Treatment of urinary incontinence in overweight women by a multidisciplinary lifestyle intervention

Health-promoting lifestyles and influencing factors among pregnant women with urinary incontinence: a multicentre cross-sectional study

OBJECTIVE

Lifestyle modification is an important part of non-surgical treatment for urinary incontinence (UI) and is strongly recommended. This study aims to explore the status and influencing factors of health-promoting lifestyle among pregnant women with UI.

DESIGN

A multicentre cross-sectional study.

SETTING

This study was conducted in obstetric clinics of three tertiary-level A hospitals in Zhejiang Province, mainland China.

PARTICIPANTS

A total of 519 pregnant women with UI were enrolled in this study from May 2023 to August 2023.

OUTCOME MEASURES

Lifestyle Profile Scale for Gravidas with Urinary Incontinence (LPG-UI) was used to assess health-promoting lifestyle status. Multivariate stepwise linear regression analysis was performed to identify significant influence factors.

RESULTS

Most participants reported mild-to-moderate UI, with over 60% experiencing UI starting from the first and second trimesters. The mean score of LPG-UI was 86.74 (SD=12.75) out of a score of 120. The results of multivariate stepwise linear regression analysis showed that those who had better environmental satisfaction (β=0.22, p<0.001), self-efficacy (β=0.168, p<0.001), social support (β=0.153, p<0.001) and knowledge of UI (β=0.104, p<0.01) have higher levels of health-promoting lifestyles, while those who had worse depression (β=-0.214, p<0.001), fewer exercise before pregnancy (β=-0.135, p<0.001) and physical work (β=-0.076, p<0.05) have lower levels of health-promoting lifestyles. A total of 38.5% variation in the regression equation could be explained.

CONCLUSIONS

The health-promoting lifestyle of pregnant women with UI needs to be further promoted. Governments and the social sector need to do more to improve the accessibility of environments such as sports and healthcare. Meanwhile, increasing the individual health responsibility of pregnant women with UI and promoting help-seeking behaviours are also top priorities. More social and emotional support should be added to improve self-efficacy and positive moods to enhance health promotion lifestyles.

The Clinical Symptoms and Psychological Status of Biofeedback Electrical Stimulation Combined with Pelvic Floor Muscle Training during the Treatment of Mild Stress Urinary Incontinence after Holmium Laser Enucleation of the Prostate

INTRODUCTION

To study the clinical symptoms and psychological status of biofeedback electrical stimulation combined with pelvic floor muscle training during the treatment of mild stress urinary incontinence (SUI) after holmium laser enucleation of the prostate (HoLEP).

METHODS

Group A was treated by biofeedback and electrical stimulation; Group B was treated by pelvic floor muscle training; and Group C was treated by biofeedback and electrical stimulation combined with pelvic floor muscle training. Patients in the 3 groups had follow-up evaluations every 8, 16, and 24 weeks. Clinical symptoms of urinary incontinence were assessed using the 24-h urinary pad test, the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF); and psychological status was evaluated using the modified Hospital Anxiety Depression Scale (HADS).

RESULTS

The results of ICIQ-UI-SF showed that there were differences within and between the three groups at 8 weeks, 16 weeks, and 24 weeks (p < 0.05). The results of the 24-h pad tests were similar (p < 0.05), except for no difference between group B and group C at 8 weeks (p > 0.05). In the study with the score of HADS >35, the differences among the three groups were statistically significant (p < 0.05). There was no significant difference among the three groups at 0 and 8 weeks (p > 0.05). There were differences in the results between group C and the other two groups at 16 and 24 weeks of treatment (p < 0.05). For patients with HADS <35 at week 0, the results were basically the same except for the difference between groups at week 8. HADS of all patients were no statistical difference (p > 0.05).

CONCLUSIONS

Biofeedback electrical stimulation combined with pelvic floor muscle training is an efficient nonsurgical combination therapy for the symptoms of SUI after HoLEP for benign prostatic hyperplasia. In addition, the recovery of the patient's psychological state does not coincide with the recovery of urinary incontinence; therefore, we propose that patients still need additional psychological treatment after SUI disappears.

The Role of Gene Expression in Stress Urinary Incontinence: An Integrative Review of Evidence

Stress urinary incontinence (SUI) is defined as unintentional urine leakage occurring as a consequence of increased intraabdominal pressure due to absent or weak musculus detrusor contractility. It affects postmenopausal women more often than premenopausal and is associated with quality of life (QoL) deterioration. The complex SUI etiology is generally perceived as multifactorial; however, the overall impact of environmental and genetic influences is deficiently understood. In this research report, we have disclosed the upregulation of 15 genes and the downregulation of 2 genes in the genetic etiology of SUI according to the accessible scientific literature. The analytical methods used for the analysis of gene expression in the studies investigated were immunohistochemistry, immunofluorescence staining, PCR, and Western blot. In order to facilitate the interpretation of the results, we have used GeneMania, a potent software which describes genetic expression, co-expression, co-localization, and protein domain similarity. The importance of this review on the genetic pathophysiology of SUI lies in determining susceptibility for targeted genetic therapy, detecting clinical biomarkers, and other possible therapeutic advances. The prevention of SUI with the timely recognition of genetic factors may be important for avoiding invasive operative urogynecological methods.

Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis

Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m² should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings.

Natural history of urinary incontinence from first childbirth to 30-months postpartum

PURPOSE

The objectives of this study were to determine the incidence of UI in a large cohort of primiparous women before and during pregnancy and over the course of 30-months postpartum, and to identify risk factors for UI during and after pregnancy.

METHODS

Nulliparous women aged 18-35 years with singleton pregnancies were interviewed in their third trimester and asked about urinary incontinence before and during pregnancy (n = 3001). After delivery these women were interviewed at 1, 6, 12, 18, 24 and 30-months postpartum and asked about urinary incontinence occurring in the month prior to each interview. Multivariable logistic regression models identified risk factors for UI during pregnancy and during the follow-up period.

RESULTS

Overall, 4% reported having urinary incontinence before pregnancy and 36.8% during pregnancy. The strongest predictor of urinary incontinence during pregnancy was urinary incontinence before pregnancy (adjusted OR 13.11, 95% CI 7.43-23.13). Among the women with no subsequent pregnancies, the rate of urinary incontinence increased from 12.5% at 6-months postpartum to 27.4% at 30-months postpartum, 52.1% reported UI at one or more postpartum data collection stages, and the strongest predictors of postpartum UI were UI before pregnancy (adjusted OR 3.95 (95% CI 1.60-9.75) and during pregnancy (adjusted OR 4.36, 95% CI 3.24-5.87).

CONCLUSION

Our findings suggest that primiparous women who report UI before and during pregnancy should be monitored for the continuation or worsening of UI over the course of the first 2-3 years postpartum, and treatment options discussed.

It's About Time: The Temporal Burden of Lower Urinary Tract Symptoms Among Women

This secondary analysis studied 50 transcripts of women who shared day-to-day experiences of lower urinary tract symptoms (LUTS) and characterized temporal (time-associated) features of living with LUTS. Findings revealed two overarching time-associated themes: The Complexity of LUTS and The Quest for Empowerment over LUTS. Findings suggest that the temporal burden of LUTS is the accumulated impact of symptoms and symptom management on women's daily lives within multiple contexts across the life course. Increasing nurses' knowledge of the temporal context of LUTS may heighten awareness and improve symptom detection and management.