Objective Our objective was to determine the prevalence of functional disability among older women with urinary incontinence (UI). Methods We conducted a secondary analysis of the 2005-06 National Social Life, Health and Aging Project (NSHAP). Daily UI was defined as answering “daily” to the question, “How frequently...have you had difficulty controlling your bladder, including leaking small amounts of urine, leaking when you cough or sneeze, or not being able to make it to the bathroom on time?” We then explored functional status. Women were asked about seven basic activities of daily living (ADLs). Statistical analyses with percentage estimates and 95% confidence intervals (CI) were performed. Logistic regression was performed to assess the association between functional status and daily UI. Results In total, 1,412 women were included in our analysis. Daily UI was reported by 177 (12.5%) women. Functional dependence or disability with any ADLs was reported in 62.1% (95% CI 54.2%, 70.1%) of women with daily UI. Among women with daily UI, 23.6% (95% CI 16.8%, 30.5%) reported specific difficulty or dependence with using the toilet signifying functional limitations which may contribute to urine leakage. After adjusting for age category, race/ethnicity, education level, and parity, women with daily UI had 3.31 increased odds of functional difficulty or dependence compared with continent older women. Conclusion Over 60% of older women with daily UI reported functional difficulty or dependence and 1/4 of women with daily UI specifically reported difficulty or dependence with using the toilet.
SCP with or without PC is associated with improved posterior support and decreased obstructive and irritative bowel symptoms at 1 year in women with apical and posterior prolapse.
Objectives The prevalence of functional disability for basic activities of daily living (ADLs) in older women with fecal incontinence (FI) is not well characterized. Our objective was to determine the prevalence of functional disability among in community-dwelling older women with fecal incontinence. Study Design We conducted a secondary database analysis of the 2005–06 National Social Life, Health and Aging Project (NSHAP), a cross-sectional study of community-dwelling older adults conducted by single in-home interviews. FI was defined an affirmative answer to the question, “Have you lost control of your bowels (stool incontinence or anal incontinence)?” with a frequency of “at least monthly”. We then examined functional status. Women were asked about seven basic ADLs. Statistical analyses with percentage estimates and 95% confidence intervals (CI) were performed. Results 1,412 women were included in our analysis. FI, at least monthly, was reported by 5.5% (n=77) of community-dwelling older women. 63.2% (95% CI 50.1, 76.4) of women with FI reported difficulty or dependence with ≥1 ADLs and 31.2% (95% CI 18.9, 43.6) specifically reported difficulty or dependence with using the toilet. After adjusting for age category, race/ethnicity, education level, women with FI had 2.6 increased odds (95% CI 1.26, 5.35) of difficulty or dependence compared with women with no FI. Other significant risk factors for increased functional difficulty/dependence included obesity (body mass index ≥30kg/m2) and depressive symptoms. Conclusions Consistent with other large epidemiologic studies, we found monthly FI was reported by 5.5% (n/N=77/1,412) of older women. Over 60% of community-dwelling older women with FI report functional difficulty or dependence with ≥1 ADL and specifically, over 30% of women with FI report difficulty or dependence using/reaching the toilet. Due to the high prevalence of functional disability in older women with FI, we purpose that initial evaluation and treatment of FI may be improved by considering functional status.
Pseudolipomatosis is an artifactual microscopic change in tissues that resembles fatty infiltration, most often described in the gastrointestinal tract. The fatlike spaces represent air or gas bubbles that enter the mucosa through microscopic ruptures secondary to gaseous insufflation. We report a series of cases of pseudolipomatosis encountered in gynecologic tissues removed during hysteroscopic procedures, a finding not previously described. We identified 300 consecutive hysteroscopic procedures performed at our institution from 2006 to 2008. Patients' medical records were reviewed to collect pertinent clinical data. Slides from all cases were systematically reviewed. The diagnosis of pseudolipomatosis was established by consensus. Twenty-eight cases of pseudolipomatosis, representing 9.3% of patients who under went hysteroscopy, were identified. Pseudolipomatosis was found in 9 endometrial curettings or biopsy tissues, 8 endometrial or endocervical polyps, 8 uterine fibroids, 2 fallopian tubes, and 1 endocervical biopsy. The type of distention medium used and length of hysteroscopic procedure did not differ significantly between cases with and without pseudolipomatosis. Pseudolipomatosis vacuoles varied in distribution from crowded clusters to sparsely scattered and solitary. Occasionally, vacuoles were found in vascular channels. Vacuoles were round or ovoid, unilocular, and variable in size. Immunohistochemical staining for adipocyte and endothelial markers were negative. We hypothesize that pseudolipomatosis derives from air that is almost invariably introduced into the uterus during media insufflation for hysteroscopy, creating a bubble under pressure. The air enters tissues either through lining microruptures or during the biopsy procedure. Pseudolipomatosis is a relatively common, easily overlooked finding in hysteroscopically derived specimens that may be misdiagnosed when prominent.
Women with POP identified the most important FAQs related to treatment success and complications, quality of life, and understanding how the treatment works. This information will be used to develop a comprehensive decision aid for women considering treatment options for POP.
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