Treatment of urinary incontinence in cystic fibrosis

Optimizing sexual and reproductive health across the lifespan in people with cystic fibrosis

With improved therapies, people with cystic fibrosis are living longer and healthier lives and increasingly have questions surrounding their sexual and reproductive health. This article will summarize the important issues of which providers should be aware during the lifespan of people with cystic fibrosis, including puberty, adulthood, and menopause. A wide range of sexual and reproductive health topics are addressed such as puberty, transgender and gender nonbinary identities, contraception, sexually transmitted infections, hypogonadism, sexual functioning, cyclical hemoptysis, and urinary incontinence. We discuss gaps in knowledge and current evidence as well as management strategies to optimize care. Our goal is to support providers to enable them to give comprehensive care throughout the lifespan of people with cystic fibrosis.

Gynecologic health care for females with cystic fibrosis

•

Females with CF may have cyclic lung symptoms, yeast infections, and urinary incontinence.

•

Contraception is safe, but comorbidities should be considered in method selection.

•

Females with CF have reduced fertility, though the etiology is unknown.

•

Females with CF underutilize basic preventive gynecologic services.

As females with cystic fibrosis (CF) increasingly reach their reproductive years, gynecologic issues have become an important area of clinical care and research. First, females with CF may have disease-specific gynecologic problems, including cyclic pulmonary symptoms, vaginal yeast infections, and urinary incontinence. Next, contraceptive methods are thought to be overall safe and effective, however further research is needed to confirm this and to understand the lower rates of uptake among females with CF compared to the general population. Further, females with CF have reduced fertility, although the etiology of this is unknown and under investigation. While assisted reproductive technologies may help achieve pregnancy, decision-making around parenthood remains complex. Finally, while patients and providers agree on the importance of sexual and reproductive health care, females with CF underutilize basic preventive services such as cervical cancer screening, and better approaches are needed to bridge the gap with gynecology. In this review, we discuss the current state of gynecologic care for females with CF, as well as clinical and research opportunities for improvement.

Challenges Faced by Women with Cystic Fibrosis

Women with cystic fibrosis (CF) face several unaddressed concerns related to their health. These areas of concern include explanations and guidance on a sex disparity in outcomes, timing of puberty, effects of contraception, prevalence of infertility and impact of pregnancy, and prevention of urinary incontinence and osteoporosis. These understudied topics leave women with numerous unanswered questions about how to manage sexual and reproductive health in the setting of CF. Because people with CF are living longer and healthier lives, there is an increasing awareness of these important aspects of care and multiple ongoing studies to address these understudied topics.

Novel therapeutic approaches for the management of cystic fibrosis

Cystic fibrosis (CF) is a genetic condition characterised by the build-up of thick, sticky mucus that can damage many of the body's organs. It is a life-long disease that results in a shortened life expectancy, often due to the progression of advanced lung disease. Treatment has previously targeted the downstream symptoms such as diminished mucus clearance and recurrent infection. More recently, significant advances have been made in treating the cause of the disease by targeting the faulty gene responsible. Hope for the development of potential therapies lies with ongoing research into new pharmacological agents and gene therapy. This review gives an overview of CF, and summarises the current evidence regarding the disease management and upcoming strategies aimed at treating or potentially curing this condition.

[Prevalence and impact on quality of life of urinary incontinence in an adult population with chronic obstructive pulmonary diseases, literature review]

INTRODUCTION

Patients with obstructive lung diseases (OLD) are at-risk population for urinary incontinence (UI) with high frequency of increased intra-abdominal pressure because of chronic cough symptoms.

AIM OF THE STUDY

This review is aimed at determining the prevalence of UI and its impact on quality of life, patient healthcare research, diagnosis and treatment of UI among this population.

MATERIALS AND METHOD

Literature review from January 2001 to 2018 on Medline (PubMed) using keywords urinary incontinence, chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, quality of life.

RESULTS

The largest study showed that in a population of 14,828 people, whose 995 were diagnosed COPD, UI prevalence was 34.9% in people with COPD, versus 27.3% among the general population of the study (P=0.0048). Results in the other studies of the review were similar. UI was more severe in OLD patients and occurred on young subjects. Stress urinary incontinence symptoms were predominant, during cough but also during spirometry and chest rehabilitation sessions. Despite an impact on quality of life and treatment of OLD, UI was neglected.

