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Objective: To assess the accuracy of patients' perceptions of the risks associated with localised prostate cancer treatments (radical prostatectomy [RP], radiotherapy [RT], and active surveillance [AS]), and to identify correlates of misperceptions., Patients and Methods: We used baseline data (questionnaires completed after treatment information was provided but before treatment) of 426 patients with newly diagnosed localised prostate cancer who participated (87% response rate) in a prospective, longitudinal, multicentre study. Patients' pretreatment perceptions of differences in adverse outcomes of treatments were compared to those based on the literature. We used univariate and multivariate linear regression to identify correlates of misperceptions., Results: About two-thirds (68%, n = 211) of the patients did not understand that the risk of disease recurrence is comparable between RP and RT. More than half of the patients did not comprehend that RP patients are at greater risk of urinary incontinence (65%, n = 202) and erectile dysfunction (61%, n = 190), and less at risk of bowel problems (53%, n = 211) compared to RT patients. Many patients overestimated the risk of requiring definitive treatment following AS (45%, n = 157) and did not understand that mortality rates following AS, RP, and RT are comparable (80%, n = 333). Consulting a radiotherapist or a clinical nurse specialist was positively associated with, and emotional distress was negatively associated with, better understanding of the risks (P < 0.05), although effect sizes were small., Conclusion: Prior to choosing treatment, most patients with prostate cancer poorly understood the differences in treatment risks. Greater efforts should be made to better understand why these misperceptions occur and, most importantly, how they can be corrected.

Objective: The aim of the study was to assess pelvic floor symptoms and attitudes in an ethnically diverse population., Methods: We conducted a cross-sectional survey of women presenting to 2 community-based, ethnically diverse gynecology clinics. Before being seen by a provider, participants were asked to complete a questionnaire., Results: A total of 312 women were included: 32.7% white, 50.3% African American, and 17.0% Hispanic. Other racial/ethnic groups were excluded secondary to small samples size. The median (interquartile range) age was 34.0 (27.0-44.0) years. The groups differed with respect to most demographic characteristics, such as income, education, and nation of origin. Nocturia and urinary frequency were the most commonly reported symptoms. African American respondents were more likely to report nocturia than white respondents (odds ratio, 2.4; 95% confidence interval, 1.2-4.8). Respondents' views of normal urinary function generally did not vary by race/ethnicity. However, Hispanic respondents were less likely than white respondents to agree that it is normal to leak urine after having children (odds ratio, 0.28; 95% confidence interval, 0.11-0.68). Among women who reported at least 1 symptom, 46.7% reported that at least 1 symptom bothered them, and this did not differ with respect to race/ethnicity (P ≥ 0.59). African American respondents were more likely than whites to report their urinary leakage to their doctors (P = 0.006)., Conclusions: Our study demonstrates that with few exceptions, bladder symptoms and attitudes are similar among reproductive-age women of various racial/ethnic groups in a community setting.

Background: Urinary incontinence is frequently experienced by children with spina bifida, putting them at increased risk for low self-esteem and impacting upon participation in home, school and leisure activities. However, little is known about children's experiences of these continence issues., Objective: This study explored the experiences of children and young people with spina bifida around continence issues, social participation and peer relationships, in order to identify potential areas of support healthcare professionals can provide., Methods: Children and youth aged 6-18 years with diagnoses of spina bifida and neurogenic bladder and their parents were invited to participate in semi-structured interviews. Descriptive thematic analysis was employed., Results: Eleven children (with a range of mobility levels, types of spina bifida and degrees of bladder control) and their parents participated in the study. Three broad themes were identified, which encompassed the following: (1) normal versus different; (2) independence, ownership and the road to continence; and (3) peer relationships and acceptance., Discussion: The experiences discussed by the children and parents in this study ranged from minimal impact of incontinence on their day-to-day living to significant social isolation and rejection. The stigma of incontinence was apparent in all interviews. Children and youth who were able to control their bladder with minimal accidents had greater independence and more opportunities for social participation. Healthcare professionals need to take into account that parents and their children may differ in attitudes and desires about the management of incontinence., (© 2015 John Wiley & Sons Ltd.)

Introduction: While urinary incontinence is often labeled as a taboo in the literature, we found no scientific data addressing this issue exclusively. The aim of our study was to measure the perception of urinary incontinence as a taboo and how this compares to other medical conditions that may be embarrassing., Methods: 150 test persons completed a self-administered 13-item questionnaire about perception and knowledge of urinary incontinence. Data were analysed with the SPSS 10.0.5 software package using the U-test, Chi-square-test, Yates-correction, Fisher's exact test and Kolmogorov-Smirnov test., Results: Eighty-six (60.6%) of 142 respondents thought that urinary incontinence constituted a taboo in Austria. To be incontinent was considered significantly more embarrassing than depression or cancer, respectively (p = 0.001)., Conclusion: Despite its high prevalence, urinary incontinence is still considered a taboo in up to 60% of our Austrian test persons. The level of shame and embarrassment of urinary incontinence is significantly higher than that of depression and cancer.

