Urinary incontinence, related factors and menopause-related quality of life in mid-aged women assessed with the Cervantes Scale

Association of menopausal status and hormone use with bladder health and lower urinary tract symptoms in US women: results from the RISE FOR HEALTH study

OBJECTIVES

Most previous studies of genitourinary symptoms associated with menopause focus on comparisons of postmenopausal to premenopausal women and less is known about bladder health during menopause. We evaluated associations of menopause status and hormone use with bladder health and lower urinary tract symptoms (LUTS).

METHODS

Data were collected from May 2022 to December 2023 from a regionally representative cohort of community-dwelling adult women in the United States. Bladder health and LUTS were measured using validated questionnaires. Analyses included multivariable linear and logistic regression models.

RESULTS

Of 3,423 eligible participants, 3,126 responded to menopause and hormone use questions. Of these, 1,226 were premenopausal, 260 perimenopausal, and 1,640 postmenopausal. Premenopausal women reported hormone use more often than perimenopausal or postmenopausal women (38.3% vs. 21.5% and 13.2%). Across multiple bladder health scales (BHS, range 0-100) and bladder function indices (BFI, range 0-100), perimenopause and postmenopause status were associated with worse scores compared with premenopause status. Perimenopausal women were more likely to report urgency UI [OR 2.27, (95% CI: 1.49-3.46)] and other LUTS compared to premenopausal women. Hormone use was associated with worse bladder health in postmenopausal women [postmenopause/hormone -6.0 Overall BHS, (95% CI: -9.8 to -2.2)] and BFI [postmenopause/hormone BFI -4.8, (95% CI: -7.4 to -2.2)].

CONCLUSIONS

Promotion of bladder health and LUTS prevention is important as women approach the menopause transition. Hormone use was infrequently reported in perimenopausal and postmenopausal women and was associated with worse bladder health postmenopause.

Effect of pelvic floor muscle training on urinary incontinence symptoms in postmenopausal women: A systematic review and meta-analysis

OBJECTIVE

Urinary incontinence (UI) is common in women of all age groups, but postmenopausal women (MW) have a higher incidence of these symptoms. The International Continence Society suggests that women with UI should first try a conservative treatment, such as pelvic floor muscle training (PFMT), which aims to enhance the strength and rectify the activation patterns of the pelvic floor muscles. The aim of this study was to examine the effectiveness of PFMT, either on its own, or in conjunction with other physical therapy, in reducing the severity of UI symptoms in MW.

METHODS

A comprehensive literature search was performed to identify relevant publications from major medical databases. A meta-analysis was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model. In addition, the included studies were assessed for quality, heterogeneity and publication bias.

RESULTS

After screening, application of the inclusion/exclusion criteria, and bias assessment, five randomized controlled trials were evaluated. PFMT was found to have a significant and substantial impact on the level of UI in the total patient population (standardized mean difference between the intervention and control groups -1.30, 95%CI: -1.97, -0.62, pz ≤ 0.01, I2 = 88.5 %; probability of benefit = 0.92). A second analysis, after the removal of studies that combined PFMT with electrostimulation or biofeedback, returned similar results.

CONCLUSIONS

PFMT is an effective intervention for the management of UI in MW. Our analysis shows a 92% chance of significant improvement for patients receiving PFMT in comparison with controls. Future studies should examine its efficacy in MW subgroups with symptoms of genitourinary syndrome of menopause (GSM).

Stress urinary incontinence among Jordanian women living in rural areas: Prevalence, associated factors and self-management behaviours

Objectives: To assess the prevalence of stress urinary incontinence (SUI) among Jordanian women aged 35–65 years living in in rural areas and its associated risk factors.

Patients and methods: A cross-sectional study utilising a convenience sample of 1000 non-pregnant women who were recruited from healthcare centres and community settings. Participants completed a structured questionnaire that included demographic and gynaecological data, and questions about SUI. Descriptive analysis and logistic regression were used to analyse the data.

Results: Overall, 551 women (55.1%) reported having SUI with a duration of 37.9–47.6 months. The mean age of the women was 45.38 years and 29.6% were post-menopausal. Moreover, 40.6% were overweight, 38.9% obese, and 16.9% were smokers. Married women comprised 81.8%; with 37.1% having four to six children and 92.8% had a normal delivery, whereas 28% had a history of caesarean section. Coughing was the major precipitating factor for SUI (87.7%). In addition, 64.8% of women with SUI did not avoid activities that precipitated SUI such as housekeeping and lifting, and 78.6% did not seek any medical care. The major significant correlates for SUI were: high body mass index (odds ratio [OR] 2.506, 95% confidence interval [CI] 1.744–3.600, P < 0.001), being aged >50 years (OR 1.716, 95% CI 1.183–2.489, P = 0.004), a history of gynaecological/pelvic surgery (OR 1.631, 95% CI 1.206–2.205, P = 0.001), and vaginal delivery (OR 1.052, 95% CI 1.004–1.101, P = 0.033).

Conclusion: SUI prevalence among Jordanian women is high with symptoms reported in more than a half of study participants. Older age, obesity, a history of gynaecological surgery, and history of vaginal delivery were the major correlates of SUI. Public awareness is needed to identify the condition for early diagnosis and treatment of SUI.

Abbreviations: BMI: high body mass index; OR: odds ratio; (M)(S)(U)UI: (mixed) (stress) (urge) urinary incontinence

Validation of the UDI-6 and the ICIQ-UI SF - Croatian version

INTRODUCTION AND HYPOTHESIS

Despite the widespread use of UDI-6 and ICIQ-UI SF in Croatia, it remains unknown whether a realiable and valid measure for the population of interest is used. Thus, the aim of this study was to translate, adapt and validate the UDI-6 and the ICIQ-UI SF in Croatia.

