Prevalence of urinary leakage in nulliparous women with respect to physical activity and micturition habits

Prevalence and Risk Factors for Urinary Incontinence in Nulliparous Women: A Contemporary, Population-Based Cohort Study

IMPORTANCE AND OBJECTIVES

Epidemiologic studies of incontinence largely focus on parous women, and there are limited data regarding nulliparous women. Our objectives were to evaluate risk factors for urinary incontinence among a nationally representative, contemporary sample of nulliparous women of all ages in the United States and to describe the prevalence and subtypes of urinary incontinence and nocturia in this population.

STUDY DESIGN

This cross-sectional, population-based study used the National Health and Nutrition Examination Survey cycles 2011-2018 to assemble a sample of nulliparous women 20-80 years old. Crude and adjusted odds ratios were estimated using multivariable logistic regression for the exposures of interest: body mass index (BMI), age, physical activity, prior hysterectomy, and current smoking. Prevalence of urinary incontinence and nocturia were estimated.

RESULTS

Among 1,603 nulliparous women, prevalence of any urinary incontinence was 29.38%. Prevalence of stress, urgency, and mixed urinary incontinence and nocturia, respectively, were 27.68%, 19.64%, 10.57%, and 58.95%. Women with a BMI ≥25 (calculated as weight in kilograms divided by height in meters squared; adjusted odds ratio [aOR], 1.57; 95% confidence interval [CI], 1.11-2.23), at least 45 years (aOR, 3.75; 95% CI, 2.31-5.83), and current smoking (aOR, 1.63; 95% CI, 1.07-2.49) had increased the odds of incontinence compared with women without these risk factors. When stress urinary incontinence (SUI) was considered alone, only women with a BMI ≥25 (aOR, 1.66; 95% CI, 1.20-2.31) and age at least 45 years (aOR, 3.17; 95% CI, 2.01-5.00) had increased odds of SUI compared with women without these risk factors.

CONCLUSIONS

Urinary incontinence and nocturia are prevalent in nulliparous women, and age, elevated BMI, and current smoking may represent risk factors for incontinence in this population.

Analysis of pelvic floor electrical physiological parameters in nulliparous women with stress urinary incontinence

Background

To investigate the changes in pelvic floor electrical physiological parameters in nulliparous women with stress urinary incontinence (SUI).

Methods

A retrospective survey was conducted on 922 women aged 20–40 years who received health examinations at the First Affiliated Hospital of Nanjing Medical University between July 2017 and December 2019. The women were split into two groups: those who had SUI (n=87) and those that did not (n=835). Questionnaires and pelvic floor electrical physiological indexes were collected.

Results

The mean age of the group of women with SUI was 29.77 years, while the mean age of the group of women with no SUI was 24.49 years. The body mass indexes (BMI) of the women with SUI were significantly higher than those of the women with no SUI. Importantly, the normal rates of type I and II fibers in the women with SUI were obviously lower than those in the women with no SUI. Moreover, the vaginal dynamic pressure in the women with SUI was significantly lower than in the women with no SUI. The study also found that the incidence of SUI in nulliparous women was higher in those aged 30–40 and that both low-weight and obese women had an increased risk of SUI. Type I and type II muscle fibers were more abnormal in the women with SUI than in those with no SUI. In multivariate logistic regression, the ages, BMIs, and type I fiber indexes of nulliparous women were related to SUI.

Conclusions

Nulliparous women have a higher rate of SUI. Compared to women with no SUI, the possible potential risk factors are age (>30 years), higher BMI, and abnormal type I muscle fiber of the pelvic floor.

Occurrence Rates and Predictors of Lower Urinary Tract Symptoms and Incontinence in Female Athletes

Introduction and hypothesis

To assess the prevalence of lower urinary tract symptoms (LUTS) and incontinence in female athletes and to determine the etiological factors.

Methods

An anonymous self-questionnaire was collected from 623 casual female athletes aged 18 to 56 years, who were involved in 12 different sports. The surveys were distributed by hand to the athletes, during their sports fitness tests, in a sports center. We investigated the relationship between urinary disorders and factors such as age, body mass index (BMI), parity, duration of physical exercise, and type of sport.

Results

The prevalence of LUTS was 54.7%, and 30% for urinary incontinence. Changes in urinary frequency were detected in 91 (14.6%) women. Prevalence of dysuria was 13.3%, urinary straining was present in 173 (27.8%) athletes, whereas urinary urgency had an estimated prevalence of 37.2% with 232 athletes suffering from this disorder. Urgency was very common in volleyball players, as was dysuria among hockey and basketball players, whereas straining mainly affected aerobic participants and cyclists. Long training hours and competitive practices were correlated with the onset of LUTS. High-impact sports were more frequently associated with incontinence, while low-impact sports with LUTS. The sport with the main number of incontinent people was football. Urge incontinence affected a lot of athletes, mainly cyclists and football players. Stress incontinence was more frequent in hockey and volleyball players.

