Physical activity and incident urinary incontinence in middle-aged women

Women Who Avoid or Stop Exercise Due to Lower Urinary Tract Symptoms: Prevalence, Symptom Profile, and Associated Factors

OBJECTIVE

To determine the prevalence of women who report avoiding exercise or stopping a workout due to lower urinary tract symptoms (LUTS) in a community population, characterize symptoms in these women, and identify clinical and demographic factors associated with exercise cessation due to LUTS.

METHODS

A cross-sectional online survey was administered to community-based women. The prevalence of having avoided exercise or stopped a workout due to LUTS was calculated. Clinical and demographic variables along with comprehensive urinary symptoms assessed by the Lower Urinary Tract Research Network-Symptom Index (LURN-SI 29) were compared between women with and without the outcome. Multivariable logistic regression and random forest models were used to identify variables associated with the outcome.

RESULTS

Out of 1707 women who completed the survey, 18.9% reported avoiding exercising or stopping a workout due to LUTS. For these women, multiple domains of LUTS were noted, including incontinence, pain, voiding difficulty, urgency, and nocturia. Multivariable logistic regression identified LURN SI-29 score, White race, and prior vaginal delivery as significantly associated with the outcome, while the random forest model identified LURN SI-29 score, age, and body mass index (BMI) as most important.

CONCLUSION

In a population-based study, 1 in 5 women reported avoiding exercise or stopping a workout due to LUTS. Their reported LUTS span multiple symptom domains, and factors associated with stopping exercise include symptom severity, older age, higher BMI, White race, and prior vaginal delivery. Addressing LUTS may improve the resumption and continuation of exercise in women.

Urinary Incontinence in Elite Female Athletes

PURPOSE OF REVIEW

To summarize the current understanding on the epidemiology, pathophysiology, and management strategies of urinary incontinence (UI) in female athletes, highlighting findings specific to nulliparous elite athletes.

RECENT FINDINGS

UI occurs in about 20-50% of female athletes of all ages and parity status, around 40% for younger nulliparous athletes, and is more prevalent in high-impact sports. Possible contributing factors to UI in female elite athletes include pelvic floor laxity and bladder neck descent, pelvic floor muscle fatigue, low energy availability, and hypermobility syndrome. In female elite athletes, urinary symptoms negatively affect quality of life, although the effects of symptoms on exercise participation are not well understood. Current management strategies are primarily conservative and centered on behavioral modifications and pelvic floor muscle physiotherapy. UI in female elite athletes appears to be multifactorial. Clarifying how individual factors influence UI in this population will inform athlete counseling, prevention, and treatment strategies.

Sport-related risk factors for moderate or severe urinary incontinence in master female weightlifters: A cross-sectional study

BACKGROUND

Urinary incontinence (UI), defined as the involuntary loss of urine, is a common, multifactorial condition. It is unclear whether physical activities, their intensity or frequency, may affect the potential for UI in addition to known risk factors in the general population. Higher prevalence of UI has been observed when engaging in high-impact sports, but research is sparse regarding UI in strength sports. Since the Olympic-style weightlifting has seen an unprecedented increase in women's participation in recent years, this study provides much-needed data to investigate whether weightlifting predisposes women to UI.

OBJECTIVES

The aim was to conduct a survey of female Master athletes in countries that are members of the International Weightlifting Federation using a validated incontinence severity index and to study (1) whether known risk factors in the general population increase the odds of UI in female competitive weightlifters and (2) whether sport-related factors are associated with UI after adjusting for known risk factors. The outcomes of interest were moderate or more severe UI and incontinence during lifts specific to weightlifting competitions.

RESULTS

Respondents consisted of 824 female competitive weightlifters from 29 countries, ages 30 to 79, median 41 years. Prevalence of moderate or more severe incontinence was 32%. Higher BMI, prior pregnancies, and depressive mood increased the odds, but age was not associated. Athletes who had engaged in high-impact sports prior to starting weightlifting training were at a higher risk of UI, but participation in prior strength sports was not associated with UI. The predictive probability of moderate or more severe UI increased with more hours per week of weightlifting training.

CONCLUSIONS

Our findings indicate that while female weightlifters had a higher prevalence of moderate or severe UI than in a general population according to the National Health and Nutrition Examination Survey, and that athletes who had engaged in high-impact sports prior to starting weightlifting were at a higher risk of UI.

Does total knee arthroplasty affect overactive bladder symptoms in female patients?

INTRODUCTION AND HYPOTHESIS

In the current study we hypothesized that total knee arthroplasty might improve the overactive bladder symptoms by providing pain relief and improving physical function.

METHODS

One hundred patients who underwent total knee arthroplasty were preoperatively evaluated for overactive bladder and 47 patients that met inclusion criteria were included in this study. All the patients included in the study were assessed both preoperatively and at the 3rd month postoperatively using the Overactive Bladder-Validated 8 (OAB-V8) questionnaire for overactive bladder symptoms, the Oxford Knee Score (OKS) for pain and physical function, and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity.

RESULTS

The mean age of the patients was 65.4 ± 7 (56-83) years. The OAB-V8, OKS and IPAQ-SF scores significantly improved at the 3rd month postoperatively compared with the initial assessment. All the OAB-V8 domains, namely, frequency, urgency, nocturia, and urgency urinary incontinence, significantly improved following total knee arthroplasty.