METHODS

The study included a total of 232 consecutive patients with urinary incontinence symptoms. The translation to Croatian followed standardized procedure. All participants underwent urodynamic assesment and completed UDI-6 and ICIQ-UI SF questionnaires at inclusion and 2 weeks after to assess test-retest reliability. Cronbach α coefficient was calculated in order to assess internal consistency.

RESULTS

Both questionnaires had high internal consistency (Cronbach α for UDI-6 and ICIQ-UI SF was .83 and .85, respectively) and high test-retest reliability (intraclass correlation coefficient .99 for instruments). Strong correlation was found between urodynamic findings and total scores in UDI-6 and ICIQ-UI SF (ρ = 0.88 and 0.89, respectively). Women with stress urinary incontinence (SUI) and detrusor overactivity (DOA) group had significantly higher scores on UDI-6 (Mdn = 33.33 and Mdn = 50, respectively) compared to women with no urodynamic abnormality (Mdn = 0; p < 0.001). Women with no urodynamic abnormality scored significantly lower on ICIQ-UI SF (Mdn = 0; p < 0.001) compared to women with SUI (Mdn = 14) and DOA (Mdn = 16). Women with DOA scored worse on Irritative and Obstructive symptoms when comparing with two other groups (p < 0.001), while women with SUI had significantly worse score on Stress symptoms subscale (p < 0.001).

CONCLUSIONS

The UDI-6 and ICIQ-UI SF have very good psychometric characteristics and can be used in Croatian urogynecology practice.

Quality of life of women with urinary incontinence in rehabilitation treatment

This article analyzed how sexual satisfaction, suffering, severity and impact of urinary incontinence, and psychological morbidity affected women's quality of life and whether suffering mediated the relationship between psychological morbidity and quality of life. The study included 80 women diagnosed with urinary incontinence receiving rehabilitation treatment. Regression analysis showed that sexual satisfaction, suffering, and urinary incontinence severity and impact predicted quality of life and that suffering mediated the relationship between psychological morbidity and quality of life. The findings suggest that interventions should be tailored according to the suffering reported by women and the impact of the urinary incontinence on the couple's sexual relationship.

Assessing sexual problems in women at midlife using the short version of the female sexual function index

Assessment of sexual function is a complex process, especially in women, which requires in any individual case: time, appropriate training and experience. The prevalence of female sexual dysfunction is quite variable depending on the studied population, assessment methods, comorbid conditions and treatments, and age. A large number of screening methods have been developed over the last decades which range from tedious, exhaustive and boring tools to very simple standardized questionnaires. The 19-item female sexual function index (FSFI-19) is among the most used and useful- instrument designed to assess female sexual function in all types of circumstances, sexual orientation and perform the comparison of transcultural factors. A short 6-item- version of the FSFI-19 has been developed to provide a quick general approach to the six original domains (one item per domain). Nevertheless, further studies are needed to demonstrate its validity in different clinical situations as it has been extensively demonstrated with the original tool.

Application of the 10-item Cervantes Scale among mid-aged Ecuadorian women for the assessment of menopausal symptoms

BACKGROUND

The majority of instruments used to evaluate menopausal symptoms are long and complex. In this sense, more simple tests are being designed to rapidly obtain a snapshot of the global clinical picture.

OBJECTIVE

To assess menopausal symptoms in mid-aged women using the short 10 item version of the original menopause Cervantes Scale (CS-10).

METHOD

This was a cross sectional study in which a total of 451 Ecuadorian women (40-59 years) were surveyed with the CS-10 and a general socio-demographic questionnaire containing personal and partner data.

RESULTS

Median age of the whole sample was 48 years. A 41.2% were postmenopausal, 44.3% abdominally obese (waist circumference >88cm), 6% diabetic, 16.9% hypertense, 11.5% smoked, 6.9% currently used hormone therapy, 9.5% phytoestrogens and 6.7% psychotropic drugs. For the entire sample, median [interquartile range] CS-10 global scores were 10.0 [9.5], and for pre-, peri- and postmenopausal women: 5.0 [7.0], 11.0 [9.0] and 13.5 [8.0], respectively. The CS-10 displayed good internal consistency (Cronbach's alpha 0.87). According to the CS-10, the three most prevalent menopausal symptoms were: muscle and joint pains (88.5%), hot flushes (77.6%) and skin dryness (71.4%). Multiple linear regression analysis found that postmenopausal status, parity, unhealthy perceived status, psychotropic drug use, partner erectile dysfunction, lower coital frequency and living at high altitude were related to higher CS-10 global scores.

CONCLUSION

In this mid-aged Ecuadorian female sample severity of menopausal symptoms, as determined by the CS-10, were related to environmental and female/partner personal and socio-demographical aspects.

Evaluation of bioelectrical activity of pelvic floor muscles and synergistic muscles depending on orientation of pelvis in menopausal women with symptoms of stress urinary incontinence: a preliminary observational study

OBJECTIVES

Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt.

DESIGN

Preliminary, prospective observational study.

SETTING

Department and Clinic of Urology, University Hospital in Wroclaw, Poland.

PARTICIPANTS

Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study.

PRIMARY OUTCOME MEASURES

Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe.

SECONDARY OUTCOME MEASURES

Evaluation of activity of the synergistic muscles by sEMG and surface electrodes.

RESULTS

No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles.

CONCLUSIONS

This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM.