Electronic Technology drives innovation in Incontinence management
It seems that electronic technology is driving innovation in the world of incontinence with the announcement of another sensor technology for determining the dampness of a incontinence pad.
With a two-fold purpose of improving urinary incontinence care while standardizing data collection, Gweepi Medical Inc. is developing a wireless sensor and software system for nursing homes and other healthcare providers.
Gweepi’s disposable sensor patch is applied to a pad. When it becomes wet, the wireless sensor sends an alert to nursing staff, who can attend to the wearer immediately. We’ve already mentioned similar systems in our news section over the last 12 months but what’s interesting about the Gweepi system is that it also stamps and stores the time and severity of the episode, opening up the potential for a personalized care plan based on aggregated data.
Automating the collection and aggregation of data related to incontinence incidents could make it easier for nursing homes to gather quality metrics and help put together more tailored continence management programmes to better meet user’s needs.
Inspired by a family member who had a diaper alert system for a child, Shivaprakash saw the opportunity in the senior care market and joined up with former classmate Matt Racki, a software engineer, to form Gweepi. They now have a functional prototype and are working on refining their business model.
Shivaprakash said there are multiple avenues the company could take for marketing the product but for a start, the company has a commitment from an East Coast nursing home to pilot the system there and will be actively looking for funding in the near future.
Gestational diabetes raises risk of long-term urinary incontinence
Women with gestational diabetes mellitus (GDM) are at increased risk of postpartum urinary incontinence, including stress, urge, and mixed type, according to Taiwanese investigators. And the problems may persist for at least two years after delivery, a finding that goes against the common belief that genitourinary problems subside soon after delivery.
The study also found that quality of life is often compromised in these women, Dr Chi-Mu Chuang from Taipei Veterans General Hospital and National Yang-Ming University said.
“Women with GDM should be provided with timely consultation and support once urinary incontinence occurs,” Dr Chuang and colleagues advise in a report online in the British obstetrics journal BJOG.
The impact of GDM on postpartum urinary incontinence was studied in 6,653 pregnant women who delivered a single term infant between 2002 and 2007 at a single hospital in Taiwan. A total of 580 of the women had GDM.
At six weeks postpartum, the percentage of women with urinary incontinence was higher in the GDM group than the non-GDM group: stress urinary incontinence, 11.9% vs 5.6%; urge urinary incontinence, 4.4% vs 1.6%; mixed urinary incontinence, 2.7% vs 0.3%.
After adjusting for multiple confounding factors, GDM was a significant independent risk factor for all types of urinary incontinence, with odds ratios of 1.97 for stress urinary incontinence, 3.11 for urge incontinence and 2.73 for the mixed type.
The authors say, “Compared with women without GDM, women with GDM tended to exhibit more severe symptoms of stress incontinence for up to two years postpartum, whereas for urge or mixed incontinence, more severe symptoms were found only at six months postpartum.”
Quality of life was “generally poorer” among women with GDM, the researchers say. In particular, based on the Incontinence Impact Questionnaire 7, women with GDM who required insulin had a higher likelihood of functional impairment than women with GDM who required conservative treatment only or women without GDM (p<0.05, by the chi-square test for trend).
In their paper, Dr Chuang and colleagues say the “epidemiological value” of the study lies in the establishment of a positive relationship between GDM and urinary incontinence, “in addition to the established positive relationships between diabetes mellitus and urinary incontinence, and between gestation/delivery and urinary incontinence.”
“This finding,” they say, “suggests that diabetes and gestation/delivery may have additive or synergistic effects on postpartum urinary incontinence. However, the underlying biological pathway was not investigated in the current research, and merits further in-depth study.”
A few quick statistics about Incontinence
Urinary incontinence is very a common condition that millions of women silently struggle with. Treatment is available, though most women never talk about their incontinence with their doctor or healthcare professional.
Moderate to severe incontinence, weekly or daily urinary leaking, increases with age but can occur anytime in life. While only 7 percent of women ages 20 to 39 have urinary incontinence, about 17 percent of women ages 40 to 59 and 23 percent of women ages 60 to 79 experience urinary incontinence. The prevalence increases to more than 30 percent in women older than 80.
Only about 50 percent of women with these treatable conditions ever discuss it with their healthcare professional, starting the discussion is the first best step.
Robotic prostatectomy cuts incontinence risk
Robot-assisted radical prostatectomy appears to provide better functional results for incontinence and potency, according to the authors of a study from Turin, Italy.