CONCLUSIONS

Our results showed that following total knee arthroplasty, overactive bladder questionnaire scores significantly improved at the 3rd month postoperatively.

Pelvic floor tissue damping during running using an intra-vaginal accelerometry approach

BACKGROUND

While cumulative loading of the pelvic floor during exercise appears to increase the risk of developing pelvic floor disorders, the pathophysiologic role of pelvic floor loading is poorly understood. The aim of this exploratory study was to present a method for evaluating vibrational frequency damping of the female pelvic floor and to investigate the potential utility of this approach in a preliminary evaluation.

METHODS

Female participants were instrumented with an intravaginal accelerometer and a hip-mounted accelerometer, then ran on a treadmill at 7 km/h and 10 km/h both before and after a 30-min self-selected pace. Displacement of the pelvic floor relative to the bony pelvis was calculated using double integration of the accelerometer data. Vibrational damping coefficients were calculated using a wavelet-based approach to determine the effect of continence status, parity, running speed and time on vibrational damping.

FINDINGS

Seventeen women (n = 10 reported regularly leaking urine while exercising, while n = 7 reported not leaking) completed the running protocol. No differences in vibrational damping were detected between continent and incontinent women when all frequency bands were evaluated together, however significant effects of parity, time, running speed and continence status were found within specific frequency bands. Parous women demonstrated less damping in the 25-40 Hz band compared to nulliparae, damping in the 13-16 Hz band was lower after the 30-min run, and incontinent women demonstrated lower damping in the 4.5-5.5 Hz band than continent women when running at 7 km/h.

INTERPRETATION

Intra-vaginal vibrational damping may be useful in detecting biomechanical mechanisms associated with pelvic floor disorders experienced by females during exercise.

Physical activity and urinary incontinence during pregnancy and postpartum: A systematic review and meta-analysis

To assess the association of physical activity and urinary incontinence, or its recovery, during pregnancy and postpartum. A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Two reviewers independently selected studies, assessed quality and extracted data. Odds ratios with 95% confidence intervals were calculated using fixed effects or random effects models, for low and moderate heterogeneity between studies, respectively. Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69-1.18) and OR 1.31 (95% CI: 0.74-2.34), respectively. Due to a lack of available data, urinary incontinence recovering could not be assessed. The available low evidence does not show that physical activity during pregnancy or postpartum is associated with urinary incontinence. Moderate physical activity should therefore be encouraged for the evidence-based benefits on other obstetrical outcomes.

Physical multimorbidity and incident urinary incontinence among community-dwelling adults aged ≥50 years: findings from a prospective analysis of the Irish Longitudinal Study on Ageing

BACKGROUND

There are no prospective studies on the association between multimorbidity and urinary incontinence (UI), while mediators in this association are unknown. Thus, we aimed to (i) investigate the longitudinal association between multimorbidity and UI in a large sample of Irish adults aged ≥50 years and (ii) investigate to what extent physical activity, polypharmacy, cognitive function, sleep problems, handgrip strength and disability mediate the association.

METHODS

Data on 5,946 adults aged ≥50 years old from the Irish Longitudinal Study on Aging were analysed. The baseline survey was conducted between 2009 and 2011 and follow-up after 2 years was conducted. Information on self-reported occurrence of UI in the past 12 months and lifetime diagnosis of 14 chronic conditions were obtained. Multivariable logistic regression and mediation analysis were conducted.

RESULTS

After adjustment for potential confounders, compared to having no chronic conditions at baseline, having three (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.30-2.48) and four or more (OR = 1.86; 95% CI = 1.32-2.60), chronic conditions were significantly associated with incident UI. Mediation analysis showed that polypharmacy, sleep problems and disability explained 22.7, 17.8 and 14.7% of the association between multimorbidity (i.e. two or more chronic conditions) and incident UI, respectively.

CONCLUSION

A greater number of chronic conditions at baseline were associated with a higher risk for incident UI at 2-year follow-up among adults aged ≥50 years in Ireland. Considering the effects of different medications on UI and improving sleep quality and disability among people aged ≥50 years with multimorbidity may reduce the incidence of UI.

Physical Activity, Diet, and Incident Urinary Incontinence in Postmenopausal Women: Women's Health Initiative Observational Study

BACKGROUND

Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI).

METHODS

We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food-frequency questionnaire, with incident UI subtypes after 3 years among 19,741 post-menopausal women in the Women's Health Initiative Observational Study. Odds ratios (OR) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression.

RESULTS

Women who reported total physical activity (MET-hours/week) ≥30 vs <0.1 were 16% less likely to develop urgency UI (OR=0.84; 95% CI 0.70, 1.00) and 34% less likely for mixed UI (OR=0.66; 0.46, 0.95), although linear trends were no longer statistically significant after adjusting for baseline weight and weight change (P-trend=0.15 and 0.16, respectively). The association between physical activity and incident stress UI was less consistent. Higher uncalibrated protein intake was associated with increased odds of incident urgency UI (≥19.4% versus <14.1% of energy intake OR=1.14; 95% CI 0.99, 1.30; P-trend=0.02), while confidence intervals were wide and included 1.0 for calibrated protein intake. Other macronutrients were not associated with urgency UI and macronutrient intake was not associated with incident stress or mixed UI (P-trend>0.05 for all).