Aim: This paper is a report of a study conducted to characterize the stigma of urinary frequency and urgency and differentiate it from the stigma of incontinence and to describe race/ethnic and gender differences in the experience of stigma among a diverse sample of individuals., Background: Lower urinary tract symptoms, including frequency, urgency and incontinence, are susceptible to stigma, but previous stigma research has focused almost exclusively on incontinence., Method: The Boston Area Community Health Survey is a population-based, random sample epidemiological survey of urologic symptoms (N = 5503). Qualitative data for this study came from in-depth interviews conducted between 2007 and 2008 with a random subsample of 151 black, white and Hispanic men and women with urinary symptoms., Findings: Respondents reported stigma associated with frequency and urgency - not just incontinence. The stigma of frequency/urgency is rooted in social interruption, loss of control of the body, and speculation as to the nature of a non-specific 'problem'. Overall, the stigma of urinary symptoms hinged upon whether or not the problem was 'perceptible'. Men felt stigmatized for making frequent trips to the bathroom and feared being seen as impotent. Women feared having an unclean body or compromised social identity. Hispanic people in particular voiced a desire to keep their urinary symptoms a secret., Conclusion: The stigma of urinary symptoms goes beyond incontinence to include behaviours associated with frequency and urgency. Healthcare practitioners should assess for stigma sequelae (e.g. anxiety, depression) in individuals with frequency and urgency, and stress treatment options to circumvent stigmatization., (© 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.)

Obesity is a significant and increasing health problem for older individuals, caregivers, and health care financing and delivery systems. While the relationship between obesity and urinary incontinence has been studied fairly extensively in community-dwelling individuals, little is known about obesity and continence status, or nursing care needs of nursing home residents with these conditions. The results of the study reported here, gathered from observations and interviews with nursing home residents and their caregivers, provide a first step in examining this increasingly important issue.

Objective: Numerous studies have identified a reduced health-related quality of life (QoL) in patients with urinary incontinence (UI). The aim of this study was to assess and compare QoL in women with UI in the island of Crete, Greece, and in Turkey., Methods: Incontinent women from two community-based primary health care (PHC) groups (Greece and Turkey) and one outpatient clinic-based group were studied., Results: A total of 231 (24.7%) women out of 932 women from the PHC group in Greece and Turkey reported UI whereas another 38 incontinent women visited the secondary care outpatient clinic. Mean Incontinence Quality of Life questionnaire (I-QoL) total score of women visiting PHC centers was 73.8 (SD = 23.5). There was significant difference among the three groups regarding I-QoL total and subscale scores, with women from the Greek community-based group having the highest score (mean = 81.8, SD = 20.7, P < 0.001). Impaired QoL was significantly associated with severity (P < 0.001), incontinence type (P = 0.026), seeking secondary care, and Turkey as sample setting (P < 0.001)., Conclusion: Urinary incontinence is a frequent problem for women visiting PHC centers, affecting negatively their quality of life. Besides incontinence severity, Turkey as place of residence emerged as another essential predictor of impaired quality of life, suggesting that other social and cultural factors may also play an important role.

Background and Aims: Life satisfaction in the elderly has usually been found to be closely related to self-rated health, and less to diagnoses and more objective measures of health status. However, few studies have examined the relative importance of various specific diagnoses in population-based samples., Methods: In this study, we investigate the relationship between life satisfaction and medical diagnoses in a non-demented sample of 392 participants aged 80 and older., Results: Among 25 common diagnoses, only sleeping problems, urinary incontinence and stroke were significantly related to life satisfaction. Men with angina pectoris and eczema were less satisfied with life compared with men without these diagnoses, whereas women with peptic ulcer were less satisfied with life compared with women without this diagnosis., Conclusions: Our results confirm previous findings of a weak relationship between medically based measures of health and life satisfaction. However, health care and future studies of health and quality of life need to focus on the fact that meaning and consequences of various diseases differ among individuals and that gender may partially account for variability.

Urinary incontinence (UI) can be distressing for women of all ages, and in many cases, women are not given the opportunity to discuss urinary issues or explain the profound effects on quality of life. Although a few studies have examined the lived experience of UI in women, none have focused on Alaskan women living in the 49th state, or "The Last Frontier". To address these gaps, this study explored and analyzed the experiences of 17 Alaskan women living with UI in rural and urban settings.

The relationship between health and happiness was explored using a cross-sectional survey of 383 community-dwelling older adults. As a function of self-reported health, median happiness was increasing at a decreasing rate; happiness variability was decreasing at a decreasing rate. In multivariable logistic regression, lowest-quartile happiness was associated with poverty, unfavorable subjective health, debilitating pain and urinary incontinence, but not with the comorbidity count or other comorbidities. The results, robust to common method bias, suggest that subjective health measures are better predictors of happiness than objective measures are, except for conditions that disrupt daily functioning or are associated with social stigma.

The aim of this study was to identify the reasons why women with recurrent bothersome urogynaecological symptoms do not seek further treatment. A cohort of 17 women with recurrent incontinence or prolapse symptoms following a prolapse repair were identified and interviewed about their reasons for not seeking help when their symptoms recurred. The mean time between the surgery and the interview was 3 years. The interview transcripts were analysed using constant comparison derived from Grounded Theory. Dominant themes were beliefs about ageing, attitudes towards incontinence, health professionals and treatment and access to services. These factors may be important when counselling women postoperatively.

Objectives: To compare the prevalence of frequency and nocturia and the bother they impose in a population-based sample of men and women using current International Continence Society (ICS) definitions of lower urinary tract symptoms (LUTS) and commonly used alternative definitions of these LUTS to emphasize the importance of standardizing the definitions when evaluating overactive bladder (OAB) syndrome; we also describe the spectrum of LUTS and bother they impose in this population with OAB., Subjects and Methods: Several validated disease-specific measures were used in a population-based, cross-sectional telephone survey of adults aged >or=18 years in five countries. The population with OAB was defined as those participants who answered 'yes' to questions about urgency or urgency urinary incontinence according to ICS standards. The prevalence of daytime frequency and nocturia within the OAB population was examined using two different criteria for each symptom. Frequency was defined using the current ICS definition (i.e. subject's perception of whether they urinated too often during the day) or more than eight daytime voids. Nocturia was defined according to the ICS definition of having to wake once or more per night to void and using the threshold of waking twice or more per night to urinate. Urinary symptom bother within the OAB population was compared using the different criteria for frequency and nocturia., Results: In all, 1434 participants (502 men and 932 women) were classified as having OAB; 31% of men and 25% of women with OAB had daytime frequency consistent with the ICS definition. The ICS-defined frequency identified a population with a varied distribution of reported daytime voiding frequencies; most respondents reported frequencies below the threshold of nine daytime voids. The ICS-defined daytime frequency was reported as bothersome by more than half of the OAB population (46% of men, 66% of women). Of the OAB population, approximately 75% reported one or more nocturia episodes per night, and approximately 40% reported two or more per night. The proportion of the OAB population that was bothered by nocturia increased markedly as the number of nocturia episodes increased. Among those with OAB, the most prevalent combination of OAB symptoms was urgency and nocturia. More than half of those with OAB reported urgency combined with three or more other LUTS (including voiding and postmicturition symptoms), and the number of LUTS reported increased with age. The proportion of the population reporting symptom bother increased as the number of reported LUTS in that population increased., Conclusions: The ICS definitions for daytime frequency as 'the subject's perception of urinating too often' and for nocturia as 'one or more episodes per night' adequately described bladder symptoms within the OAB population when assessed by the level of symptom bother. Urgency was uncommon in isolation and did not alone impose as high a level of bother as when combined with other LUTS. In this population, the most predominant manifestation of OAB was a combination of urgency with one or more other OAB symptoms. Symptom bother became more common as the number of symptoms reported increased. LUTS other than the defining symptoms of OAB were also highly prevalent within the OAB population.

Purpose: The aim of this study was to describe experiences of living with urinary incontinence (UI) among persons who do not desire further assessment and treatment., Methods: This was a qualitative, descriptive interview study, and the method was phenomenological. Eleven women were interviewed; all had been in contact with a district nurse to obtain a prescription for sanitary protection. None of the women desired further treatment for UI., Findings: The women described living with UI as a manageable problem with which they had learned to live. They showed strength and desire to manage on their own. In many cases, other health problems overshadowed leakage problems. Several women saw health care services as a barrier that needed to be overcome before help could be obtained. Three key constituents emerged in the analysis: "learning to live with it despite difficulties," "other illnesses are more important," and "reluctance to seek care." For these women, the essence of the phenomenon of living with urinary incontinence (UI) can described as "a situation to accept and adjust to."

Purpose: This paper describes a project to develop and clinically evaluate a novel toileting device for women called the Non-Invasive Continence Management System (NICMS). The NICMS device is designed to provide an alternative toileting facility that overcomes problems some women experience when using conventional female urinals., Design: A single product evaluation was completed; participants used the same device with 1 or 2 interface variants., Subjects and Setting: Eighty women from 6 countries who were either mobile or wheelchair dependent evaluated the product over a 15-month period., Results: The device was found to be useful in some circumstances for women and their caregivers., Conclusion: Significant further development is required for it to work reliably and to provide an acceptable device in terms of reliability, size, weight, noise, and aesthetics.

Aim: The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI)., Background: Living with long-term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective., Method: Fourteen women with UI (range: 34-52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts., Findings: The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub-themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub-themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness., Relevance to Clinical Practice: Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self-care abilities.

Aim: This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of 'treatment effects' in the context of pad use., Method: Key pad performance characteristics were identified from the literature and focus group work. Semi-structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative 'treatment effects', and to rank pad characteristics by their importance., Results: Achieving effective and discrete containment of urine was the dominant factor impacting on women's lives. Sub-themes embraced physical effects, psychological impact and social functioning. The five pad characteristics ranked most important for day time use were: 'to hold urine, to contain smell, to stay in place, discreteness, and comfort when wet. For night use discreteness was replaced by to keep skin dry'. High levels of reported anxiety were associated with perceived risk of poor pad performance, lack of discreteness and need for complex regimes for pad management., Conclusion: Insufficient attention has been paid to the balance between the beneficial and negative treatment effects of absorbent pads to date. Existing continence-related quality of life measures are not designed for conditions where change in symptoms is not an outcome measure. The study findings provide the basis for developing a more sensitive, patient-oriented, quality of life measure for pad-users which can aid product selection, new product development and inform future evaluative comparisons between products/products and treatments., Relevance to Clinical Practice: This paper illustrates the complex influence on quality of life caused by using absorbent pads to contain incontinence. It raises awareness of the importance of careful selection of the most appropriate pad for each individual to minimize unfavourable side effects, and the need for a new quality of life measure designed for pad-users.

