Predictors of female urinary incontinence at midlife and beyond

Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow-up study

OBJECTIVE

To investigate how reproductive history was associated with urinary incontinence in midlife.

DESIGN

A follow-up study.

SETTING

Denmark.

POPULATION

A total of 39 977 mothers who participated in the Maternal Follow up (2013-2014) in the Danish National Birth Cohort. National registries provided their reproductive history.

METHODS

How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression.

MAIN OUTCOME MEASURES

Self-reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence.

RESULTS

At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10-1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35-0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86-0.98). Compared with no tear/first-degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86-0.97) whereas third/fourth-degree tears were associated with more (OR 1.14, 95% CI 1.04-1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence.

CONCLUSIONS

Vaginal birth was associated with a higher risk of long-term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.

Urinary Incontinence in Midlife According to Weight Changes Across and After Childbearing Years

INTRODUCTION AND HYPOTHESIS

The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife.

METHODS

Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression.

RESULTS

At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight.

CONCLUSIONS

Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.

The effect of 12-month postoperative weight change on outcomes following midurethral sling for stress urinary incontinence: a secondary analysis of the ESTEEM and TOMUS randomized trials

INTRODUCTION AND HYPOTHESIS

Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI).

METHODS

This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome.

RESULTS

Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts (p = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes.

CONCLUSIONS

Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes.

Assessment of the Elastographic and Electromyographic of Pelvic Floor Muscles in Postmenopausal Women with Stress Urinary Incontinence Symptoms

Background. Shear wave elastography is an effective method for studying the condition of various musculoskeletal soft tissues. The primary aim of this study was the objective elastographic and electromyographic assessment of the pelvic floor during the rest and contraction of the pelvic floor muscles (PFM) in postmenopausal women. Methods. This was a prospective observational study that was carried out at the University Hospital in Wroclaw, Poland, between January 2017 and December 2019. Patients. The target group of the study included postmenopausal women with stress urinary incontinence. The primary outcomes were the features of the elastographic assessment of the pelvic floor during rest and contraction of the PFM obtained using shear wave elastography. Results. Based on the inclusion and exclusion criteria for the study, 14 patients took part in the measurements. There was a significant difference between the elastographic assessment of the pelvic floor during rest and contraction of the PFM at all locations in front of the urethra. No statistically significant correlation was found between the results of elastography and the bioelectrical activity of PFM. Conclusion. The elasticity of the periurethral structures is higher during active pelvic floor muscle contraction than at rest, it seems that shear wave elastography is an effective test that objectively assesses the strength of PFM contraction.

[Clinical path and life quality of women under 75 years with an urinary incontinence relevant to surgical treatment]

OBJECTIVES

Urinary incontinence has a high prevalence and a significant impact on quality of life, especially for women. Surgery is possible after failure of lifestyle changes, physiotherapy. Analyzing the care pathway of women under 75 years of age who have undergone surgery for urinary incontinence in link with recommendation and suggest possible improvements.

METHODS

Quantitative, multicentric, retrospective survey carried out between 10/09/2019 and 25/11/2019, based on anonymous self-report questionnaire, among women aged between 32 and 75 and operated in different hospitals in Loire (France).

RESULTS

Ninety-three answers were exploited out of 204. Among the women, 49.5 % had stress, 50.5 % mixed incontinence. Before the intervention, it had evolved for 5 years on average and caused discomfort evaluated at an average 7.5/10. Eighty percent frequently used protective pads and bladder training. Lifestyle changes and the voiding diary were not used much. Eighty-six percent of women felt comfortable to speak to a physician. Seventy-three percent had performed a urodynamic test, 47 % an abdominal ultrasound and 40 % a urinalysis. Seventy-seven percent performed physiotherapy, 39 % self-administered physiotherapy, 7 % used medication. The postoperative quality of life was evaluated at 7.8/10; 58 % felt healed and 69 % considered their sex life had improved.

