Urinary Incontinence

Multiple tools have been evaluated and validated for the assessment of urinary incontinence impact on QOL. Among all of the aspects of pelvic floor dysfunction, this has been the most widely assessed, using QOL assessment tools. We have therefore chosen to utilize the most commonly accepted QOL questionnaires, which have been utilized in clinical practice as well as research. The short-form Incontinence Impact Questionnaire (IIQ-7) has been extensively evaluated, validated, and is well accepted.1 Its questions include various aspects (domains) of QOL impact, including physical activities, social activities, travel, and emotional health. It is easy to complete, and the questions are readily understandable by most patients (Figure 14-3.1).

Because many patients' QOL impact from their incontinence is primarily related to one particular activity, we modified the IIQ by adding a question in which the patient identifies the particular activity that is most impacted by her urinary incontinence. This Individual IIQ (IIIQ) (Figure 14-3.2) has been particularly useful in younger women with stress incontinence who may be impacted during specific physical activities such as running, working out, or playing on the trampoline with their children, to name a few examples.2 For overactive bladder patients, examples of frequently identified activities include going to the theater, airplane travel, and going to social events. It is very important to evaluate treatment outcome by including the same activity that the patient identified during her initial evaluation in the outcome assessments.

We also utilize the short form of a well-evaluated symptom inventory, the Urogenital Distress Inventory (UDI-6) in assessing women with urinary incontinence, as well as genital prolapse (Figure 14-3.3). The short form has also been widely studied and validated. Included subscales are irritative, obstructive/discomfort, and stress symptoms. Its questions are clear and well understood by most patients. It has been used clinically as well as in research, and complements the IIQ-7 well. We have thus adopted it in the evaluation of our patients.

FORM B:

INCONTINENCE IMPACT QUESTIONNAIRE

INSTRUCTIONS

You have cert Jill artivitira you <io incanyuiRonyour life Wore interested in leaminR nnKjT effort, if any, urinary incontinence and/or prolapse bus bad on these artivitk-t The questions beSou refrr to yuuj/t in which your activities might have cliangcd. For each (ju est ion, mark (X) the respotwe that indicates to what extent activities han't»™ affected b>' urine leakagc and/or prolapse.

MR»

0

0

0

0

0

Patient Name:

.

Has urine leakage and/ur prolapse affected > our

i, Ability to physically do the following household chores: rooking. cleaning, laundry?

not at all

□ rarely

frequently

all of the time

not applicable

1. Ability to participate in physical recreation-walking. swimming, other?

not at all

□ rarely

frequent!)

all of the time

not applicable

3. Ability lo travel to entertainment activities: movies, concerts, etc.?

not at all

□ ranrly

frequently

all of the time

not applicable

4. Ability to travel liyrar or bus more than 30 minutes from home?

riot at all

□ rarety

frequently

all of the time

not applicable

5 Participation in wcia)/relationship activities outside of the home?

not at oil

□ rarely

frequently

all of the time

not applicable

6. Emotional health?

not at all

□ rarely

frequently

all of the time

not applicable

7. Feding frustrated?

rot at all

□ rarely

frequently

44470 1■ ~ ■ 1 __

COSFWEATIAI.

SS?i ■

Figure 14-3.1. Short-form Incontinence Impact Questionnaire (IIQ-7).

IlKj FORM C: INDIVIDUAL

INCONTINENCE IMPACT QUESTIONNAIRE

MR#

0

0

01 0

0

h'urc.ioh question, rn.uk (X) the n*s]>oiise that indkales the citrnt to which your bladder control problem affects j-our artiNilws.

My hUdder control problem affects my;

i. Ability to do household chores (washing dishes, ctcaning house, ctc.)

not al all

□ raraiy

frequently

al] of the lime

not applicable

2, Ability to mjcialize and interact with friend* and colleagues

not at all

□ rarely

frequently

all of the time

not applicable

3. Quality and quantity of sleep

not at 41)!

□ rarefy

frequently

all of the time

not applicable

4 Performance of routine exercise or participation in sports (walking, aerobics, tennis, swimming, jogging, etc.)

not at all

rarely

frrqucntly

all of the time

not applicable

5. Personal and intimate relationships (including hugging and sexual intercourse)

not at all

rarely

frequently

all of lïhc lime

not applicable

6, Ability to participate in entertainment activities (sitting through the movies, pla>ing cards. walcWng T.V. program)

not at all

□ rarely

frequently

all of the time

not applicable

7. Ability to perform my jnt>

not at al]

□ rarely

frequently

all of the time

not applicable

8, Ability to war the clothes I want

not at all

□ rarely

frequently

all of the time

not applicable

9, Ability to go places 1 want

not at all

frequently

all (rf (he time

not applicable

10. Liit an activity (not listed above) which is particularly affected by your urine loss:

not at all

rarely

frequently

all of the time

not applicable

III I 1 1 1 1 1

1 1 1

1

■ Mease en fee one teffer per space

Figure 14-3.2. Individual Incontinence Impact Questionnaire (IIIQ).

Figure 14-3.3. Short-form Urogenital Distress Inventory (UDI-6).

FORM A:

UROGENITAL DISTRESS INVENTORY

instructions

You may ha« certain symptoms lhal indicate the type of urinary incontinence s ou arc experiencing. The questions below refer to in which m may learn about your incontinence, For each question, mark (X) the response that indicates your symptoms.

instructions

You may ha« certain symptoms lhal indicate the type of urinary incontinence s ou arc experiencing. The questions below refer to in which m may learn about your incontinence, For each question, mark (X) the response that indicates your symptoms.

MR-J o J o 1 o ; o 1 o 1

Visit Datei 1 M 1 \!

20

Dateof Birth] 1 11

1

1

9

!

Patient Name:

l)o you experience, ami, if

io, how much

aw you bothered by:

l. Frequent urination?

not at all

□ rarely

frequently

alt of the time

not applicable

2. Urine leakage related to the feeling of urgency?

not at all

□ rarely

frequently

.ill of the time

not applicable

3. Urine leakage related to physical activity, coughing, or sneezing?

not .it all

□ rarely

frequent])'

all of the time

not applicable

4, Small amounts (drops) of urine leakage?

not at all

□ rarely

frequently

all of the time

not applicable

5. Difficulty emptying your bladder?

not at all

□ rarely

frequently

all of the time

not applicable

6. Pain or discomfort in the lower abdominal or genital area?

not at ¡il)

□ rarely

frequently

all of the time

not applicable

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