Quality-of-Life Measures Physicians caring for incontinent women should ask them about the way the incontinence specifically affects their lives and to what degree the incontinence bothers them. There often is discord between the objective symptom severity and subjective bother. Only by understanding each woman’s situation can treatment be appropriately planned and response evaluated. Some women may be completely satisfied if they are able to sit through a movie without running to the bathroom, even if they leak urine at other times. Others may be satisfied only if they are 100% dry. Given that the latter is likely an unrealistic goal, knowing that the patient feels this way gives the provider the opportunity to educate her about the likely outcome of treatment.
Physicians may use one of several well-designed, validated quality-of-life measures. An expert summary of the literature in this area conducted for the International Consultation on Incontinence recommended the instruments summarized in Table 26.4. These instruments were found to be valid, reliable, and responsive to change following standard psychometric testing.
Table 26.3 Medications that May Affect the Urinary Tract 1.
Sedatives such as the benzodiazepines may cause confusion and secondary incontinence, particularly for elderly patients.
2.
Alcohol may have similar effects to benzodiazepines and also impairs mobility and causes diuresis.
3.
Anticholinergic drugs may impair detrusor contractility and may lead to voiding difficulty and overﬂow incontinence. Drugs with anticholinergic properties are widespread and include antihistamines, antidepressants, antipsychotics, opiates, antispasmodics, and drugs used to treat Parkinson’s disease.
4.
α-Agonists, which are often found in over-the-counter cold remedies, increase outlet resistance and may lead to voiding difficulty.
5.
α-Blockers, sometimes used to treat hypertension (e.g., prazosin, terazosin), may decrease urethral closure pressure and lead to stress incontinence.
6.
Calcium-channel blockers may reduce bladder smooth muscle contractility and lead to voiding problems or incontinence; they may also cause peripheral edema, which may lead to nocturia or nighttime urine loss.
7.
Angiotensin-converting enzyme inhibitors may result in a chronic and bothersome cough that can result in increasing stress urinary incontinence in an otherwise asymptomatic patient.
Table 26.4 Questionnaires to Assess Urinary Incontinence
The following questionnaires have been recommended by the International Consultation on Incontinence to assess symptoms of incontinence and impact of incontinence on quality of life in women.a
Urogenital Distress Inventory.
Shumaker SA, Wyman JF, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Qual Life Res 1994;3:291–306.
Urogenital Distress Inventory (UDI)-6 (short form).
Uebersax JS, Wyman JF, Shumaker SA, et al. Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Neurourol Urodyn 1995;14:131–139.
Urge-UDI.
Lubeck DP, Prebil LA, Peebles P, et al. A health related quality of life measure for use in patient with urge urinary incontinence: a validation study. Qual Life Res 1999;1999: 337–344.
King’s Health Questionnaire.
Kelleher CJ, Cardozo LD, Khullar V, et al. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 1997;104:1374–1379.
Incontinence Severity Index.