Conclusions

LUTS and incontinence are prevalent in female athletes. In many cases, the disorders were present only during sports activities. In this sample, the presence of urinary disorders did not seem to be a barrier during sports or exercise.

The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: A systematic review

Urinary incontinence (UI) has been defined as the complaint of involuntary loss of urine. There is a general belief that UI is experienced almost exclusively by the elderly and women who have given birth. However, epidemiological studies report that young women who are nulliparous also experience UI. The aim of this study was to systematically review studies investigating the prevalence of UI in nulliparous adolescent and middle-aged women and to provide an overview of risk factors associated with UI. The electronic databases PubMed, EMBASE, CINAHL, and Cochrane Library were systematically searched for eligible studies. Inclusion and exclusion criteria were defined a priori. The selected studies were reviewed and data extraction was carried out by the reviewers. Two independent researchers assessed the quality of the included studies. Eighteen studies were included in this systematic review. UI prevalence estimates varied from 1% to 42.2%. Among the women with UI of any type, 12.5% to 79% had stress urinary incontinence. BMI, childhood enuresis, and high-impact exercising were found to be the main associated risk factors. Understanding the effect of the risk factors on the pelvic floor will enable us to implement preventive strategies and advise appropriately on the prevention of UI.

Fluid intake and voiding; habits and health knowledge in a young, healthy population

Objectives

Health professionals commonly advise patients with incontinence and other lower urinary tract symptoms about modifiable contributing factors such as drinking and voiding habits. Poor drinking and voiding habits may begin early in life, before symptoms emerge. However, little is known about the habits and knowledge young people have regarding healthy drinking and voiding behaviors. This research aimed to assess the habits and health knowledge of young people regarding fluid intake and voiding.

Methods

A questionnaire was used to assess the drinking and voiding behaviors of first year university students and their knowledge about healthy fluid intake and voiding.

Results

The average daily fluid intake was >2 L/day for both genders. Poor drinking and voiding habits (such as high consumption of caffeinated drinks and alcohol, or nocturia) were common. Widely reported myths about the benefits of a high fluid intake were commonly believed.

Conclusion

More informed public education regarding healthy fluid intake, and drinking and voiding habits, is required as part of the effort to reduce the development of lower urinary tract symptoms, including incontinence.

Non-fistulous urinary leakage among women attending a Nigerian family planning clinic

Urinary leakage is an important gynecological challenge, which has a substantial impact on quality of life. The aim of this study was to determine the prevalence and types of non-fistulous urinary leakage among women attending the family planning clinic of the University of Ilorin teaching hospital, Ilorin, Nigeria. The study was a cross-sectional study carried out between January 3 and April 25 2009. One hundred and two women experienced urinary leakage out of 333 women interviewed, giving a prevalence rate of 30.6%. Stress incontinence was the most common urinary leakage (prevalence rate 12.0%). This is followed by urge incontinence (10.8%), urinary incontinence (4.8%), and overflow incontinence (3.0%). None of the women afflicted sought medical help. Conclusively, this study has demonstrated that non-fistulous urinary leakage is a common problem among women of reproductive age in this environment.

A questionnaire on pelvic floor dysfunction postpartum

Introduction and hypothesis

The incidence of obstetric anal sphincter injuries is used in Sweden as a measurement of quality of care and this might influence the reporting. However, the correlation between reported diagnosis of pelvic floor injury at delivery and pelvic floor symptoms a year later is unknown. A questionnaire could identify such symptoms and provide beneficial feedback to obstetrical practices.

Methods

We made a cross-sectional study by sending out a questionnaire about pelvic floor dysfunction to 599 women depending on reported injury at delivery. The answers provided by the groups were then compared.

Results

The questionnaire identified women with pelvic floor dysfunction. Anal incontinence was most common among women with obstetric anal sphincter injuries but also occurred among women delivered vaginally without known tears.

Conclusion

We suggest that a questionnaire is used 12–18 months after delivery to establish the short-time outcome in terms of pelvic floor dysfunction.

Prevalence and risk factors for urinary incontinence in healthy pregnant Brazilian women

INTRODUCTION AND HYPOTHESIS

Physiological and anatomical changes of pregnancy are risk factors for lower urinary tract symptoms (LUTS). This study aimed to evaluate the prevalence and risk factors for urinary incontinence (UI) in healthy pregnant women.

METHODS

A cross-sectional study was conducted in pregnant Brazilian women who enrolled in the primary health-care system in Sao Jose do Rio Preto, Brazil. Face-to-face interview and completion of two-part questionnaire were administered and done which evaluated the presence of LUTS pre- and during pregnancy. The data were analyzed by logistic regression.

RESULTS

Five hundred pregnant women were enrolled ranging from first to third trimester. LUTS present in 63.8% in these women; the main associated risk factors were multiparity and prepregnancy LUTS as well as smoking, constipation, and daily coffee intake.