Objectives: To determine how men treated for localized prostate cancer and who had permanent side-effects, and healthy controls, would value five descriptions of health states associated with side-effects of treatment for localized prostate cancer, hypothesising that patients would value the health states as less detrimental than men with no prostate cancer., Patients, Subjects and Methods: In previous research, patients with prostate cancer reported high generic quality-of-life scores after primary treatment, despite side-effects; it was suggested that these patients accepted the side-effects, i.e. urinary, bowel and sexual dysfunction, as 'part of the bargain' because they felt they were saved from a life-threatening disease. Thus, we asked 54 men who had been treated for localized prostate cancer and had permanent side-effects, and 53 healthy controls, to value five descriptions of health states. All respondents valued all descriptions using two valuation methods, a visual analogue scale (VAS, range 0-100) and time trade-off (TTO, range 0-1). The respondent functioning was assessed using the EuroQol-5D, completed with items on urinary, bowel and sexual function., Results: Patients and healthy controls had similar valuations for nine of the 10 comparisons (five health states by two methods). Valuations in both groups resulted in the same ranking order of states on the TTO and one exchange in rank order on the VAS., Conclusions: When asked to value five health states associated with side-effects of treatment for localized prostate cancer, there was no difference in the valuation of erectile, urinary and bowel dysfunction between patients with permanent side-effects after treatment and healthy controls. More likely explanations for the high generic quality-of-life scores after primary treatment for prostate cancer are a response shift and insensitivity of generic health-related quality-of-life measures.

Being afflicted with urinary incontinence in old age represents manifold medical, social, and economic problems and restrictions. The objective loss of control and decreased self-confidence result in reduced social interactions and lead to isolation and ostracism accompanied by withdrawal and depression. Giving up leisure time activities, losing social contacts, and the increasing need for long-term care often lead inevitably to a higher degree of dependency and institutionalization. In addition, the taboo still placed on this problem by those affected as well as by the attending physicians has resulted in too few patients receiving adequate diagnosis and being offered sensible treatment options. These problems can only be solved by an interdisciplinary approach. Further information, continuing education, and sensitivity toward these aspects are needed. Only then can incontinence in old age as a social and economic problem exacerbated by the demographic changes be improved.

Urinary incontinence (UI) is a prevalent health issue affecting the quality of life of many elderly women living in long-term care. Minimal consideration has been given to understanding the lived experience from women's perspectives. Using one-to-one interviews, this study explored elderly women's experiences with UI while living in long-term care facilities. Data were analyzed using thematic analysis that revealed three themes related to the meaning of UI to the women, physical implications of UI, and institutional culture of UI in long-term care. Within these three themes, the women expressed common concerns. The results of this study provided information that could influence changes in nursing practice related to individualized UI care, empowering women experiencing UI, and dispelling ageism in long-term care. The study also suggests opportunities for improving health care education related to the quality of life of women who experience UI, and the need to make the experience more visible and openly discussed as a health issue rather than the traditional condition of aging.

Aim: To gain insight into the impact of urinary incontinence on the daily lives of Moroccan and Turkish women and their preferences for treatment., Design of Study: A qualitative analysis of data from semi-structured in depth interviews with 30 Moroccan and Turkish migrant women with urinary incontinence., Setting: Six general practices with large numbers of immigrant families in four cities in the Netherlands., Method: Semi-structured in depth interviews were conducted with Moroccan and Turkish migrant women, who presented with complaints of urinary incontinence in six general practices with large numbers of immigrant families on the practice list in four different cities in the Netherlands., Results: All the women adhered closely to bodily cleanliness and considered incontinence to be dirty. As Muslims, they were obliged to perform ritual prayers preceded by ablution five times per day and the urinary incontinence breached their status of ritual purity. Therefore, they had to wash more often and experienced this as a heavy burden. In a number of the women, shame formed a reason why they could not talk to anybody about the incontinence, not even with the doctor. One-third of the women felt that their GP had not taken them seriously. Knowledge about anatomy, physiology and available treatments was mostly lacking. In addition, the women did not understand the aim of the exercises from the physiotherapist. The majority of women gave preference to help from a female doctor., Conclusion: Urinary incontinence in Moroccan and Turkish migrant women formed a considerable problem in their daily following of the Islam faith. Shame on the part of the patient and miscommunication at the doctor's surgery led to inadequate care.