CONCLUSIONS

Among post-menopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increase urgency UI, but no associations were observed between other macronutrient and UI subtypes.

Urinary incontinence in women: biofeedback as an innovative treatment method

Urinary incontinence is an involuntary urination (leakage of urine). About 200 million people suffer from this condition, and 60% of cases are concealed and untreated because of shame. It is estimated that an increasing number of young women and women of menopausal age will suffer from urinary incontinence. This disease occurs during the perinatal, perimenopausal period, as a result of brain damage or an unhealthy lifestyle. There are four main types of urinary incontinence: stress, urge, overflow and mixed form. Treatment is adapted to the severity of disease, its type and includes physiotherapeutic treatment (kinesiotherapy, physiotherapy, massage), pharmacological, psychological and surgical treatment. In recent years, growing interest has been observed in the noninvasive biofeedback method. The patient learns to contract the weakened pelvic floor muscles, constantly monitoring progress in treatment. She is also motivated by visual and auditory stimuli. Growing evidence confirms the effectiveness of this method, which to a large extent eliminates urinary incontinence. Nevertheless, attention should also be paid to prevention, which reduces the risk of involuntary leakage of urine.

Continence: Bowel and Bladder and Physical Function Decline in Women

Purpose of review

The purpose of this article is to review the various forms of incontinence, highlight their impact on older women, and to explore current literature regarding the link between physical activity, physical function, and incontinence.

Recent findings

Both urinary and fecal incontinence become more prevalent with age, and are associated with significant morbidity. In parallel, there is a well-established decline in physical function that occurs with age. Furthermore, incontinence has a bidirectional relationship with physical function decline. Given the known link between increasing physical activity and preserved physical function, there is an emerging body of literature seeking to determine whether increases in physical activity may also improve incontinence outcomes. We review some recent data on this topic.

Summary

Continence and physical function are two closely linked entities. Further research is needed to determine whether interventions that increase physical activity might result in improved continence outcomes.

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.

Pelvic floor muscle activity patterns in women with and without stress urinary incontinence while running

BACKGROUND

High-impact activities are often related to urine leakage in women, so deeper insight into continence mechanisms of pelvic floor muscles (PFMs) while running is needed. Therefore, simultaneous information about the intensity of PFM muscle activity and fibre recruitment behavior at each time point of the gait cycle can help in understanding PFM activity patterns.

OBJECTIVE

We aimed to analyse spectral changes of the pre- and post-initial contact phase during running at 3 different speeds and to compare women with stress urinary continence (SUI) to those without SUI by using a wavelet approach.

METHODS

PFM electromyography (EMG) was recorded during 7, 11 and 15km/h treadmill running and analysed with Morse wavelets. The relative distribution of power was extracted during 6 time intervals of 30ms, from 30ms before to 150ms after initial contact.

RESULTS

We included 28 women without SUI (mean [SD] age 38.9 [10.3] years) and 21 with SUI (mean age 46.1 [9.9] years). The groups did not differ in power spectra for each time interval. However, we found significantly less EMG intensity in the lower frequency bands but more intensity in the higher frequency bands in the pre-initial contact phase than at post-initial contact.

CONCLUSION

Morse wavelets could be used to extract differences between pre- and post-initial contact activation behavior of PFMs during different running speeds as well as spectral changes toward high or low frequencies. This information sheds light on specific differences in involuntary reflexive activation patterns while running. Muscular preparation and adaptation a few milliseconds before initial contact could be helpful.

URINARY INCONTINENCE AND EXERCISE: KINESIOLOGICAL DESCRIPTION OF AN INTERVENTION PROPOSAL

ABSTRACT Introduction Research shows that symptoms of urinary incontinence are common among women who engage in physical activity. Objective To conduct a kinesiological analysis of specific exercises for the pelvic floor muscles (PFM), proposing correspondences of these postures through resistance exercises. Methods This research project is of a descriptive nature with level of evidence V. Videos and photos were taken to obtain an image for the collection of data based on the accomplishment of the specific postures. Results The kinesiological study revealed that the muscles involved in the postures of exercises targeting the prevention of urinary incontinence beyond those specific to the pelvic floor were: trunk flexors; spinal erector; adductors and hip extensors. The resistance exercises corresponding to these positions in bodybuilding apparatus were the machine hack squat; sitting adductor exercises; sitting abductor exercises; the smith machine squat and the free squat or machine squat. Conclusion This study showed that it is possible to construct correspondence between exercises for the pelvic floor muscles and resistance exercises with bodybuilding equipment and free weights. A new strategy is suggested for the physical education professional, based on resistance exercises: taking a coadjuvant approach to the treatment and prevention of urinary incontinence during physical and sports exercises. Level of evidence V, Case series.

An International Classification of Function, Disability and Health (ICF)-based investigation of movement impairment in women with pelvic organ prolapse

Background

There is little evidence on movement impairment of the abdominal and pelvic floor muscles (PFM) in women with pelvic organ prolapse (POP).