CONCLUSIONS

The care pathway could be improved through systematic screening for urinary incontinence and its impact. The development of a care plan to coordinate and propose quick care could help patients to improve their life.

Incontinência urinária em idosos da estratégia saúde da família: prevalência e fatores de risco

Objetivos: determinar a prevalência da incontinência urinária (IU) e a sua relação com aspectos sociodemográficos, antropométricos, funcionais e clínicos em idosos da Estratégia Saúde da Família de Porto Alegre/RS (ESF/POA).Métodos: estudo transversal analítico, coletado prospectivamente em amostra aleatória (30 unidades da ESF/POA). Foram coletados dados sociodemográficos, antropométricos e de saúde, sendo aplicados o Questionário Minessota de atividades físicas e de lazer, o Miniexame do Estado Mental, a Escala de Silhuetas de Stunkard (imagem corporal) e testes funcionais (Senta/Levanta, força de preensão manual e velocidade de caminhada).Resultados: foram estudados 575 idosos (68,9±7,1 anos; mulheres= 64,35%) dos quais 33,04% relataram IU (mulheres= 69,5%). Foram estimados como fatores de risco para a IU: menor escore do Miniexame (OR= 0,939; p= 0,033; IC95%= 0,887– 0,995); presença de prejuízo cognitivo (OR= 1,625; p= 0,010; IC95%= 1,351– 3,113); velocidade de caminhada mais lenta (OR= 1,160; p= 0,016; IC95%= 1,028– 1,309); e menor escore no teste Senta/Levanta (OR= 0,013; p= 0,874; IC95%= 0,712 – 0,932). Quedas, atividade física, satisfação com a imagem corporal e ingestão medicamentosa não apresentaram associação significativa com a IU.Conclusão: nessa amostra, foi alta a prevalência da IU. Apresentar menor força de membros inferiores, menor velocidade de caminhada e prejuízo cognitivo foram identificados como fatores de risco para a incontinência, todos modificáveis.

Assessment of the Short-Term Effects after High-Inductive Electromagnetic Stimulation of Pelvic Floor Muscles: A Randomized, Sham-Controlled Study

Background: Physiotherapy should be performed by patients with stress or mixed urinary incontinence (SUI and MUI) to increase the strength and endurance of the pelvic floor muscles (PFMs). A method that can positively affect the pelvic floor is stimulation with high-inductive electromagnetic stimulation (HIES). The aim of the study was to evaluate the PFMs after the application of HIES in women with SUI and MUI by using surface electromyography (sEMG). Methods: This was a prospective, randomized, single-blind study with a sham intervention group. The participants were randomly assigned to the HIES group or sham group. The outcomes were features of the bioelectrical PFM activity assessed using sEMG and endovaginal probes. A single-session intervention in the HIES group included 20 min of HIES with an electromagnetic induction intensity of 2.5 T. Results: In the HIES group, there was a statistically significant difference in the PFM sEMG activity during “contractions” (p < 0.001) and “quick flicks” (p = 0.005). In the intergroup comparison, higher PFM sEMG activity after the intervention (“contraction”) was observed in the HIES group than in the sham group (after: p = 0.047; 1 h after: p = 0.017). Conclusions: The assessed HIES method seems effective for SUI and MUI patients in the short term and shows an advantage over the sham intervention in the assessment of PFM contractions.

Pelvic floor muscles after birth: Do unstable shoes have an effect on pelvic floor activity and can this be measured reliably? – A feasibility study / Der Beckenboden nach der Geburt: Verändern instabile Schuhe die Aktivität und kann diese reliabel gemessen werden? – Eine Machbarkeitsstudie

Background

Women often suffer from urinary incontinence after childbirth. Pelvic floor muscle training is an evidenced-based intervention to prevent urinary incontinence and improve its symptoms

Aim

The primary purpose of this study was to determine if there is a change in the activation of the pelvic floor muscles with different extrinsic parameters (barefoot versus unstable shoe). Second, we wanted to define variables that can be measured reliably and correlated with pelvic floor activity.

Methods

Data of 15 women who were 8 weeks to 6 months postpartum were analyzed. Two conditions (“barefoot” and “kyBoot”) were tested, with each participant performing three different tasks: walking, standing with an active pelvic floor, and standing with a passive pelvic floor. Three-dimensional kinematics of the body were recorded. Activity of the abdominal, back, and gluteal muscles was measured using surface electromyography (EMG). The activity of the pelvic floor was recorded using a vaginal electrode. Maximum pelvic floor activity was compared for each condition, and correlations among pelvic floor activity, kinematic variables, and skeletal muscle activity were determined.

Results

The maximum activity of the pelvic floor while walking was significantly higher when participants were barefoot than when they were wearing kyBoot shoes. For the standing trials, no significant differences between the conditions were detected. No surrogate marker was found to measure the pelvic floor activity.

Conclusion

With regard to the pelvic floor musculature, no recommendation is possible in favor of or against wearing unstable shoes. Technical developments are necessary to provide solutions to reliably measure the pelvic floor activity.

Vitamin D and Urinary Incontinence among Korean Women: a Propensity Score-matched Analysis from the 2008-2009 Korean National Health and Nutrition Examination Survey

A recent study investigated the role of vitamin D in urinary incontinence (UI). However, very few data are available on this topic. Therefore, we evaluated these relationships using nationally representative data from Korea. We included 6,451 women over the age of 20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. We conducted a propensity-matched study by identifying women with UI. Women without UI, matched for menopause, number of pregnancies, hypertension, diabetes, body mass index, age, stroke, asthma, and chronic obstructive pulmonary disease, were selected as a control group at a 2:1 ratio. The χ² test, t-test and logistic regression analyses were used. Following propensity score matching, 558 UI cases and 1,116 normal controls were included, and confounders (menopause, hypertension, diabetes mellitus, asthma, age, obesity, and number of pregnancies) were evenly dispersed and did not differ significantly between the groups. There was no significant difference between the mean vitamin D levels of the UI and normal groups (vitamin D: 18.4 ± 6.6 vs. 18.5 ± 7.0 ng/mL; P = 0.752). Additionally, there was no significant difference in the distribution of vitamin D levels (< 20 ng/mL, 20-30 ng/mL, > 30 ng/mL: 63.8%, 30.5%, and 5.7% in normal controls, 64.0%, 27.8%, and 8.2% in UI cases; P = 0.107). In conclusion, low serum vitamin D is not significantly and independently related to female UI after propensity score matching in representative Korean data.

Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study

Objectives

In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position.

Materials and methods

This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance.

Results

In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104).

Conclusion

The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM.

Risk factors associated with urinary incontinence in Portugal and the quality of life of affected women

OBJECTIVE

To identify risk factors for urinary incontinence (UI) and assess the quality of life (QoL) of affected women.

METHODS

A cross-sectional study was conducted of all women with UI who attended the urology and gynecology services of four hospitals in central Portugal between March and December 2012. Information was obtained from participants using questionnaires assessing sociodemographic, obstetric, gynecologic, and lifestyle variables.

RESULTS

Among 505 participants, 351 (69.5%) had urgency UI, 107 (21.2%) stress UI, and 47 (9.3%) mixed UI. Stress UI was associated with smoking, alcohol consumption, constipation, gravidity, parity, and vaginal infections (P≤0.02 for all). Urgency UI was associated with age above 50 years, employment, smoking, and sitting for 2 hours or less per day (P≤0.02 for all). Mixed UI was associated with age 50 years or younger, smoking, sitting for 2 hours or less per day, and frequently carrying more than 3 kg in weight (P<0.001 for all). A negative impact on QoL was reported by 501 (99.2%) women. Compared with younger participants, women older than 50 years presented with more sleep/energy disturbances and performance limitations (P≤0.04 for both).