CONCLUSION

UI prevalence seemed higher on population with OLD, to a greater degree of severity. Quality of life self-evaluation was further decreased when UI was associated with pulmonary disease.

Client and clinical staff perceptions of barriers to and enablers of the uptake and delivery of behavioural interventions for urinary incontinence: qualitative evidence synthesis

AIM

To evaluate factors influencing uptake and delivery of behavioural interventions for urinary incontinence from the perspective of clients and clinical staff.

BACKGROUND

Behavioural interventions are recommended as first-line therapy for the management of urinary incontinence. Barriers to and enablers of uptake and delivery of behavioural interventions have not been reviewed.

DESIGN

Qualitative evidence synthesis.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsychInfo, AMED (inception to May 2013); Proceedings of the International Continence Society (ICS) (2006-2013).

REVIEW METHODS

Studies where data were collected from clients or staff about their experiences or perceptions of behavioural interventions were included. Two reviewers independently screened records on title and abstract. Full-text papers were obtained for records identified as potentially relevant by either reviewer. Two reviewers independently filtered all full-text papers for inclusion, extracted findings and critically appraised studies. We used an approach akin to Framework, using a matrix of pre-specified themes to classify the data and facilitate its presentation and synthesis.

RESULTS

Seven studies involving 200 participants identified clients' views. Findings identified from at least one study of moderate quality included increased fear of accidents and convenience of treatment. Factors enabling participation included realistic goals and gaining control. Six studies involving 427 participants identified staff views. Findings identified from at least one study of moderate quality included staff education and perceptions of treatment effectiveness. Enabling factors included teamwork and experience of success.

CONCLUSION

There is little detailed exploration of clients' experiences of, and responses to, behavioural interventions. Evidence for staff relates predominantly to prompted voiding in long-term residential care. Studies of the uptake and delivery of other behavioural interventions in other settings are warranted.

Physiotherapy management of cystic fibrosis

For many years physiotherapy for cystic fibrosis (CF) was synonymous with a daily routine of postural drainage and percussion. Improved longevity and a desire for independence, together with a clearer understanding of the pathophysiology of the disease, has led to the development of many airway clearance techniques. The contribution of ‘chest’ physiotherapy remained unchallenged until recent times when lack of robust evidence and the presentation of asymptomic infants and adults led some physiotherapists to question this traditional approach. As survival increases into the fourth and fifth decade unique complications have evolved and physiotherapy management is challenged with nonrespiratory aspects of treatment. This review will consider the evidence for, and current practice of airway clearance, the value of exercise and the emerging problems of musculoskeletal complications and incontinence.

Physiotherapeutic management strategies for the treatment of cystic fibrosis in adults

Physiotherapy has long been considered a cornerstone of condition management for people with cystic fibrosis (CF). The presentation of CF has changed over time with an increased life expectancy and increased expectations of people with CF to have a complete lifestyle. In turn, the scope of strategies used in physiotherapy for CF have also changed dramatically over the years, moving away from routine postural drainage and manual techniques toward an individualized regimen including the choice of many different forms of airway clearance, such as both independent and assisted, exercise, treatments to promote continence and good posture, inhalation therapy, oxygen, and noninvasive ventilation. This article describes the techniques and overall strategies used by physiotherapists in helping people with CF to manage the symptoms and progression of their condition.

Measurement of pelvic floor muscular strength with the Colpexin pull test: a comparative study

INTRODUCTION AND HYPOTHESIS

The aim of this study is to compare the Colpexin pull test (CPT) with the Oxford muscle grading scale (OMGS) in assessing pelvic floor muscle strength.

METHODS

In phase 1, 15 asymptomatic women underwent OMGS and CPT using three different spheres to select the ideal size. CPT values as well as patient/examiner comfort and ease of CPT performance were recorded. In phase 2, 30 women with stress urinary incontinence underwent CPT and OMGS by two examiners during two separate sessions. Statistical analysis was performed.

RESULTS

In phase 1, the 36-mm sphere was selected based on resting (p < 0.001), contraction CPT (p < 0.001), patient ease (p = 0.018), patient comfort (p = 0.004), and examiner comfort (p < 0.001). In phase 2, there was good intra-rater and inter-rater agreement in maximum CPT. Both tests were positively correlated (r = 0.50, p < 0.001).

CONCLUSION

CPT is an objective measure of pelvic floor strength and provides consistent, reproducible results.