CONCLUSIONS

The prevalence of UI during pregnancy is high, highlighting the presence of the risk factors associated with UI during pregnancy.

Physical activity and urinary incontinence among healthy, older women

OBJECTIVE

To examine the association between physical activity and risk of developing urinary incontinence (UI).

METHODS

Prospective analysis from the Nurses' Health Study of women aged 54-79 years. Physical activity was reported in 1986 and biennially afterward. To determine stable, long-term activity levels, data were averaged across all questionnaires (bottom quintile: 6.2 metabolic equivalent task hours per week or less; top quintile: more than 28.6 metabolic equivalent task hours per week). From 2000 to 2002, 2,355 cases of incident UI were identified using self-reports of leaking urine. Type of incontinence was determined from questions regarding the circumstances during which leaking occurred. We estimated adjusted odds ratios (ORs) of developing incontinence across quintiles of physical activity levels using logistic regression, controlling for numerous potential confounding factors.

RESULTS

Increasing levels of total physical activity were significantly associated with a reduced risk of UI (top versus bottom quintile of metabolic equivalent task hours per week, OR 0.81, 95% confidence interval [CI] 0.71-0.93; P for trend across quintiles <.01). Walking, which constituted approximately half of total physical activity among our participants, was related to 26% lower risk of developing UI (top versus bottom quintile, OR 0.74, 95% CI 0.63-0.88; P for trend across quintiles <.01). Specifically, total physical activity and walking were associated with a significant reduction in stress UI (physical activity: P for trend =.01; walking: P for trend =.01), but neither was related to incidence of urge UI (P for trend =.8 and P for trend =.3, respectively).

CONCLUSION

Physical activity was associated with a significant reduction in UI. Results appeared somewhat stronger for stress UI than urge UI.

LEVEL OF EVIDENCE

II.

Urinary incontinence in women with low back pain

Urinary incontinence (UI) is a common female dysfunction, affecting women in all ages. Experienced physiotherapists and experts on low back pain (LBP) have since long observed and discussed the empirical association between LBP and UI. The aim of this study was to describe the occurrence of UI in women with LBP and to compare this group with a reference group of comparable age, language, culture and parity. The authors of this study had previously collected all original data from the reference group. A validated questionnaire concerning UI was answered by 200 consecutive women with LBP visiting specialised physiotherapy clinics in the area of Stockholm. Inclusion criteria were LBP, female, not pregnant, Swedish speaking, age between 17 and 45 years. Seventy-eight percent of the women with LBP reported UI. In comparison with the reference group, the prevalence of UI and signs of dysfunctional pelvic floor muscles (PFM) were greatly increased (p < 0.001) in the LBP group. Logistic regression analysis showed that the condition LBP and PFM dysfunction i.e. inability to interrupt the urine flow (p < 0.001) were risk factors for UI irrespective of parity. Physiotherapists treating patients with LBP should be aware of possible incontinence problems in this patient group.

Should we actively screen for urinary and anal incontinence in the general gynaecology outpatients setting?--A prospective observational study

The Department of Health in the UK recommends as good practice in continence services that opportunistic screening for urinary and anal incontinence is carried out by all healthcare professionals. The aim of this study was to record the prevalence of urinary and anal incontinence in a general gynaecology clinic. In addition, to ascertain the proportion of women with incontinence who wish further help and assess the current opportunistic screening for incontinence. Overall, the prevalence of urinary incontinence is 26.8% and the prevalence of mixed (urinary and anal) incontinence is 8.4% of women attending a general gynaecology clinic. The prevalence of both types of incontinence increases with the age of the women. Although a significant proportion wished to receive help, 61.6% of women with urinary incontinence were not specifically asked about urinary incontinence and 66.6% of women with anal or mixed incontinence were not specifically asked about anal incontinence. Our current screening for incontinence is unsatisfactory.

Urinary incontinence in a group of primiparous women in the Czech Republic

BACKGROUND/AIM

Not only the process of childbirth itself, but also processes during pregnancy seem to be strongly associated with urinary incontinence (UI). According to some epidemiological studies, UI during pregnancy occurs in 23-70% of the pregnant women. These studies also documented some risk factors (e.g., race, age, or body mass index). The aim of our study was to explore the prevalence of UI during pregnancy in the Czech Republic.

METHODS

474 primiparas who gave birth at our maternity ward from June 14, 2004, through January 31, 2005, received a questionnaire. The questionnaire concentrated on the occurrence and presentation of UI before and during pregnancy.

RESULTS

339 women (72%) completed the questionnaire. UI and the length of pregnancy are significantly related. We found a baseline UI prevalence before pregnancy of 17%, but before delivery one of 64%. We did not find any statistically significant relation between the prevalence of UI during pregnancy and body mass index before pregnancy as well as before delivery, weight gain during pregnancy, age, and birth weight.

CONCLUSION

Our results show that pregnancy is a risk factor for the development of UI.