Background: The aim of the study was to evaluate health associated attitudes of elderly individuals taking part in a community based health promotion programme. It was of interest to focus on mobility, hypertension and urinary incontinence, problems frequently observed in geriatrics., Methods: Participants in the health promotion programme were asked to answer a standardized questionnaire about their individual risk factors and habits concerning some of the main risk factors in the elderly: social isolation, immobility, hypertension, urinary incontinence. Mobility and risk assessment for falls was assessed in a standardized way using the Chair-rising- and Timed-upand-go tests., Results: The percentage of people with a healthy life style was significantly higher than in a comparable population group. Gait disturbance, mobility limitation and risk of falls were not present. 38.7 % suffered from urinary incontinence. Hypertension was, if present, diagnosed and adequately treated. The participants knew their prescribed drugs and seemed to have an excellent compliance., Discussion: The participants in the health promotion programme showed an exceptionally high level of health awareness. Nevertheless, the incidence for reported urinary incontinence was significantly higher than in known epidemiological studies. The calm, reassuring atmosphere in which the questionnaire was completed and the large amount of time spent with the participants could explain this finding. The difference in dealing with hypertension and urinary incontinence is obvious. Further health promotion and disease prevention programmes for the elderly should be focused on the complex process of ageing and not only on specific single topics.

Introduction: Behavioral strategies such as pelvic floor muscle exercises (PFME), bladder retraining, and dietary modifications are generally considered to be the first line of treatment for urinary incontinence (UI). Yet little is understood about the client's abilities/motivation to manage their UI in the home setting. Self-care, the ability of clients to act on their own behalf to achieve and maintain health, is a fundamental component of these strategies. Despite the frequently chronic nature of UI, there is growing evidence that such maintenance of behavioral therapies is sporadic at best., Objective: The purpose of this study was to enhance understanding of self-care strategies that individuals with UI employ, the perceived benefits of these strategies, the factors that influence their self-care choices, and the factors that impede or facilitate maintenance of behavioral therapies., Method: In this qualitative descriptive study, individual and focus group interviews with community-dwelling participants were conducted to enhance understanding regarding the participants' management of UI at home and why they maintain certain strategies and not others. Data were collected via loosely constructed individual (n=25) and focus group (n=3) interviews to facilitate open discussion of participants' perceptions., Results: Thirty-eight individuals (33 women and 5 men) participated in the study. Analysis of data resulted in a major category of self-care strategies related to UI that was further subcategorized into factors that facilitated PFME and barriers to PFME performance. Factors that facilitated PFME included: (a) realistic goals and expectation, (b) positive affirmation, (c) follow up, and (d) maintaining an exercise routine. Barriers noted were: (a) insufficient information, (b) characteristics of the exercises, (c) competing interests, (d) financial cost, and (e) minor psychosocial impact., Conclusions: This study described the self-care strategies that participants with UI had initiated and maintained and additionally explored the perceived facilitators and barriers to self-care choices. Two major themes emerged: (a) self-care efforts were motivated by desire for a normal daily lifestyle and (b) participants were motivated to maintain strategies by the ability to visualize progress and by knowledge that they were progressing. These findings support the need for client-focused teaching that is grounded in the individual's daily realities and goals.

Both urinary and fecal incontinence are frequently occurring problems with costly consequences - physically, emotionally, and economically. General self-management strategies to promote continence, as well as behavioral and medical interventions, are often advocated. In this article, strategies based on a cognitive model are directed toward 2 overall goals: managing cognitions that are largely outside the individual's control while altering those within the individual's control, and improving management of continence with cognitive techniques. This approach expands and supports the behavioral and medical approaches to continence care. Nurses can use this comprehensive approach to increase the likelihood of positive continence outcomes.

Bladder control problems, especially urinary incontinence (UI) and urinary freqency and urgency, are prevalent among older adults. The purpose of this project was to determine older adults' educational needs, preferred format, and interest in bladder control educational materials. Eighty-one older adults participated in focus groups conducted at senior centers, churches, and senior apartment dwellings located in Philadelphia, PA. A doctorally prepared nurse acted as the moderator, using a questionnaire that included items on general health issues and specific questions about bladder control issues. Participants showed interest in learning more about bladder control issues, discussed their preferences in relation to format for receiving health-related information, and expressed their interest in bladder control educational materials. This information can be used to devise an educational program about bladder control that is acceptable to older adults and can be easily accessed in settings where they reside or recreate.

Purpose: The purpose of this study was to use narrative analysis as a method for examining the lived experience and meaning of long-term, female urinary incontinence (UI)., Method: Cognitive anthropology and critical medical anthropology provided the overall framework for this study. Theoretical saturation (Strauss, 1987) was achieved after 17 community-dwelling women with long-term (greater than 5 year's duration) UI were interviewed. Informants participated in two face-to-face, audiotaped, interviews and a semi-structured, topical outline for each interview was used. A field journal was used to supplement and validate other data. Informant's narratives were analyzed to emphasize the overall plot type of their stories., Findings: In this study, three dominant plot types emerged from women's narratives: the UI Quest Narrative, UI Restitution and Redemption Narratives, and the UI Victim Narrative. These plot types provide a beginning understanding of the lived experience and meaning of long-term female UI., Conclusions: Study findings suggest (a) long-term female UI is primarily conceptualized as a condition integrated into a larger life story, (b) women with long-term UI relate stories that follow a narrative format, and (c) long-term, female UI is heterogeneous. Findings go beyond existing literature by suggesting that women's UI narratives serve an important function in understanding the lived experience and the meaning of UI.