CONCLUSION

UI is associated with several risk factors and has a negative impact on QoL. Appropriate investigation regarding the factors associated with the types of UI should be performed to diminish its impact on QoL.

Prevalence of urinary incontinence and its association with multimorbidity in women aged 50 years or older: A population-based study

AIMS

To evaluate the prevalence and associated risk factors for urinary incontinence, as well as its association with multimorbidity among Brazilian women aged 50 or over.

METHODS

This was a secondary analysis of a cross-sectional population-based study including 622 women 50 years or older, conducted in the city of Campinas-SP-Brazil. The dependent variable was Urinary Incontinence (UI), defined as any complaint of urine loss. The independent variables were sociodemographic data, health-related habits, self-perception of health and functional capacity evaluation. Statistical analysis was carried out using the Chi-square test and Poisson regression.

RESULTS

The mean age of the women was 64. UI was prevalent in 52.3% of these women: Mixed UI (26.6%), Urge UI (13.2%) and Stress UI (12.4%). Factors associated with a higher prevalence of UI were hypertension (OR 1.21, CI 1:01-1:47, P = 0.004), osteoarthritis (OR 1.24, CI 1:03-1:50, P = 0.022), physical activity ≥3 days/week (OR 1.21, CI 1:01-1:44, P = 0.039), BMI ≥ 25 at the time of the interview (OR 1.25, CI 1:04-1:49, P = 0.018), negative self-perception of health (OR 1.23, CI 1:06-1:44 P = 0.007) and limitations in daily living activities (PR 1:56 CI 1:16-2:10, P = 0.004).

CONCLUSIONS

The prevalence of UI was high. Mixed incontinence was the most frequent type of UI. Many associated factors can be prevented or improved. Thus, health policies targeted at these combined factors could reduce their prevalence rate and possibly decrease the prevalence of UI.

Incidence and remission of urinary incontinence at midlife: a cohort study

OBJECTIVE

Urinary incontinence (UI) is often considered to be an age-related disease that develops gradually as women grow older. Much remains to be learnt about factors that promote its incidence or its remission. Our objective was to assess its incidence and risk factors.

DESIGN

Longitudinal cohort study.

SETTING

French GAZEL cohort.

POPULATION

A cohort of 4127 middle-aged women (aged 47-52 years at baseline) over an 18-year period (1990-2008).

METHODS

UI was defined as 'difficulty retaining urine'. The question was asked at baseline and repeated every 3 years over an 18-year period. Two groups (UI incidence and remission) were analysed according to status at baseline (continent or incontinent). A multivariable analysis (Cox model) was used to estimate the risk factors for UI incidence and remission.

MAIN OUTCOME MEASURES

Annual incidence and remission rates and risk factors for UI incidence and remission.

RESULTS

The annual incidence and remission rates for UI were 3.3% and 6.2%, respectively. High educational level (hazard ratio [HR] = 1.28; 95% confidence interval [95% CI] = 1.05-1.55), parity, i.e. at least one baby versus no baby (HR = 1.64; 95% CI = 1.19-2.27), menopause (HR = 5.44; 95% CI = 4.47-6.63), weight gain, i.e. for each kilogram change in weight (HR = 1.00; 95% CI = 1.00-1.02), onset of depressive symptoms (HR = 1.31; 95% CI = 1.09-1.57) and impairment in health-related quality of life incidence (social isolation dimension [HR = 1.29; 95% CI = 1.04-1.60] and energy dimension [HR = 1.41; 95% CI = 1.17-1.70]) were associated with an increased probability of UI. The factors associated with persistent UI were age (HR = 0.58; 95% CI = 0.55-0.61), weight gain (HR = 0.99; 95% CI = 0.98-0.99) and transition to menopausal status (HR = 1.54; 95% CI = 1.19-1.99).

CONCLUSIONS

Our study suggests that, in our population of middle-aged women, age, menopause, weight gain, onset of depression and impaired health-related quality of life may promote UI.