First author Francesco Porpiglia, MD, of San Luigi Gonzaga Hospital-Orbassano (Turin), University of Turin, and colleagues studied 120 patients with organ-confined prostate cancer who were randomly assigned to one of two groups of 60 men based on surgical approach: robot-assisted radical prostatectomy or laparoscopic radical prostatectomy. All interventions were performed with the same technique by the same single surgeon.
Demographic, perioperative, and pathologic results were recorded and compared. Continence was evaluated at the time of catheter removal and 48 hours later, and continence and potency were evaluated after 1, 3, 6, and 12 months.
No differences were recorded in terms of perioperative and pathologic results, complication rate, or PSA measurements. The continence rate was higher in the robotic prostatectomy group at every time point: continence after 3 months was 80% in the robotic surgery group and 61.6% in the laparoscopic surgery group (p=.044), and after 1 year, the continence rates were 95.0% and 83.3%, respectively (p=.042), as reported online in European Urology (July 20, 2012).
Among patients who were potent preoperatively and treated with nerve-sparing techniques, the rate of erection recovery was 80% and 54.2%, respectively (p=.020).
Two simple ways to tackle incontinence
There is no reason why anyone should have to feel embarrassed about incontinence, but it continues to be a common chronic health condition that diminishes quality of life.
Many women experience urinary incontinence for the first time during or after pregnancy. The physical changes of pregnancy, along with the stresses put on the pelvic floor, can cause urine leakage with exertion, coughing or sneezing. For many women, this problem resolves within several months postpartum. However, without treatment, some women may continue to have a chronic incontinence issues for life.
There are two main types of urinary incontinence, listed below. Some women develop a mix of the two.
Causes:
-A weak pelvic floor.
-Urethral sphincter dysfunction.
Women who have stress incontinence experience urine leakage when pressure is put on the bladder during laughing, coughing, sneezing, or with exercise.
Causes:
-Pregnancy or pelvic surgery such as C-section.
-Injury to pelvic area.
-Diseases such as diabetes, stroke, MS or other neurological conditions.
This condition is more commonly called ”overactive bladder.” Urge incontinence occurs when there is nerve dysfunction that causes bladder contractions outside of normal urination. Women with urge incontinence find that they have episodes where they experience an extremely strong and immediate need to urinate. The bladder contractions can make it difficult to make it to a bathroom.
Treatment
The first line of treatment is to strengthen the pelvic floor to help provide greater support and control. The pelvic floor muscles play an important role throughout a woman’s life in maintaining proper alignment of the spine and support and function of the pelvic organs. The muscles of the pelvic floor span from the pubic bone to tailbone, forming a figure eight around the urethra, vagina and anus. Weak pelvic muscles result in sagging and loss of support of the pelvic organs, and can lead to incontinence problems if not corrected.
Pelvic floor exercises (sometimes called “Kegel” exercises) are a great way to strengthen these muscles and are simple to perform, but require that you first identify how to correctly contract the pelvic floor muscles. One method for locating the pelvic floor muscles is to note the area that contracts when you stop urinating. The muscles responsible for stopping urine flow are the pelvic floor muscles. You can use the urine stop-and-start test when initially learning how to locate and isolate the muscle group.
Pelvic Floor Exercises
Two or three times a day, do 5-10 repetitions of each exercise listed below. Build up to two times a day of 25-50 repetitions of each exercise. If your pelvic floor muscles fatigue quickly, do fewer repetitions each time, but increase the frequency throughout the day.
Quick Flicks:
Contract your pelvic floor muscles quickly and release.
Elevator:
Slowly contract your pelvic floor muscles (think of lifting up like an elevator moving up floors), progressively increasing your contraction, and then slowly releasing back down. You can increase the effectiveness of this exercise by holding for five seconds at the top of the contraction.
Your abdomen, buttocks, and thighs should not be tensed when doing these exercises. Lie, sit, or stand with your legs slightly apart so you can isolate the correct area. No one will be able to tell that you are doing these exercises, so you can do them anywhere. It’s helpful to give yourself a ”cue” to do your exercises; for example, try to remind yourself to do them while brushing your teeth or driving to work. You should contract your pelvic floor muscles each time you lift something, laugh, sneeze, or cough to provide support and prevent further weakening.
Increasing pelvic floor strength is helpful for reducing stress incontinence, and the exercises can be part of the treatment for those with ”overactive bladder” or urge incontinence issues.