The study described in this article aimed to identify issues relating to incontinence and assess the impact of referral to a continence adviser on the lives of people with multiple sclerosis (MS). The study design used an in-depth, two-phase anonymous mail survey within a general community as nominated by the participants. Fifty-six people participated in phase 1 and eleven people completed phase 2. The results indicated that incontinence is a problem for the vast majority of participants--people with MS. One-third of the eligible participants took up the option of a consultation, assessment and treatment from a continence nurse. Reasons for not taking up the visit from the continence nurse included 'managing OK', 'didn't think it would help', 'embarrassed' and 'too busy'. Increasing awareness of urinary incontinence in the community is important and education needs to focus on at-risk groups in presenting the range of options available to assist people experiencing incontinence.

Over the last 5 years, the National Association For Continence has sponsored epidemiologic surveys of adults across the United States in order to quantify the prevalence of bladder control problems in the community, to understand how quality of life of those people experiencing these medical disorders is affected, and what beliefs people in general hold surrounding bladder health. Collectively, these nationwide surveys offer statistically significant documentation of how widespread, how far-reaching, how misunderstood, and how real the symptoms of urinary incontinence and related symptoms of overactive bladder are, and lay a foundation to support future investment in research, education, and collaboration.

Purpose: The aim of this study was to examine the individual quality of life (QoL) of men following radical prostatectomy for prostate cancer. The following research questions were addressed: (a) What are the most important areas of quality of life for men following radical prostatectomy? (b) How do these men rate their satisfaction in each area and what is the relative importance of each area to their overall quality of life?, Methods: The purposive sample consisted of 11 men with prostate cancer who had undergone a radical prostatectomy 3 to 4 months earlier. QoL was examined using the SEIQoL-DW (Schedule for the Evaluation of Individual QoL: A Direct Weighting Procedure). The data were analyzed by means of qualitative content analysis (five most important QoL areas)., Findings: The 11 respondents named a total of 55 QoL areas which they described and labelled. They then rated their current satisfaction in each area, and how important each one was to them. A second analysis of the content was made to identify the main QoL areas. The 55 quality of life areas mentioned by respondents were reduced to the following categories: health, activity, family, relationship with a partner, autonomy, independence, hobby, financial security, and sexuality. Health, family, and relationship with a partner are the thee areas which had the most impact on QoL. Overall, the respondents had a high quality of life value. Impotence and incontinence did not appear to have a very negative impact on quality of life., Conclusions: SEIQoL-DW was used for the first time in patients with prostate cancer. In a urology department where nurses and patients are confronted daily with the topics of intimacy, sexuality, and sense of embarrassment, more importance should be placed on the topic of sexuality when taking a patient history. Nurses should be trained in communication techniques that enable them to engage patients in a safe and therapeutic dialogue about their sexual concerns related to the diagnosis of prostate cancer. SEIQoL-DW can support the communication with patients.

Introduction: Very little is known about a patients perception of the severity of incontinence, absorbent product use, and interaction with health care professionals despite the growing prevalence of bladder control disorders such as urinary incontinence (UI) and overactive bladder., Purpose: Using a simple mail-in questionnaire, this survey was meant to evaluate the limitations in intervention for UI in women due to communication shorffalls. It cites common resources utilized once a woman finds significance to her bladder control problem. The survey explores the adequacy of intervention relative to the effective availability of information, materials, and treatment. The objective was to understand the current patient-professional relationship in order to evaluate different vehicles that might effectively increase communication regarding incontinence issues., Methods: In partnership with a mail order medical product company, the author formulated a questionnaire that was mailed by the company to 1,500 women. Half of the sample was derived from randomly selected "leads" from advertising sources and personal referrals who had identified themselves as incontinent but had never purchased incontinence supplies from them. The other half were randomly selected customers who had purchased the company's incontinence products. The 33-item multiple-choice questionnaire had 422 responses; of these, 405 women, aged 56 and older were evaluated. A research firm that conducts and analyzes consumer surveys using standard consumer research protocol tabulated results., Findings: Of those suffering from UI, two groups emerged. The first felt that incontinence was related to aging, and were not embarrassed to discuss it with their physician. They had mixed feelings regarding impact on quality of life. The second group was reluctant to seek professional advice and was uncomfortable speaking about it. They felt strongly about its negative impact on daily life. Respondents from both groups who seek professional assistance still desired more information about the causes, treatments, and coping mechanisms. Most wanted more provider interaction and wanted their doctor or health care provider to proactively initiate discussion on incontinence and provide information, educational materials, and product samples., Conclusion: Respondents indicated that they want more information regarding incontinence. While they may not be equipped to fully understand the problem, they expect doctors, nurses, medical professionals, retail outlets, medical supply companies, and mail order houses to provide the information. Since respondents are receiving information through consumer advertising, which is usually commercially funded, a partnership between the health care community and these sources to produce this information would be ideal.

Objective: The purpose of this pilot study was to evaluate the performance of reusable absorbent body-worn products for adults with moderate/heavy urinary incontinence, compare their performance with a group of equivalent disposable products, and establish the need for a larger statistically robust study., Setting and Subjects: Ten men and 4 women living in the community were recruited from locations throughout the United Kingdom., Methods: A randomized multiple crossover design was used in which all subjects were given the opportunity to test each product. All the products were available on the UK market in January 2001. The following tools were used in the evaluation: a product performance questionnaire and a pad leakage diary. Overall opinion was used as the primary outcome indicator., Results: The reusable Paddy T was the best performing product overall, outperforming the disposable products. For low leakage and good absorbency (the most important product attributes identified by the subjects), the disposable all-in-one product performed best during the day. However, the Paddy T performed best for night use. The remaining reusable products performed poorly overall., Conclusions: Reusable products for moderate/heavy incontinence remain unpopular for use in isolation. Surprisingly, a product manufactured from terry toweling, a traditional material, performed relatively well. Reusables may provide a useful alternative to disposable products in certain circumstances. The results from this study do not support a more comprehensive costly study.