Objectives

The aim of this study was to determine the movement impairments and interactions between the PFM and abdominal muscles in POP.

Method

The PFM and abdominal muscles of 100 conveniently sampled South African women with POP were assessed by ultrasonography, electromyography (EMG), the PERFECT scale, Sahrmann scale and a Pressure Biofeedback Unit (PBU). A demographic questionnaire determined contextual factors (exercise and medical history) and Visual Faces Scale pain intensities. Data were analysed descriptively and with Spearman and Pearson correlation coefficients.

Results

Participants (59 ± 9.31 years) were mostly unemployed (80%), physically inactive (85%), with comorbidities, heart or vascular disease, hypothyroidism and depression. The mean levator hiatus at rest (56.38 mm, standard deviation [SD] 9.95), thickness (5.1 mm, SD 1.41), amount of movement (4.28 mm, SD 6.84), strength (level 1.89, SD 1.13) and endurance (4.04 s, SD 3.32) of the PFM indicated dysfunction. Median values of zero were found for the Sahrmann scale (interquartile [IQ] range [0–1]) and PBU (IQ range [0–2]) and 10.95 µV for abdominal EMG (IQ range [7.9–17.8]). Pelvic floor muscle strength, endurance, movement and EMG activity correlation was fair (r > 0.4, p < 0.001), as was PFM strength, endurance and abdominal muscle function (r > 0.4, p < 0.05).

Conclusion

Movement impairment of local and global stability and mobility functions of PFM and abdominal muscles was present, as well as correlations between these functions. Addressing these impairments may affect the identified contextual factors (socio-economic, psychological and lifestyle factors) and the possible activity limitations and participation restrictions in patients with POP. Further research is needed to investigate these interactions.

Clinical implications

The findings suggest that assessment and management of patients with POP might need to be based on a comprehensive neuro-musculoskeletal assessment and a holistic approach. Standardised protocols for patients with pelvic floor dysfunction (PFD) should therefore be used with caution. Randomised controlled trials should investigate patient-specific and holistic intervention approaches.

Changes in incontinence after hysterectomy

PURPOSE

Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy.

METHODS

108 patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively. Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively.

RESULTS

In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress incontinence correlated with BMI (r = 0.25, p < 0.01) and urge incontinence with age (r = 0.24, p < 0.02). Further, improvement after hysterectomy in stress incontinence was associated with younger age (r = 0.20, p < 0.04). Improvement in urge incontinence was positively associated with BMI (r = 0.22, p = 0.02). A slight but significant loss was seen in lean body mass 13 and 30 days postoperatively.

CONCLUSIONS

Hysterectomy was not significantly associated with the risk of incontinence; in particular, when no further vaginal surgery is performed. Hysterectomy may even have a slightly positive effect on incontinence and de-novo cure.

A PERDA DE URINA É INFLUENCIADA PELA MODALIDADE ESPORTIVA OU PELA CARGA DE TREINO? UMA REVISÃO SISTEMÁTICA

RESUMO Atualmente, diversos estudos relatam incontinência urinária (IU) entre mulheres jovens nulíparas e fisicamente ativas. Contudo, alguns investigam a prevalência da IU de acordo com as modalidades esportivas, enquanto outros investigam a carga de treino. A finalidade do presente estudo foi verificar se a modalidade esportiva é mais determinante na prevalência de IU do que a carga de treino entre mulheres jovens nulíparas. Para esta revisão sistemática, três revisores independentes realizaram uma busca de publicações originais nas bases de dados PubMed, LILACS e SciELO, entre 1994 e 2015. Foram utilizadas como estratégia de busca as palavras-chave: urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registradas na MeSH e no DeCS. Foram incluídos apenas estudos originais publicados nas línguas português, inglês e espanhol, que verificaram a IU em mulheres nulíparas, atletas ou praticantes de atividade física. Foram selecionados 873 estudos, mas somente dez artigos satisfizeram os critérios de inclusão e exclusão. Todos os artigos foram do tipo transversal, dos quais quatro relacionaram a IU com as modalidades esportivas, cinco verificaram a carga de treino com a perda de urina e um estudo verificou ambos os aspectos. Foi encontrada uma alta taxa de prevalência de IU entre atletas. Parece haver evidência de que as atividades que exigem salto, aterrissagem longa e corrida são as mais propensas a provocar perda de urina. Além disso, a maior carga de treino parece estar associada com a quantidade de urina perdida. Esta revisão evidencia as altas taxas de IU em praticantes de grandes cargas de treinamento associadas a esportes com salto, especialmente entre atletas. Contudo, ainda não há resposta para qual fator esportivo é mais determinante para a perda de urina entre mulheres nulíparas.