In addition, those with urge incontinence can improve the condition with the following bladder-retraining program:
1. When you feel a strong bladder urge, stop and stand (or preferably sit) very still.
2. Squeeze your pelvic floor muscles 5-6 times to prevent leaking.
3. Relax by taking a deep breath and exhaling several times until the urge reduces.
4. Slowly walk to the bathroom. If the urge suddenly becomes strong again, go back through the steps to regain control and retrain your bladder response.
Additional treatments can range from biofeedback and behavior interventions to medications and surgery. The key for effectively treating an incontinence problem is proper diagnosis and follow-up with a healthcare provider who is trained to treat this condition.
Remember, if you suffer from incontinence, you are not alone! It is an easily solvable and common problem that you don’t need to feel ashamed of.
Survey shows benefit of Pelvic Floor Exercises for Urinary Incontinence
A July 2012 review by the American based Agency for Healthcare Research and Quality (AHRQ) should give you more reason to start pelvic floor (otherwise known as kegel) exercises.
According to the review, about 25% of young women and 44% to 57% of middle-aged and postmenopausal women experience involuntary urine loss. Their findings show that age, pregnancy, childbirth, menopause, hysterectomy, and obesity put women at a higher risk of suffering from urinary incontinence. Fortunately, there are several forms of treatment for women suffering from urinary incontinence.
An independent team of investigators analysed 889 studies and prepared a comparative effectiveness review. The AHRQ review compared different treatments for urinary incontinence that included doing pelvic floor muscle (Kegel) exercises, bladder training; using medical devices, weight loss, medications and electrical stimulation, among others.
They found that “pelvic floor muscle training, combined with bladder training is effective for treating women with urinary incontinence without the risk of side effects. The drugs for urgency incontinence showed similar effectiveness. However, with some drugs, more women discontinued treatment due to bothersome side effects.”
Drug reduces urge incontinence in Overactive Bladder trial patients
Fesoterodine fumarate (Toviaz) appears to reduce urge incontinence in patients with overactive bladder who had a suboptimal response to tolterodine tartrate extended release (Detrol LA), according to a phase IV study.
The 14-week randomized, placebo-controlled, double-blind multicenter study assessed fesoterodine, 8 mg, in patients with OAB who had been taking tolterodine, 4 mg, for 2 weeks and had less than 50% reduction in urge urinary incontinence episodes. After open-label treatment with tolterodine, 4 mg, treatment with fesoterodine, 4 mg, was started for 1 week, followed by treatment with fesoterodine, 8 mg.
The study results demonstrated that fesoterodine, 4 mg, for 1 week followed by fesoterodine, 8 mg, statistically significantly reduced the average number of urge urinary incontinence episodes (-2.37 episodes from baseline) per 24 hours (p<.0001) in OAB patients who had a suboptimal response to tolterodine, 4 mg. The safety and tolerability profiles of fesoterodine and tolterodine were consistent with previous studies. The most common treatment-emergent adverse events for both fesoterodine and tolterodine were dry mouth and constipation.
“This study adds to the body of evidence supporting fesoterodine as an effective treatment for patients with overactive bladder, including patients who may not have responded to tolterodine,” said principal investigator Steven A. Kaplan, MD, of New York-Presbyterian Hospital/Weill Cornell Medical Center, New York. “Health care professionals often question how to treat patients who have had a suboptimal response to tolterodine, which is commonly used but does not have a dose higher than 4 mg, and these data may help to guide treatment decisions.”
Drug treatments for urge incontinence are used alongside bladder re-training.
NICE calls for regular assessments of neurology patients with urinary problems
People who have neurological conditions and also experience symptoms of lower urinary tract dysfunction should be offered detailed assessments, NICE has said.
The health body has issued the clinical guidance in a bid to minimise the distressing effects caused by incontinence and other urinary problems on those with conditions such as stroke, multiple sclerosis, and head or spinal cord injuries.
Under the guidance, healthcare professionals across England and Wales are advised to undertake thorough assessments of such patients, including obtaining information about their urinary tract and neurological symptoms, other health problems such as bowel or sexual problems, and their use of medication and therapies.
Factors such as mobility, hand function, cognitive function, social support and lifestyle should also be assessed, with the information gained used to inform the management of each patient’s urinary problem.
NICE says that these assessments should happen at least every three years, although individual circumstances – such as a patient’s age, diagnosis and type of management – may mean they need to be undertaken more frequently.
NICE’s director of the centre for clinical practice, Professor Mark Baker, said: “Incontinence is common in people who have conditions caused by damage to their brain, spinal cord or other parts of their nervous system. It can be particularly problematic when there is an underlying neurological condition because these people may have mobility, hand function and sight impairments and so may need extra support to manage the effects.”