[Renal diseases in cystic fibrosis]

Patients with cystic fibrosis (CF) show a continuing improvement in their life expectancy thanks to advances in knowledge of this disorder, allowing better multidisciplinary routine monitoring and earlier therapeutic interventions. Likewise, more than of 40% of these patients are adults and CF is no more only a pediatric disease. Due to their higher life expectancy, CF patients present new and unusual complications that were not recorded before. Among them, some renal disorders have to be added to the CF-related renal diseases. They are due to frequent and prolonged exposure to various potentially nephrotoxic factors that need to be taken into account early enough in order to avoid renal failure : essentially risk factors for kidney stones formation, bacterial infections with their associated immune complexes diseases, nephrotoxic effects of antibiotics, diabetes mellitus. Because we observed a case of IgA glomerulonephritis in a 35-year-old patient with cystic fibrosis, we have searched about all these renal consequences due to this affection and here report them.

Urinary incontinence in 9-16 year olds with cystic fibrosis compared to other respiratory conditions and a normal group

BACKGROUND

Individuals with cystic fibrosis (CF) are deemed at risk of developing urinary incontinence (UI) due to repeated coughing and other factors causing increased pressure on the pelvic floor. Increased incidence of UI is recognised in women and increasingly in men and children. However, there is little comparison with normal controls and other respiratory conditions with chronic cough. Our aim was to report the incidence, degree and impact of UI in 9-16 year olds related to clinical status in CF, compared to these.

METHODS

9-16 year olds were invited to fill in a self-administered anonymous/confidential questionnaire at clinic. Data recorded were sex, age, height, weight, spirometry expressed as percentage predicted. Normal controls - age and sex only recorded.

RESULTS

No significant differences were found between incidence of UI (21% CF; 22% respiratory; and 17% normal controls, P=0.43). No relationship found between respiratory or nutritional status and UI. Laughing, exercise and cough were the most common causes of UI. No difference between groups for age range, physiotherapy, breathlessness, antibiotics, urinary tract infections and menarche. Only 6% reported more than a few drops of UI.

CONCLUSION

Incidence of urinary incontinence is no different between 9-16 year old girls and boys with CF, and controls.

A novel solution for severe urinary incontinence in women with cystic fibrosis

BACKGROUND

To explore whether Tension-free Vaginal Tape offers a solution for women with cystic fibrosis who suffer from severe stress incontinence.

METHODS

Four adults with cystic fibrosis were formally assessed by gynaecological and urological specialists, prior to hospital admission for surgery.

RESULTS

The procedure was tolerated well by all patients. In three, leakage ceased completely. The fourth patient experienced considerable improvement in symptoms.

CONCLUSIONS

Tension-free Vaginal Tape is a safe, effective and worthwhile solution for stress incontinence in females with cystic fibrosis.

A comparison of the prevalence of urinary incontinence in girls with cystic fibrosis, asthma, and healthy controls

Urinary incontinence (UI) is recognized as a significant problem in adult females with cystic fibrosis and can often have a marked impact on day-to-day activities. The prevalence and severity of UI in the pediatric cystic fibrosis (CF) female population is less clear and there are no comparative data with healthy children or children with other respiratory disorders. An anonymous self-completed semi-structured questionnaire was used to study the prevalence rates of UI in girls with CF aged between 11 and 17 and compared it to age-matched asthmatic and healthy girls. The prevalence of UI in girls with CF was significantly higher (17/51, 33%) than the asthmatic (4/25, 16%) and healthy girls (2/27, 7%) (P = 0.02). It may manifest as early as 11 years of age and is associated with increasing lung disease. Surprisingly it is perceived as a relatively minor problem in terms of the distress it causes. Pediatric CF clinics should be routinely addressing UI as a potential problem in all girls from the age of 11 years.

How has research in the last five years changed my clinical practice?

The first instruction to examination candidates is to read and answer the question actually set. Doing so in this case leads to the following

CONCLUSIONS

how research has changed my clinical practice includes the act of doing research, as well as reading about the work of others. Thus, this article refers to my own clinical practice (tertiary referral paediatric respiratory medicine in a setting where we do not service an accident and emergency department), rather than that of others. This means excluding important conditions such as acute croup and uncomplicated community acquired pneumonia. I should write about what has changed my practice, not what other people think I ought to have changed. So this will be a personal view, limited to research published in a peer review format at the time of writing. I shall also assume that change is an ongoing process, so I shall include change in progress, provided it is supported by published literature.