Physical activity and the pelvic floor

Pelvic floor disorders are common, with 1 in 4 US women reporting moderate to severe symptoms of urinary incontinence, pelvic organ prolapse, or fecal incontinence. Given the high societal burden of these disorders, identifying potentially modifiable risk factors is crucial. Physical activity is one such potentially modifiable risk factor; the large number of girls and women participating in sport and strenuous training regimens increases the need to understand associated risks and benefits of these exposures. The aim of this review was to summarize studies reporting the association between physical activity and pelvic floor disorders. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include that urinary incontinence during exercise is common and is more prevalent in women during high-impact sports. Mild to moderate physical activity, such as brisk walking, decreases both the odds of having and the risk of developing urinary incontinence. In older women, mild to moderate activity also decreases the odds of having fecal incontinence; however, young women participating in high-intensity activity are more likely to report anal incontinence than less active women. Scant data suggest that in middle-aged women, lifetime physical activity increases the odds of stress urinary incontinence slightly and does not increase the odds of pelvic organ prolapse. Women undergoing surgery for pelvic organ prolapse are more likely to report a history of heavy work than controls; however, women recruited from the community with pelvic organ prolapse on examination report similar lifetime levels of strenuous activity as women without this examination finding. Data are insufficient to determine whether strenuous activity while young predisposes to pelvic floor disorders later in life. The existing literature suggests that most physical activity does not harm the pelvic floor and does provide numerous health benefits for women. However, future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods.

Demographic, health conditions, and lifestyle factors associated with urinary incontinence in elderly from Florianópolis, Santa Catarina, Brazil

OBJECTIVE

To determine the prevalence and factors associated with urinary incontinence in the elderly population of Florianópolis, in the State of Santa Catarina, Brazil.

METHODS

We used data from EpiFloripa Idoso 2009/2010 survey, a cross-sectional population-based study including 1,705 elderly of both the sexes. Poisson's regression (crude and adjusted analysis) was applied to verify the association between the urinary incontinence outcome and exploratory variables (sociodemographic, lifestyle, and health conditions).

RESULTS

Among the elderly, 29.4% reported urinary incontinence; 36.3% were women and 17.0% men. The factors associated with greater prevalence of urinary incontinence were being female, aged more than 70 years old, having 0 to 4 schooling years, being insufficiently active, having bronchitis or asthma, stroke or cerebral ischemia, presenting mild or moderate/severe dependence, and polypharmacy.

CONCLUSION

The prevalence of urinary incontinence was high among the investigated elderly. Sociodemographic variables and those related to lifestyle and health conditions were associated with higher prevalence of urinary incontinence. Knowledge of the factors associated with urinary incontinence in aged individuals can guide actions to reduce and prevent this important issue, which affects the elderly.

Urinary Incontinence Before and After Bariatric Surgery

IMPORTANCE

Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.

OBJECTIVES

To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.

DESIGN, SETTING, AND PARTICIPANTS

The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).

INTERVENTION

Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter.

MAIN OUTCOMES AND MEASURES

The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up.

RESULTS

Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.

CONCLUSIONS AND RELEVANCE

Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.

Conservative Management of Urinary Incontinence in Women

Urinary incontinence in women has a high prevalence and causes significant morbidity. Given that urinary incontinence is not generally a progressive disease, conservative therapies play an integral part in the management of these patients. We conducted a nonsystematic review of the literature to identify high-quality studies that evaluated the different components of conservative management of stress urinary incontinence, including behavioral therapy, bladder training, pelvic floor muscle training, lifestyle changes, mechanical devices, vaginal cones, and electrical stimulation. Urinary incontinence can have a severe impact on our healthcare system and patients' quality of life. There are currently a wide variety of treatment options for these patients, ranging from conservative treatment to surgical treatment. Although further research is required in the area of conservative therapies, nonsurgical treatments are effective and are preferred by some patients.

Treatment status and risk factors for incidence and persistence of urinary incontinence in women

INTRODUCTION AND HYPOTHESIS

The objective of this analysis was to describe urinary incontinence (UI) incidence and persistence over 5 years in association with treatment status, sociodemographic, medical, and lifestyle factors, in a racially/ethnically diverse population-based female sample.

METHODS

The Boston Area Community Health Survey enrolled 3,201 women aged 30-79 years of black, Hispanic, and white race/ethnicity. Five-year follow-up was completed by 2,534 women (conditional response rate 83.4 %), allowing population-weighted estimates of UI incidence and persistence rates. Predictors of UI were determined using multivariate logistic regression models.

RESULTS

Incidence of UI at least monthly was 14.1 % and weekly 8.9 %. Waist circumference at baseline and increasing waist circumference over 5-year follow-up were the most robust predictors of UI incidence in multivariate models (P ≤ 0.01). Among 475 women with UI at baseline, persistence was associated with depression symptoms [monthly UI, odds ratio (OR) = 2.39, 95 % confidence interval (CI) 1.14-5.02] and alcohol consumption (weekly UI, OR = 3.51, 95 % CI 1.11-11.1). Among women with weekly UI at baseline, 41.7 % continued to report weekly UI at follow-up, 14.1 % reported monthly UI, and 44.2 % had complete remission. Persistence of UI was not significantly higher (58.2 % vs. 48.0 %, chi-square P = 0.3) among untreated women. Surgical or drug treatment for UI had little impact on estimates for other risk factors or for overall population rates of persistence or remission.

CONCLUSIONS

Women with higher gains in waist circumference over time were more likely to develop UI, but waist circumference was not predictive of UI persistence. UI treatments did not affect associations for other risk factors. Additional research on the role of alcohol intake in UI persistence is warranted.

Impact of behaviour and lifestyle on bladder health

Bladder conditions, including UTI, UI, and bladder cancer, are highly prevalent and affect a wide range of populations. There are a variety of modifiable behavioral and lifestyle factors that influence bladder health. Some factors, such as smoking and obesity, increase the risk or severity of bladder conditions, whereas other factors, such as pelvic floor muscle exercise, are protective. Although clinical practice may be assumed to be the most appropriate ground for education on behavioral and lifestyle factors that influence bladder health, it is also crucial to extend these messages into the general population through public health interventions to reach those who have not yet developed bladder conditions and to maximize the prevention impact of these behaviors. Appropriate changes in these factors have the potential for an enormous impact on bladder health if implemented on a population-based level.

Urinary incontinence in physically active women and female athletes

A literature review was performed on the topic of urinary incontinence during physical activity and sports. This paper reviews the prevalence, risk factors, pathophysiology and treatment modalities of urinary incontinence in physically active women and female athletes. Urinary incontinence affects women of all ages, including top female athletes, but is often under-reported. The highest prevalence of urinary incontinence is reported in those participating in high impact sports. Pelvic floor muscle training is considered the first-line treatment, although more research is needed to determine optimal treatment protocols for exercising women and athletes. Trainers, coaches and other athletes' caregivers should be educated and made aware of the need for proper urogynaecological assessment.

A prática de exercícios físicos é um fator modificável da incontinência urinária de urgência em mulheres idosas

INTRODUÇÃO: A literatura aponta que alguns fatores de risco para incontinência urinária podem ser modificados por um estilo de vida saudável; no entanto, pouco se conhece sobre os fatores associados à incontinência urinária de urgência (IUU), cuja prevalência aumenta com a idade. OBJETIVO: Analisar os fatores de risco modificáveis da IUU em mulheres idosas. MÉTODOS: A amostra foi composta por 200 idosas (60 anos ou mais) com média de idade de 69,06 ± 6,26 anos. Foram identificadas a presença de IUU e os fatores de risco comportamentais (consumo de café, consumo de bebidas alcoólicas, hábito de fumar e presença de constipação). Também foi aplicado o Domínio 4 do Questionário Internacional de Atividade Física (IPAQ) para identificação do nível de atividade física e mensurados Índice de Massa Corporal e Circunferência da Cintura. Os dados foram tratados por meio de estatística descritiva e inferencial, com nível de significância de 5%. RESULTADOS: A prevalência de IUU na amostra foi de 15,5%. Entre os fatores modificáveis, apenas o nível de atividade física associou-se com a ocorrência de IUU, sendo que a prática de exercícios físicos apresentou-se como um fator de proteção entre mulheres muito ativas (OR = 0,288) e pouco ativas (OR = 0,356). CONCLUSÃO: Os sintomas de urgência miccional podem ser amenizados com a prática regular de exercícios físicos. Através de um estilo de vida saudável é possível minimizar uma série de fatores modificáveis na gênese da incontinência urinária de urgência.

Improvements in physical activity and functioning after undergoing midurethral sling procedure for urinary incontinence

OBJECTIVE

The primary objective was to estimate the effect of the midurethral sling on improving leisure physical activity levels and physical functioning in women with stress urinary incontinence (SUI). Our secondary objective was to identify possible risk factors for postoperative insufficient physical activity.

METHODS

We conducted a prospective, observational study of women undergoing outpatient midurethral sling for SUI. Women completed validated questionnaires for incontinence, leisure physical activity, and physical functioning at baseline and 6 months postoperatively. The primary outcome was leisure physical activity level. We used multiple logistic and linear regression to estimate the effect of improvements in urinary symptoms and life effect on physical activity levels and physical functioning scores.

RESULTS

Ninety women underwent surgery and 85 returned for follow-up. At baseline, 38% had sedentary, 18% had moderate, and 44% had sufficient leisure physical activity levels. Postoperatively, this modestly improved to 26% sedentary, 20% moderate, and 54% sufficient levels. The median leisure physical activity energy expenditure increased from 396 to 693 metabolic equivalent-minutes per week (P=.04). Physical functioning scores also significantly improved (mean score 44 compared with 55 points, P<.001). On multiple logistic regression, improvements in incontinence life effect were associated with increased odds of leisure physical activity improvement (adjusted odds ratio 1.66; 95% confidence interval 1.08-2.54). On multiple linear regression, improvements in both urinary incontinence severity and effect were associated with improvements in physical functioning scores (P<.01 for both). Factors associated with insufficient postoperative physical activity included low baseline physical activity levels and smaller improvements in urinary effect scores.

CONCLUSION

Midurethral sling and subsequent improvements in urinary incontinence are associated with improved leisure physical activity levels and physical functioning.

The epidemiology of urinary incontinence in women with type 2 diabetes

PURPOSE

Little research has been conducted on the epidemiology of urinary incontinence in individuals with type 2 diabetes. We examined prevalence, incidence and risk factors for urinary incontinence among women with type 2 diabetes in the NHS (Nurses' Health Study) and NHS II.

