Pelvic Floor Biofeedback for the Treatment of Urinary Incontinence and Fecal Incontinence

Pelvic floor muscle dysfunction and symptoms of incontinence may affect any gender and age. Incontinence is embarrassing and socially limiting for patients and is not the result of normal aging. This health issue can successfully be treated with surface electromyography (sEMG) biofeedback when this modality is used by a knowledgeable and skilled provider. In combination with sEMG, behavioral intervention regarding fluid intake, normalized toileting patterns, and education on muscle function empower patients to overcome their symptoms. This article describes two patient cases, one with stress incontinence and fecal incontinence, the other with urge incontinence.

The Effect of OnabotulinumtoxinA on the Symptoms and Quality of Life in Women with Urge Urinary Incontinence

Objectives: To determine the effect of OnabotulinumtoxinA intradetrusor injection on quality of life (QOL) and symptoms of women with urge urinary incontinence. Methods: Twenty five postmenopausal patients with urge urinary incontinence, underwent cystoscopy and 200 U OnabotulinumtoxinA intradetrusor injections (0.5 cc at each injection). The effects of botox have been evaluated on urge urinary incontinence and quality of life. Results: The mean urge urinary incontinence per day was 7.25 which decreased to 2.87 (month 1) and 3.12 (month 6); P value = 0.019. The mean of nocturnal episodes was 3 which decreased to 0 and 1in the first and sixth months, respectively (P = 0.007). Baseline mean I-QOL total score was 43.37 which reached 82.12 (month 1) and 78.87 (month 6); P < 0.001. Conclusions: OnabotulinumtoxinA significantly decreased urinary urge incontinence and nocturia at month 1 and 6. The quality of life of patients has improved.

Female urge Incontinence is Associated with Somatosensory Amplification, Health Anxiety and Depression

Purpose: Incontinence is a condition that can cause significant problems that can affect patients’ quality of social, emotional, psychological and sexual life. The aim of this study was to evaluate the level of anxiety, health anxiety, depression, and somatosensory amplification in patients with urge incontinence. Materials and Methods: The study group consisted of 58 patients that met the inclusion criteria. The control group consisted of 67 volunteer participants that did not have physical or psychiatric illness and incontinence complaints. All participants filled out sociodemographic data form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatosensory Amplification Scale (SSAS), and Health Anxiety Inventory (HAI). Results: The mean duration of incontinence in patients with urge incontinence was 16.55 ± 10.03 months. The mean age in urge incontinence group and the control group were 40.98 ± 9.58 and 39.1 ± 7.89 years, respectively. The mean values of SSAS, HAI, and BAI scores in the incontinence group were significantly higher than the control group (p <0.001), but there was no significant difference between the groups in terms of BDI scores. The linear regression analysis indicated that HAI and BAI significantly affected SSAS (p = 0.025 and 0.019, respectively). Conclusions: Anxiety, health anxiety and somatosensory amplification are more common in patients who report urge incontinence. For these reasons, we believe that psychiatric evaluation should be included in the diagnosis and treatment process of patients presenting with urgency and incontinence symptoms. Keywords: Incontinance, Somatosensory Amplification, Beck Depression Inventory, Beck Anxiety Inventory, Urgency.

Diagnostic Potential of Low Serum Platelet, Albumin and Prolong PT-INR for Overactive Bladder and Nocturia in Chronic Hepatitis-Related Liver Cirrhosis

Overactive bladder (OAB) is defined as urgency, usually with frequency, nocturia, and incontinence. Patients with liver cirrhosis often present with urinary complaints. The possible reason for this is fluid redistribution, which may induce OAB resulting from portal hypertension and ascites. We conducted this study to investigate predictors of OAB in cirrhotic patients. A total of 164 patients with chronic viral hepatitis-related liver cirrhosis were enrolled and 158 (96.3%) completed the Overactive Bladder Symptoms Score (OABSS) questionnaire. Age, severity of liver cirrhosis, comorbidities, serum sodium level, use of diuretics, body mass index and renal function were also recorded. In the study cohort, the prevalence of OAB was 31.01% and the prevalence of urge incontinence (OAB wet) was 18.3%. Patients with an urgency score ≥2 in OABSS had a significantly lower platelet level (p = 0.025) regardless of the use of diuretics. In addition, 98 patients (62%) with nocturia and 29 patients (18%) with urge incontinence had significantly lower levels of serum albumin (p = 0.028 and 0.044, respectively). In conclusion, patients with liver cirrhosis have a high prevalence of overactive bladder. A low platelet and low serum albumin level in these patients may be predictors for overactive bladder. And longer PT-INR is also a possible biomarker for nocturia.

CIDP PRESENTING AS MYELORADICULOPATHY

Chronic inammatory demyelinating polyradiculoneuropathy (CIDP) is a relapsing or chronic progressive disorder which is one of the causes of hypertrophic neuropathy. Enlarged nerve roots were identied in few patients. We now report a case of CIDP with highly thickened or enlarged nerve roots severe enough to cause cord compression and myelopathy. A 38 year old woman presented with weakness and sensory disturbances in lower limbs with sensory level at L1 and bladder disturbances in form of urgency and urge incontinence . MRI showed a non enhancing isointense mass lesion from L1 to S1 causing compression over conus . During surgery the cauda equina nerve roots were found to be thickened , entangled with ' bag of worms' appearance. Nerve conduction studies showed all her peripheral nerves to be inexcitable. Her CSF protein was mildly elevated. Diagnosis of CIDP with thickened nerve roots was considered and she was started on steroids and subsequently showed improvement. Thus, CIDP may present with symptoms of myeloradiculopathy due to thickened nerve roots causing cord compression.