Prevalence and risk factors of urinary incontinence among Estonian postmenopausal women

Aims

To estimate the prevalence of urinary incontinence (UI) and to assess its risk factors among postmenopausal Estonian women.

Methods

In 2004, 1363 women participating in the Estonian Postmenopausal Hormone Therapy Trial were asked at the closure visit to the trial physician about symptoms of UI. The type of incontinence was assessed with the help of a questionnaire, based on recommendations from the working group set up by the Finnish Gynaecological Association. Frequency characteristics were analysed by descriptive statistics. Risk factors were examined using logistic regression.

Results

Mean age of study women was 53.3 years (min = 48, max = 67; SD 4.0). The prevalence of UI was 18.12% (95% CI: 16.07 - 20.17). Stress incontinence was diagnosed in 78.83% (95% CI: 73.32 - 84.33) and urge or mixed incontinence in 21.17% (95% CI: 15.67 - 26.68) of women who reported incontinence. Prevalence of UI slightly increased with age. Women who used hormone therapy (HT) (OR 1.67; 95% CI: 1.17 - 2.39), had had hysterectomy (1.73, 95% CI: 1.06 - 2.83), and those with secondary education (OR 1.87, 95% CI: 1.23 - 2.82) or basic education (OR 3.29, 95% CI: 1.80 - 6.02) had a higher risk for UI. Parity, having a BMI over 30 kg/m², being a smoker or a former smoker, having diabetes and being physically or sexually active, tended to increase the risk of UI.

Conclusions

About one in five postmenopausal women in Estonia reported to have UI. Risk factors linked with UI, its prevalence in other age groups and the impact of UI on quality of life deserve more research.

Trial registration

Number: ISRCTN35338757

Factors associated with persistent urinary incontinence

OBJECTIVE

Many women with urinary incontinence (UI) have symptoms that continue over many years; however, virtually nothing is known about factors that are associated with persistent UI.

STUDY DESIGN

We studied 36,843 participants of the Nurses' Health Study, aged 54-79 years at baseline for the UI study, who provided UI information on biennial questionnaires from 2000 through 2008; follow-up in the Nurses' Health Study is 90%. In total, 18,347 women had "persistent UI," defined as urine leakage ≥1/mo reported on all 5 biennial questionnaires during this 8-year period; 18,496 women had no UI during this period. Using multivariable-adjusted logistic regression, we estimated odds ratios (ORs) of persistent UI vs no UI across various demographic, lifestyle, and health-related factors, which were derived from reports in 2000.

RESULTS

Increasing age group, white race, greater parity, greater body mass index (BMI), and lower physical activity levels were each associated with greater odds of persistent UI, as were several health-related factors (ie, stroke, type 2 diabetes, and hysterectomy). Associations with persistent UI were particularly strong for increasing age group (P trend < .0001; OR, 2.75; 95% confidence interval [CI], 2.54-2.98 comparing women aged ≥75 vs <60 years) and greater BMI (P trend < .0001; OR, 3.14; 95% CI, 2.95-3.33 comparing women with BMI ≥30 vs <25 kg/m(2)); moreover, black women had much lower odds of persistent UI compared to white women (OR, 0.27; 95% CI, 0.21-0.34).

CONCLUSION

Factors associated with persistent UI were generally consistent with those identified in previous studies of UI over shorter time periods; however, older age, white race, and obesity were particularly strongly related to persistent UI.

Self-reported urinary incontinence and factors associated with symptom severity in community dwelling adult women: implications for women's health promotion

Background

Urinary incontinence (UI) continues to affect millions of women worldwide and those living in resource poor settings seem to be more affected. The purpose of this study was to determine the prevalence of UI and factors associated with UI symptom severity (UISS) among women in a selected district in India.

Methods

A cross-sectional design was used to collect data from a sample of 598 community dwelling women in the age range of 20 to 60 years. Data was collected using a questionnaire survey of participants who were found in their homes.