He added: “Incontinence can have a huge impact on a person’s daily activities, and can increase demand on carers, such as partners and family members.”
Technology trial improves Incontinence management in Care Home
Technology is becoming increasingly common in homecare to enable people to live independently but it is still very much a rarity in care homes, yet monitoring people through technology can enable people in care homes to be more independent, keep them safe and allow staff to give more individualised care.
St Cecilia’s Care Home in Scarborough was one of the first care homes in the UK to install monitoring equipment to check for incontinence and falls.
St Cecilia’s, in partnership with North Yorkshire County Council, introduced a range of monitoring equipment in June 2009, this included 18 enuresis sensors, a chair occupancy sensor, two falls detectors, three door exit sensors and a nursecall overlay.
The home cares for people suffering from mild to severe cases of dementia and the equipment gives quick and timely alerts to incontinence and residents out of bed or outdoors.
In recognition of its pioneering work, the care home has just been shortlisted for an Innovation Nation award and was recently visited by the Department of Health.
“We were approached by North Yorkshire County Council to trial the equipment and we thought it would help to give people with dementia more independence and choice,” says Mike Padgham, owner of the home.
He has found it has helped the home give the residents better care. “Each resident has an assessment so we can determine what equipment they need. We can monitor if they have a fall or if they go out of their bedroom and there are urinary sensors so we don’t need to keep checking if they need changing. Previously staff would have had to make regular ‘just in case’ checks on people suffering incontinence, which was intrusive for the residents.
“It has also given them more independence as they can go outside when they want to now as, if they fall in the garden out of sight, the sensor which can be worn as a wrist watch will go off. It allows them to be safe and also be independent. Their relatives are very pleased with it. Initially staff were worried that we were going to reduce staff levels or use the technology to watch them but it has given them more time to spend on one to one care. It has even enabled us to accept residents with higher care needs,” he says.
The equipment was trialled from June 2009 to August 2010 at St Cecilia’s care home and its success means it is still being used every day in the home.
Simple steps to improve continence levels within Care Home settings
1. Establish a culture that promotes continence, rather than just checking and changing incontinence products. This includes establishing teams of incontinence specialists, setting incident-reduction goals, raising awareness of a plan, periodically ensuring guideline compliance, benchmarking and establishing a staff competency program.
2. Develop a formal bowel and bladder programme. One of the best ways to decrease the incidence of incontinence in long-term care residents is having a clear bowel and bladder program that is in compliance with current clinical guidelines (e.g. NICE). Often suppliers of incontinence pads can supply such a programme.
3. Promote continence with broad staff education and training. Low incontinence incidents and positive survey results may lull many providers into a false sense of security, sometimes surveyors may overlook how the home is promoting continence and you might continue the same process that has contributed to higher incidents of falls, nosocomial infection or depression. Proper staff education and support on perineal care is essential to help eliminate skin breakdown or redness before it can occur as well.
4. Properly assess and identify vulnerable areas. Proper assessments include identifying the type of incontinence, and often the cause. The assessment should lead to the proper care plan and also the type of incontinence product and care that will best support the highest possible level of continence for each individual. A structured program can help identify and treat some very simple underlying causes of incontinence, such as medications, poor dexterity or mobility, anatomical defects or lack of appropriate staff.
5. Keep your eyes and ears open. It might seem simplistic, but many homes link cost with effectiveness when often a more expensive treatment or product will be more effective and reduce overall costs through such areas as reduced treatment of skincare issues or laundry bills. There are undoubtedly many treatments available for incontinence, but the best treatment is simply to pay vigilance and attention to each individual clients situation.
6. Be mindful of the total cost of incontinence. Incontinence pads represent only a fraction of care costs. Consider other metrics such as change rates, cost of laundry, nursing time, medications or ointments, falls and cost of skin injuries.
7. Understand that it’s more than just a physical problem. Preserving the dignity of the resident is paramount. Staff can help residents emotionally by making them feel confident, and by providing quality support products that reduce the incidence of embarrassing leakage.
8. Provide easily identifiable products. Make it as easy as possible for staff to identify the proper supplies, including undergarments and topical treatments, e.g. through using products where the packaging means that names can be read from across the room and also colour-coded packs and products. Staff can are often be overworked, so different products can be quickly identified can help when staff are busy.
Some Mistakes to avoid are:
- Using outdated continence management policies or guidelines.
- Assuming a good survey and few incontinence incidents mean you are managing the problem well.
- Skipping an initial assessment of vulnerable areas of the body.