Attitudes toward older adults with incontinence vary significantly between societies and cultures. Intangible consequences arising from such attitudes may exert enormous psychosocial strain on affected older adults, caregivers, family members, and social networks. Health providers should consider psychologic, gender based,and sociocultural differences in formulating efficient screening and therapeutic strategies for older adults who have UI.

Toilets and continence play critical roles in the lives of people who care for a relative at home. Issues around toileting are central to the relationship between the carer and the person being cared for, with the bathroom often becoming the most important place in the house.

In this paper, we explore social aspects of the management of urinary incontinence (UI) by women in their middle years. Drawing on interview data with 75 women, and on sociological theories of the body, we illustrate the problematic nature of UI. The occurrence of UI is commonly regarded as a sign of bodily neglect and a lack of self-discipline. To ensure continued social membership, women must devise ways and adhere to various social rules to manage the physiologically "leaky" body that defies cultural norms of restraint and control. Managing UI involves anticipating and masking a problem that invokes persistent cultural ideas about the female body.

This study investigated the frequency, nature and experience of urinary incontinence in post-natal women. Surveys were completed by 224 women, 50% of whom indicated that they had experienced accidental urine loss. The majority of women who had experienced any symptoms were moderately to greatly bothered by them. A variety of strategies were used to manage the problem; however, 42% of the women who experienced accidental urine loss had taken no action to ease the problem. Women received information about urinary incontinence and pelvic floor exercises from a variety of health care professionals, but this was not consistently provided. The implications of these findings are discussed.

Objective: Incontinence-specific and generic measures of well-being were regressed on potential predictors to identify incontinent respondents at risk for psychosocial distress and to understand the relationship between urinary incontinence (UI) and other determinants of social and emotional status., Design: Survey data were collected May 1994 through April 1996., Setting: Telephone interviews as a supplement to a nationally representative monthly consumer survey., Participants: Analyses were based on 1,116 continent and 206 incontinent respondents age 40 and older., Measurements: Incontinent respondents self-reported the extent to which urine loss restricted social activities or affected their feelings about themselves. All respondents were asked whether they felt depressed, lonely, or sad. Covariates included sex, age, race, education, social desirability, health status, frequency of urine loss, quantity of loss, and urgency., Results: The majority of incontinent respondents reported that urine loss did not restrict activities or diminish self-esteem. Incontinent respondents who were younger, male, less educated, lower in social desirability, in poorer health, or losing greater quantities of urine were more likely to report psychosocial distress, although these correlates were not consistently significant. Compared with continent respondents, significantly higher percentages of incontinent respondents reported feeling depressed, lonely, or sad. In the multivariate models, incontinence retained an independent association with loneliness, but not with sadness or depression., Conclusion: Even though the direct psychosocial impact of urine loss may be minor in many cases, UI is associated with a constellation of physical and behavioral factors that can impose a social and emotional burden. This suggests that UI cannot be adequately evaluated or treated without consideration of the patient's overall quality of life.

The purpose of this study was to explore and describe women's beliefs, knowledge, and need for education regarding female urinary incontinence (UI). Findings suggest that almost half of the women surveyed believed UI was normal. A majority believed it is a problem for women, but felt they could not talk about it freely. Most knew professional help was available and indicated they would seek help if incontinent, but expressed a need for more information. They varied in their beliefs regarding the efficacy of various treatment modalities. Implications for nursing practice are discussed.

Objective: The objective of this study was to test the validity and reliability of the Incontinence Impact Questionnaire (IIQ-7), a 7-item self-report instrument designed to assess the impact of urinary incontinence (UI), in men., Subjects: Fifty-eight men with incontinence after radical prostatectomy were the subjects of the study., Methods: Content validity was assessed by a panel of experts. Construct and criterion validity were examined with 3 groups of men who had UI in a randomized controlled trial comparing pelvic muscle exercises with pelvic muscle exercises plus electrical stimulation. Internal consistency and stability coefficients for the IIQ-7 were determined., Results: The content validity index was 0.88. Four items were below the designated content validity index level. A 2-factor analysis solution (factor I-impact on daily activities; factor II-emotional impact) explained 84.94% of the variance. No significant group differences were recorded on impact of UI (F = 0.37, P =.70), nor were any differences among subjects found over time (F = 0.90, P =.50). A positive relationship was found between grams of urine loss on a 24-hour pad test and IIQ-7 scores (r = 0.34, P =.003 to.51, P =.001). When the IIQ-7 score decreased, self-reported quality of life improved as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Version 2 (r = -0.57, P =.0001 to -.49, P =.001). A strong relationship was found between responses to the question "Does leakage affect your life?" and the IIQ-7 scores. Internal consistency ranged between 0.88 and 0.92. IIQ-7 scores were consistent when urine loss was stabilized between 16 and 24 weeks after entry into the study (r = 0.89, P =.0001)., Conclusion: The IIQ-7 is a reliable measure of the impact of UI; however, the scale requires additional testing regarding construct validity in men.