Results

The prevalence of UI was 33.8% and the majority of women had negative attitudes about the condition. For instance most women were in agreement with statements such as: UI cannot be prevented or cured (98%); women with UI are cursed (97%); women are not supposed to tell anyone about the problem (90%) and others. Of the 202 women with self-reported UI, the majority reported having moderate UISS (78%) and others rated the symptoms as mild (22%). The woman’s age at first birth (p<.01) was negatively associated with UISS, while the number of pregnancies (p<.01) and weight of the largest baby ever delivered (p<.01), were positively associated with UISS. The weight of the largest baby delivered had the strongest impact on predicting UISS.

Conclusions

Many community dwelling women are suffering from UI at proportions which warrant significant public health consideration. Therefore public health programs to prevent UI or worsening of symptoms are required and should emphasize health education, because of the pervasive negative attitudes among affected and unaffected women. The predictors reported here can be used to priotize care for affected women and to encourage early uptake of health actions and behaviors that promote pelvic floor strengthening in at risk women who may be reluctant to disclose UI.

Efeitos da cirurgia bariátrica na função do assoalho pélvico

RACIONAL: A incontinência urinária é bem documentada como comorbidade da obesidade. Estudos demonstram resolução ou atenuação da incontinência após a perda de peso. Porém, os mecanismos pelos quais isso ocorre ainda não estão claros. OBJETIVO: Avaliar os efeitos da cirurgia bariátrica na função do assoalho pélvico em mulheres. MÉTODOS: Foram avaliadas 30 mulheres que estavam em lista de espera para realizar a operação. Foi verificada a prevalência de incontinência urinária no pré e no pós-operatório e seu impacto na qualidade de vida através do King's Health Questionnaire. A qualidade da contração muscular do assoalho pélvico foi avaliada através da Escala de Oxford Modificada e da perineometria. RESULTADOS: Vinte e quatro mulheres finalizaram o estudo. O índice de massa corporal passou de 46,96±5,77 kg/m2 no pré-operatório para 29,97±3,48 kg/m2 no pós-operatório, e a perda percentual do excesso de peso média foi de 70,77±13,26%. A prevalência de incontinência urinária passou de 70,8% no pré-operatório para 20,8% no pós-operatório. Após um ano da cirurgia bariátrica, houve redução do impacto da incontinência urinária na qualidade de vida em sete dos nove domínios avaliados no questionário. A mediana da Escala de Oxford Modificada aumentou de três no pré-operatório para quatro no pós-operatório. A perineometria apresentou aumento significativo na média das três contrações solicitadas, passou de 21,32±12,80 sauers para 28,83±16,17 sauers na comparação pré e pós-operatória. O pico de contração também aumentou significativamente no pós-operatório em relação ao pré-operatório, passou de 25,29±14,49 sauers para 30,92±16,20 sauers. CONCLUSÃO: A perda massiva de peso através da cirurgia bariátrica repercute positivamente na função do assoalho pélvico e na qualidade de vida das mulheres com obesidade mórbida.

[Urinary incontinence and obesity]

Obesity, defined as a body mass index (BMI) more than or equal to 30kg/m(2), promotes pelvic floor disorders such as urinary incontinence (UI) and genital prolapse. Datas from cohort studies found an association between high BMI and the onset of UI. This association seems to be predominant with for mixed UI and stress UI. For the urge UI and overactive bladder syndrome, the analysis of the literature found a weaker association. The weight is therefore the only modifiable risk factor. Thus, the weight loss by a hypocaloric diet associated with pelvic floor muscle training should be the front line treatment in the obese patient suffering from UI. Bariatric surgery can be discussed in the most obese patient, even if the risk/benefit balance should be weighed because of significant morbidity of this surgery. The results of sub urethral sling (by retropubic tension-free vaginal tape or transobturator sling) in obese patients appear to be equivalent to those obtained in patients of normal weight. Datas on per- and postoperative complications for suburethral slings are reassuring.

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.