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Purpose. To describe the prevalence and impact of bladder and bowel dysfunction on quality of life (QoL) in persons with multiple sclerosis (pwMS) in an Australian community cohort and to explore the relationships between commonly used continence measures. Methods. Patients (N = 73) recruited from a tertiary hospital database, interviewed using standardised measures, based on the framework of International Classification of Functioning, Disability and Health. Results. Of 73 participants (mean age 50 yrs, 73% female, 56% progressive MS), two thirds were bothered by urinary frequency whereas half reported urinary incontinence, and 14% bowel incontinence. Urinary problems impacted emotional health (31%), ability to perform household chores (22%) and physical recreation (28%), with detrimental impact on QoL. There was a significant relationship between symptoms, level of urogenital distress (rho = 0.74, p < 0.001) and impact of incontinence (rho = 0.68, p < 0.001). The single item of Urological Association Symptom Index assessing impact of bladder symptoms on QoL correlated significantly with all other bladder scales (rho = 0.60-0.74), making it a potential 'screening tool' to identify patients for further assessment. Conclusion. Continence issues cause significant disability in pwMS. Improved awareness of currently available treatment options and clinically robust trials are needed to assess outcomes of continence intervention. [ABSTRACT FROM AUTHOR]

The ICS defines nocturia as the complaint of waking from sleep at night one or more times to void. Few regard getting up once as significant. Most who complain of nocturia being bothersome get up at least three times a night. As with urinary incontinence, nocturia increases progressively with age, affecting more than 90% in those aged more than 80 years. As a common symptom in many conditions, it is encountered in patients presenting to a variety of health specialties and disciplines. Common disease associations include hypertension, congestive cardiac failure, cerebrovascular disease and metabolic and mental health disorders. It is associated with impaired quality of life, daytime fatigue and, in the frail elderly, an increased risk of falls, fracture and mortality. It should be regarded as a marker for comorbid poor health. Pathophysiology is usually multi-factorial, relating to one, or a combination of primary underlying disorders: polyuric states, reduced functional bladder capacity and sleep disorders. The most fundamental tool in assessing aetiology is the urinary diary which accurately documents voided volumes. Polyuria may be global, due to diabetes mellitus and other osmotic diuretic states such as hypercalcaemia. However, increasingly recognised is the entity of nocturnal polyuria, a nocturnal urine volume while in bed for the purpose of sleeping of at least one-third of total daily urine produced. Contributory factors may include age-related physiological hormonal changes, peripheral oedema, night-time fluid, alcohol and caffeine intake, obstructive sleep apnoea (OSA) and postural hypotension. Management strategies, not necessarily all with good evidence, may include: lifestyle changes, below-knee compression stockings, treatment of medical causes of peripheral oedema, afternoon/evening leg elevation, continuous positive airway pressure for OSA, and in carefully selected cases, use of arginine vasopressin. Reduced functional bladder capacity is usually due to an overactive bladder, with prostatic obstruction in men especially common. Management should focus on these disorders, but will include lifestyle changes, bladder training and other behavioural strategies, pharmacotherapy and perhaps surgery for prostatic obstruction. Nocturnal polyuria may be due to OSA because of associated blood pressure changes. Other primary sleep disorders due, for example, to affective states, chronic pain and restless legs syndrome, may result in nocturia due to patient misperception as to the reason for waking. Management should target the cause of the sleep disturbance. To date there has been no symptom-specific clinical algorithm for all-cause diagnosis for nocturia. A patient-completed screening tool to identify non-LUTS causes of nocturia (TANGO-SF) has been developed, and will be presented. [ABSTRACT FROM AUTHOR]

Background: Patients may not raise nocturia as a concern as they mistakenly consider the symptom to be a normal part of ageing. Nocturia is associated with significant morbidity and is likely to be a marker of poor health., Objective: This paper provides questions to guide diagnosis, evaluation and individualised treatment of nocturia., Discussion: Nocturia results from the interplay between nocturnal polyuria, reduced bladder storage and sleep disruption. Changes in the function of the urinary bladder, kidneys, brain and cardiovascular system, and hormone status underlie the development and progression of nocturia. Medications commonly prescribed to older people can affect development or resolution of nocturia. The bother caused to a patient by waking to void relates to disturbance of slow-wave sleep, the physical act of getting out of bed and resulting chronic fatigue. An assessment process that identifies relevant and co-existing causes of an individual's nocturia will facilitate a targeted approach to treatment.

Background and Purpose: Urinary dysfunction is associated with significant morbidity in persons with Guillain-Barré Syndrome (GBS). The aim of this study was to describe prevalence and long-term impact of bladder dysfunction on daily activities and quality of life (QoL) in persons in chronic phase of GBS and to examine the relationships between commonly used continence measures in this cohort., Methods: Prospective cohort (n=66) following GBS treatment (1996-2009) was recruited from a tertiary hospital and assessed using standardised measures for bladder dysfunction: American Urological Association (AUA) Symptom Index, Incontinence Impact Questionnaire, Urogenital Distress Inventory., Results: Sixty-six participants (64% male, mean age 56 years, median disease duration of 6.1 years) completed the study. Of these more than half reported nocturia and one-third reported urinary urgency and frequency. Urinary problems impacted on participants' daily activities: physical recreation (21%), emotional health and mood (17%), entertainment (14%), participation and mobility (>30 min) (12%), and performance of household chores (8%). Since GBS, 49% reported interference of urinary symptoms with daily life to some extent; and adverse impact on QoL (10.6%). Significant relationship between bladder symptoms; and the level of urogenital distress (p<0.001) and the impact of urinary problems (p<0.001), was noted. Higher scores on the bladder scales showed significant correlations with psychological, functional and participation scales. The single QoL item (AUA scale) correlated significantly with all other bladder scales (rho=0.63-0.86). This can be a potential 'screening tool' to identify patients for further assessment., Conclusions: Bladder dysfunction in chronic phase of GBS is not well studied. More research in longer-term screening and outcomes for bladder intervention are needed for integrated care and to guide treating clinicians.

Background: As people age, urinary incontinence becomes more common. It is socially isolating and is often a factor in the move to residential care., Objective: This article highlights the causes of incontinence in the elderly., Discussion: With careful assessment, many elderly people can be cured, and the majority significantly helped. The implications of this for social and psychological health and the impact on the health and welfare dollar are considerable.

Background: As people age urinary incontinence is increasingly prevalent, socially isolating and is often a factor in the move to residential care., Objective: To highlight the options in management., Discussion: With careful assessment many elderly can be cured, and the majority significantly helped. The implications for social and psychological health and the impact on the health and welfare dollar are considerable.

Urinary incontinence in the elderly is common. Up to 10 per cent of men and 15 per cent of women over 65 are incontinent. This rises to 30 per cent in acute care hospitals and 50 per cent in nursing homes. In many it is the cause of institutionalisation. It continues to be an 'iceberg' condition, with as few as 20 per cent of sufferers being known to health care professionals.