Urinary incontinence affects 30-60% of all women in the postmenopause. More and more women want to remove the taboo attached to incontinence, because they do not accept the reduction in quality of life, social and domestic activities. Detrusor instability (urge incontinence) and/or urethral sphincter incompetence (genuine stress incontinence) are the principal mechanisms, which lead to involuntary urine loss in older women. It is quite evident that additional factors as hypoestrogenism and urogenital atrophy influence urinary incontinence. Since in the postmenopause urge incontinence combined with urogenital atrophy its found predominantly, pharmacologic therapy with anticholinergic drugs and estrogen replacement are generally effective. Surgical therapy should be restricted to older women with genital prolapse and/or stress incontinence. In genuine stress incontinence, estrogen replacement therapy can lead to subjective improvement, but urodynamic parameters do not change objectively.

Objectives: To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults., Design: A randomized, controlled trial to determine the effects of clinical practice guideline implementation on provider attitudes and behavior, and patients' UI, health status, quality of life, and satisfaction with care. Baseline and endpoint data were collected from patients via computer-assisted telephone interviewing., Setting: Forty-one nonacademic primary care practices (PCP) in North Carolina., Participants: A total of 668 community-dwelling adults (age > 60) who had visited the one of the selected PCPs., Intervention: PCPs in the intervention group were given instruction in the detection and management of UI, educational materials for providers and patients, office system supports, and academic detailing., Measurements: The dependent measure was assessed using an eight-item screener for DS. UI (status, frequency, amount), health (physical, mental), and demographic (age, gender, marital status) and self-report information about bladder control served as predictors., Results: Wilcoxon rank sum tests showed that UI status was associated with moderate to severe DS (43% vs 30%, P = .05). Multivariate analyses showed that UI status, physical and mental health, and gender were significant predictors of DS. Among UI adults (n = 230), physical and mental health, life satisfaction, and the perception that UI interfered with daily life were significant predictors of DS., Conclusions: This study provides clear evidence that UI is related to DS in older adults.

The purpose of this study was to develop a substantive theory describing and explaining cognitive, psychosocial, and behavioural aspects of living with urinary incontinence in a nursing home. Using grounded theory methodology, data were obtained from interviews, participant observation, and minutes from meetings of resident advisory councils, and analysed concurrently using the constant comparative method. Three nursing homes located in the metropolitan area of a major American city served as sites for the study. Ethical approval was obtained from the administrator of each facility and institutional review board of a major university. Ten residents served as primary participants, consenting to provide one audiotaped formal interview, subsequent opportunities to observe and discuss their methods of bladder control, and access to their health care records. Another 33 residents from these facilities served as secondary participants, providing opportunities for observation and informal interview when their bladder control needs, issues, or methods were visible to the investigator and seemed relevant to the evolving theory. Data were collected over a period of 17 months. Findings suggest that nursing home residents with actual or potential urinary incontinence engage in a process called managing urinary incontinence. Managing urinary incontinence occurs in the context of believing that it is an inevitable part of ageing and seeking to protect physical, psychological, and social integrity. Managing urinary incontinence is a dynamic process with consequences that are influenced by the degree to which six specific strategies are used with satisfaction by the resident and supported by staff and significant others. Implications for nursing practice and research are discussed.

This article draws on extensive interviews with middle-aged Australian women experiencing urinary incontinence. Our discussion derives from the difficulties women face in seeking advice on the management of incontinence, as a consequence of their perception that the condition is an inevitability, a "normal" part of being female. Women do not, on the whole, support a single cause for incontinence but, rather, explain its incidence in terms of personal history, which may include childbearing and parturition, menopause and aging, and early socialization. In addition, women link their own continence problems with perceived personal failings (e.g., lack of exercise, being overweight) and, hence, see the condition as a symbol of their lack of moral worth. Following this, women's understandings of the relationship of incontinence to their social membership extend far beyond the difficulties of disguising their physical problems.

Incontinence is a demoralizing and costly problem that severely affects the quality of seniors' lives. With the aging Canadian population expected to double within the next 15 years, the elderly are at the highest risk of developing incontinence. It is now recognised that incontinence can be successfully managed, and in many cases, resolved. A survey was conducted with seniors experiencing problems with incontinence who were receiving home care services. Results showed that incontinence has a significant impact on their lives. Seniors tend to mistakenly see the problem as an inevitable factor in the aging process; consequently many hesitate to seek information. In addition, they face barriers to receiving incontinence care that includes knowledge and access to services and resources. Nurses have the potential to take a leading role in reducing the problem of incontinence and in reducing the impact on the lives of seniors. In order to realize this potential, nurses need to be more aware of their attitudes towards incontinence and more informed about conservative treatment options. Some thought needs to be given to the role of the general nurse, and the role of a specialized nurse such as the nurse continence advisor.

The purposes of this study were to describe what working women perceived as the cause of their urinary incontinence (UI) and to determine if there was a relationship between identifying their UI cause and reporting it.