used as an alternative treatment for women who may not want to undergo surgery or could be utilized temporarily before surgery.

Evidence Integrated with Clinical Expertise and Patient Preferences

Study Population and Setting

Women with urinary incontinence aged 55 years and above are the population involved in the study. Evidence shows that women are likely to be affected by UI two or three times than men. Hence, the need to address this problem. In the US, it is approximated that about 20 million individuals are affected by this issue.

Sample Strategy

The subjects involved will be women with urinary incontinence aged 55 years and above. They will be picked randomly and selected after meeting the required criteria of inclusion. Those patients with other existing illnesses will be examined thoroughly. The participants will be allowed to participate in the project voluntarily.

Intervention

Specialized diagnostic methods will be the primary interventions to be used for an appropriate prescription of treatment for different incontinence types.

Stakeholders

The significant stakeholders will women with urinary incontinence, a specialist nurse, an expert surgeon and a specialist physiotherapist. Other supportive stakeholders will include primary care providers, healthcare administrators and state medical directors. Also, a consent form from the research board will be required.

Barriers

The probable barriers will be external factors such as transportation challenges. Such factors are different from internal factors such as attitudes that prevent a person with incontinence from seeking care due to fear and embarrassment. Several surveys have emphasized on seeking care, although no one has operationalized challenges for surfer’s attention (Witkoś & Hartman-Petricka, 2019).

Data Collection and Evaluation tool

The project will be conducted in six months. A total of 10 classes will be done in six months. The data will be collected from the women with urinary incontinence. Data will be collected from acute patients and physicians. The appropriate prescription of treatment for UI and improved outcomes will be used to measure the efficacy of using specialized diagnostic approaches. The Michigan Incontinence Index (M-ISI) will be for screening for UI, evaluate urinary incontinence types and to compute incontinence severity. The organization and analysis of data will be done using statistical computer software.

Outcomes Evaluated

The primary outcome will be a proper prescription of treatment for different urinary incontinence types. The measure of the result will be grounded on a study by Wilson and amp; Waghel (2016) indicating that diagnosis is based on symptoms. The health care providers must evaluate the frequency, and the timing of the signs and urinary incontinence physical examination should be done. The diagnostic tests will be conducted when ruling out diseases such as urinary tract infections and renal failure. Proper classification is vital since it determines the subsequent treatment. Generally, nonpharmacologic treatment is considered best for UI treatment. Also, the results will be evaluated through reduced episodes of incontinence and lack of complications like pressure ulcers (Wilson & Waghel, 2016). Also, pre and post-survey will be used to determine the success of the diagnostic tests.

The collection of data on each of the participants will be done using an electronic medical record (EMR). The retrospective data on decreased episodes of incontinence and lack of complication will be gathered from all the participants. A longitudinal survey will be used to collect primary data. Data entry will be done using excel and analyzed using SPSS13.0 software. A two-way ANOVA will then be used to measure the outcomes before after the interventions for intervention and control groups. Also, there will be communication with the nurse manager or primary care providers for follow up on the progress of the project.

Project Dissemination

The outcomes of the project will be interpreted and reviewed for clinical implication. The results will then be summarized into logic conclusion. There will also be determining if the changes require to made before project dissemination to stakeholders and healthcare providers in other healthcare organizations. The outcomes will be printed and published in different websites for access by the members of the community. All the stakeholders will be provided with the project upon request.

Conclusion

Urinary incontinence is a common and often an embarrassing condition. The incidence of urinary incontinence is common among women than in men. UI is associated with complications such as urinary tract infections, skin diseases and adverse effect on the quality of life. Appropriate classification of urinary incontinence type is vital as it influences following treatment. A VC can be used as an alternative treatment for UI in women who may not wish to undergo surgery. Nonpharmacologic treatment is considered best for UI treatment. Also, the success of the nonpharmacologic treatment can be determined through reduced episodes of incontinence and lack of complications like pressure ulcers

References

Aoki, Y., Brown, H. W., Brubaker, L., Cornu, J. N., Daly, J. O., & Cartwright, R. (2017). Urinary incontinence in women. Nature reviews Disease primers, 3(1), 1-20.

Ditah, I., Devaki, P., Luma, H. N., Ditah, C., Njei, B., Jaiyeoba, C., … & Szarka, L. (2014). Prevalence, trends, and risk factors for fecal incontinence in United States adults 2005–2010. Clinical Gastroenterology and Hepatology, 12(4), 636-643.

Drake, M. (2017). Assessment of urinary incontinence. Oxford Medicine Online.doi:10.1093/med/9780199659579.003.0037

Dur, R., Akkurt, İ., Coşkun, B., Dur, G., Çoşkun, B., Ünsal, M., & Sivaslıoğlu, A. A. (2019).The impact of vaginal cone therapy on stress urinary incontinence compared with transobturator tape. Turkish journal of obstetrics and gynecology, 16(3), 169.

Grewal, A., Kataria, H., Dhawan, I. (2016). Literature search for research planning and identification of research problem. Indian Journal of Anesthesia; 60(9), p 635-639. doi: 10.4103/0019-5049.190618. Retrievedfrom https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037943/.

LaBossiere, J., & Herschorn, S. (2017). Pathophysiologic mechanisms in Postprostatectomy urinary incontinence. Post-Prostatectomy Incontinence, 11-21. doi:10.1007/978-3-319-55829-5_2

Nelson, H. D., Cantor, A., Pappas, M., & Miller, L. (2018). Screening for urinary incontinence in women: a systematic review for the Women's Preventive Services Initiative. Annals of Internal Medicine, 169(5), 311-319.

Wilson, J. A. & Waghel, R. C. (2016). The management of urinary incontinence. US Pharm, 41(9), 22-6. Retrieved from https://www.uspharmacist.c…

Urinary Incontinence in Women

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