MATERIALS AND METHODS

We obtained urinary incontinence information at study baseline (2000 in NHS and 2001 in NHS II) and 2 followup periods (2002 and 2004 in the NHS, and 2003 and 2005 in the NHS II). Among women with type 2 diabetes we calculated the prevalence of urinary incontinence for 9,994 women with baseline urinary incontinence information, and urinary incontinence incidence rates for 4,331 women with no urinary incontinence at baseline and urinary incontinence information during followup. Multivariable adjusted odds ratios and relative risks were estimated for associations between possible risk factors and urinary incontinence.

RESULTS

The prevalence of at least monthly urinary incontinence was 48% and at least weekly urinary incontinence was 29% among women with type 2 diabetes, and the corresponding incidence rates were 9.1 and 3.4 per 100 person-years, respectively. White race, higher body mass index, higher parity, lower physical activity, current postmenopausal hormone use and diuretic use were risk factors for prevalent and incident urinary incontinence in this study, and hysterectomy, vascular disease and longer duration of diabetes were associated with increased odds of prevalent urinary incontinence only. Increasing age and microvascular complications were associated with a greater risk of frequent urinary incontinence.

CONCLUSIONS

Urinary incontinence was common in this study of women with type 2 diabetes. We identified multiple risk factors for urinary incontinence in these women, several of which suggest ways to reduce urinary incontinence.

Characteristics of patients seeking outpatient rehabilitation for pelvic-floor dysfunction

BACKGROUND

Pelvic-floor dysfunction (PFD) affects a substantial proportion of individuals, especially women.

OBJECTIVE

The purposes of this study were: (1) to describe the characteristics of individuals with disorders associated with PFD who were seeking outpatient physical therapy services and (2) to identify the prevalence of specific pelvic-floor disorders in the group.

DESIGN

This was a prospective, longitudinal, cohort study of 2,452 patients (mean age=50 years, SD=16, range=18-91) being treated in 109 outpatient physical therapy clinics in 26 states (United States) for their PFD.

METHODS

This study examined patient demographic variables and summarized patient self-reported responses to questions related to urinary and bowel functioning at admission prior to receiving the therapy for their PFD disorders.

RESULTS

Patients primarily were female (92%), were under 65 years of age (39%: 18 to <45 years; 39%: 45 to <65 years; 21%: 65 years or older), and had chronic symptoms (74%). Overall, 67% of the patients reported that they had urinary problems, 27% reported bowel problems, and 39% had pelvic pain. Among those who had urinary or bowel disorders, 32% and 54% reported leakage and constipation, respectively, as their only problem. Among patients who had pelvic pain, most (56%) reported that the pain was in the abdominal area. Combinations of urinary, bowel, or pelvic-floor pain disorders occurred in 31% of the patients.

LIMITATIONS

Because this study was a secondary analysis of data collected prospectively, the researchers were not in control of the data collection procedure. Missing data were common.

CONCLUSIONS

Data suggested most patients with PFD receiving outpatient physical therapy services were female, younger than 65 years, and had disorders lasting for more than 90 days. Combinations of urinary, bowel, or pelvic-floor pain disorders were not uncommon.

Prevalência, tipologia e sintomas de gravidade da incontinência urinária em mulheres idosas segundo a prática de atividade física

INTRODUÇÃO: A prática de atividade física (AF) é importante para a população idosa, graças aos beneficios biopsicossociais. A incontinência urinária (IU) também vem sendo analisada, pois o avanço da idade é um fator de risco importante na sua ocorrência. OBJETIVO: Verificar a prevalência, a tipologia e os sintomas de gravidade da IU entre mulheres idosas segundo a prática de AF regular. MATERIAIS E MÉTODOS: Participaram deste estudo 209 idosas, divididas em três grupos, segundo o nível de AF. Foram coletados dados referentes à presença, tipologia, duração e gravidade dos sintomas da IU. Utilizou-se estatística descritiva e inferencial, por meio dos testes Qui-Quadrado, Mann-Whitney e Análise de Variância, conforme os grupos de variáveis. Adotou-se nível de significância de 5%. RESULTADOS: A presença de IU na amostra total foi de 33,3%, sendo a menor prevalência entre as idosas mais ativas (28,9%). Quanto à tipologia, 28,7% apresentaram IU de esforço (IUE), 14,8% IU de urgência (IUU) e 10,5% IU mista (IUM). A presença de IUU (p = 0,05) e IUM (p = 0,04) associou-se com o grupo de mulheres sedentárias. A prática de ginástica associou-se com a ausência de IU (p = 0,003). Em 43,5% da amostra, o início dos sintomas de gravidade deu-se após a menopausa. A retenção de urina sem dificuldade associou-se com a prática de AF (p = 0,029). CONCLUSÃO: A menor incidência de IU entre as idosas muito ativas pode ser atribuída aos benefícios da AF moderada ao mecanismo de continência. Além disso, a prática de exercícios físicos também parece minimizar os sintomas de urgência miccional.

Etiology of overactive bladder: a diet and lifestyle model for diabetes and obesity in older women

OBJECTIVE

To evaluate a coherent, evidence-based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB.

METHODS

A hypothetical causative model for OAB involving modifiable lifestyle factors implicated in the development of diabetes and obesity was constructed, based on a systematic literature review. Secondary analysis of data was undertaken in a prospective cohort of women aged 40 and over, living in Leicestershire, UK. Subjects included 3,411 women free from OAB at baseline and 277 incident cases of OAB. Reported diet, lifestyle, morbid, and social factors were measured at baseline and incident cases at 1-year follow-up. Graphical chain modeling was used to estimate the associations between variables and identify likely pathways involved.

RESULTS

All hypothesized lifestyle factors (physical activity, high glycemic index, and high energy intake) plus diabetes and obesity were retained within the graph as potential contributors. However, low physical activity was the only direct risk factor linked prospectively to the onset of OAB (RR 2.47; 95% CI 1.82, 3.36), in addition to older age.

CONCLUSIONS

Poor lifestyle factors causally linked to diabetes and obesity may contribute to the onset of OAB; low physical activity appears to be an important modifiable causal factor for OAB operating directly as well as indirectly via pathways involving obesity or diabetes. Further research is needed to demonstrate a causal link between lifestyle and OAB.

Body mass index, recreational physical activity and female urinary incontinence in Gansu, China

OBJECTIVE

To elucidate the influence of recreational physical activity, body mass index (BMI), and waist circumference on the risk of specific types of urinary incontinence.

STUDY DESIGN

We conducted a population-based cross-sectional survey in Gansu, China among 2603 women aged 20 years or older.

RESULTS

The study found that BMI was positively associated with urinary incontinence (P for trend=0.008) and the association was mainly observed for stress urinary incontinence (OR=1.4, 95% CI: 1.1, 1.9 for BMI=24.0-27.9 kg/m²; OR=2.3, 95% CI: 1.5, 3.6 for BMI ≥ 28.0 kg/m²; P for trend=0.0005). A positive association between stress incontinence (OR=1.7, 95% CI: 1.2, 2.5) and waist circumference was observed for women who had waist circumference between 70 cm and 75 cm compared to waist circumference less than 70 cm. Recreational physical activity was inversely associated with overall and mixed urinary incontinence (P for trend <0.0001 for both). A significant interaction between physical activity and waist circumference was found for overall (P=0.0007) and stress incontinence (P=0.001).

CONCLUSIONS

The findings that physical activity inversely associated with urinary incontinence and its interaction with waist circumference warrant further investigation, particularly in prospective studies.

Dietary macronutrient and energy intake and urinary incontinence in women

Weight loss involving diet modification improves urinary incontinence (UI) in women, but little is known about dietary correlates of UI. The authors examined intakes of total energy, carbohydrate, protein, and fats in relation to UI in a cross-sectional sample of 2,060 women in the population-based Boston Area Community Health Survey (2002-2005). Data were collected from in-person home interviews and food frequency questionnaires. Logistic regression was used to calculate odds ratios and 95% confidence intervals for the presence of moderate-to-severe UI; a severity index was analyzed in secondary analysis of 597 women with urine leakage. Greater total energy intake was associated with UI (P(trend) = 0.0001; highest quintile vs. lowest: adjusted odds ratio = 2.86, 95% confidence interval: 1.56, 5.23) and increased severity. No associations were observed with intake of carbohydrates, protein, or total fat. However, the ratio of saturated fat intake to polyunsaturated fat intake was positively associated with UI (highest quintile vs. lowest: adjusted odds ratio = 2.48, 95% confidence interval: 1.22, 5.06) and was strongly associated with severity (P(trend) < 0.0001). Results suggest that dietary changes, particularly decreasing saturated fat relative to polyunsaturated fat and decreasing total calories, could independently account for some of the benefits of weight loss in women with UI.

Prospective study of physical activity and risk of asthma exacerbations in older women

RATIONALE

The potential role of physical activity in preventing asthma exacerbations is unknown.

OBJECTIVES

To investigate the longitudinal association between regular physical activity and asthma exacerbations.

METHODS

A total of 2,818 women with asthma from a large U.S. cohort (the Nurses' Health Study) were monitored from 1998 to 2000. Physical activity was self-reported at baseline, using a validated questionnaire, and categorized in quintiles. Exacerbations during follow-up were defined as a self-report of asthma-related hospitalization, emergency department visit, or urgent office visit. Baseline information about severity of asthma, treatment, previous exacerbations, sociodemographic factors, smoking, and other potential confounders was obtained.

MEASUREMENTS AND MAIN RESULTS

Participants had a mean age of 63 years, and 71% had mild-to-moderate persistent asthma. About half of the women were ever-smokers (48% former, 6% current), and median physical activity was 10 MET x hours/week (equivalent to walking at a brisk pace for 20 minutes three times per week). Risk of exacerbations during follow-up decreased with increasing level of physical activity. In a multivariate logistic regression model, the higher level of physical activity, the lower risk of admission (odds ratio 0.85, 0.81, 0.78, and 0.76, for the 2nd, 3rd, 4th, and 5th quintiles compared with the 1st quintile, P for trend = 0.05). There were no relevant differences on stratifying by age group, smoking status, body mass index, baseline use of inhaled corticosteroids, or previous exacerbations.

CONCLUSIONS

Regular physical activity was associated with reduced risk of exacerbations in women with asthma in this longitudinal study.