Body weight through adult life and risk of urinary incontinence in middle-aged women: results from a British prospective cohort

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.

Association of overweight, obesity and risk of urinary incontinence in middle-aged and older women: a meta epidemiology study

Aims

The aim of this meta-analysis is to evaluate the potential correlation between obesity and overweight, and the vulnerability to urinary incontinence (UI) in women aged middle-aged and above.

Methods

We searched PubMed, Cochrane Library, and Embase for observational studies published between the inception of the databases and April 25, 2023. A fixed-effects model was used when the P>0.1 and the I2 ≤ 50%. In cases where I2 ≥ 50% (indicating significant heterogeneity), a random-effects model was applied. For the purpose of evaluating publication bias, a funnel plot and Egger's test were used. Stata 14.0 was used for all statistical analyses.

Findings

This meta-analysis includes 16 observational studies, covering29,618 individuals. The pooled analysis shows that being overweight(25 kg/m2≤BMI<30kg/m2) in middle-aged and elderly women is more likely to develop UI (OR=1.27; 95% CI: 1.17-1.37; I2 = 51.8%, P=0.013). Middle-aged and elderly women with obesity(30 kg/m2≤BMI<35 kg/m2) are significantly more likely to develop UI (OR=1.60; 95% CI: 1.42-1.81; I2 = 71.8%, P=0.000). In addition, the results indicated a higher probability of UI in middle-aged and older women with obesity class II (BMI≥35 kg/m2) (OR=1.85; 95% CI: 1.59-2.16; I2 = 48.1%, P=0.103). In subgroup analysis, there is no direct relationship between the obesity in middle-aged and elderly women and an increased risk of stress urinary incontinence (SUI) (OR=1.31; 95% CI: 0.99-1.74; I2 = 63.7%, P=0.011). In middle-aged and elderly women with obesity are more likely to develop urgent urinary incontinence (UUI) (OR=2.11; 95% CI: 1.54-2.89; I2 = 80.2%, P=0.000).

Conclusion

In this meta-analysis, overweight and obesity are associated with an increased risk of UI in middle-aged and elderly women. Obesity and overweight are independent risk factors for UI, as demonstrated by this study.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023421986.

U-shaped association between sleep duration and urgency urinary incontinence in women: a cross-sectional study

BACKGROUND

To investigate the association between sleep duration and urgency urinary incontinence (UUI) among adult women.

METHODS

Cross-sectional data were retrieved from the 2005-2014 National Health and Nutrition Examination Survey. To explore the association between sleep duration and urgency urinary incontinence, multivariable logistic regression and restricted cubic spline (RCS) regression analysis was carried out.

RESULTS

Among 9204 adult women, the weighted urinary incontinence prevalence was  31% for urgency urinary incontinence (UUI). The fully adjusted multivariable model revealed that participants with short (< 7 h) or long (> 9 h) sleep duration were more likely to report UUI compared to participants with normal (7-9 h) sleep duration (OR 1.20, 95% CI 1.03-1.40, p = 0.02, OR 1.40, 95% CI 1.11-1.76, p = 0.005, respectively). Subgroup analysis showed no significant interaction. Furthermore, additional analysis demonstrated a U-shaped correlation between sleep duration and incident UUI.

CONCLUSION

The non-linear association exists between sleep duration and urgency urinary incontinence. Compared with insufficient or excessive sleep, normal sleep duration is related to lower prevalence of urgency urinary incontinence. Future prospective longitudinal studies should be conducted to further investigate and determine the degree of the association between sleep time and urgent urinary incontinence.

Impact of Defined Risk Factors on Degree of Urinary Stress Incontinence and Sling Outcome: A Retrospective Cohort Analysis

Urinary stress incontinence is a distressing condition that has a severe impact on quality of life for most affected women. The insertion of the suburethral tension-free vaginal tape (TVT) is regarded as the gold-standard surgical treatment option. It is unclear whether all women with severe SUI benefit equally from TVT. Thus, the aim of our study was to identify risk factors for severe SUI and determine whether successful the resolution of incontinence after a TVT procedure was different in women with a higher degree of SUI. In total, 168 women were included in this retrospective cohort study. Women with severe SUI showed a significantly lower maximum urethral closure pressure (MUCP) (median 53 cmH2O in moderate vs. 39 cmH2O in severe, p = 0.001) and higher BMI (median 26.1 kg/m2 in moderate vs. 28.5 kg/m2 in severe, p = 0.045). Sonographic bladder neck funneling was detected significantly more often in women with severe SUI (27% in moderate vs. 57% in severe, p = 0.004). Lower MUCP and higher BMI were identified as significant predictors of severe SUI (p < 0.032). There was no difference in parity, age, functional urethral length and negative urethral stress pressure. Overall postoperative continence after the insertion of TVT was 91.9%. We found no significant difference in postoperative continence between women with severe vs. moderate SUI, suggesting that in our cohort the success of TVT was not significantly affected by the severity of SUI. In our cohort, low MUCP and high BMI were shown to be significant predictors of SUI severity. Nevertheless, treatment success of SUI with TVT did not differ substantially in women with more severe SUI.

Rumba Dance Combined with Breathing Training as an Exercise Intervention in the Management of Stress Urinary Incontinence in Postmenopausal Women: A Randomized Controlled Trial

Purpose: Stress urinary incontinence (SUI) refers to involuntary leakage from the urethra, synchronous with exertion/effort, sneezing or coughing, which has a negative effect on quality of life. Studies have shown that mild-to-moderate physical activities reduce the risk of SUI by multiple mechanisms. The objective of this study was to determine whether the Rumba dance combined with breathing training (RDBT) can reduce the severity of incontinence and improve the quality of life of patients with SUI. Methods: A randomized clinical trial was conducted with women who were sedentary, were postmenopausal, reported mild-to-moderate SUI on a 1-h pad test, were not already engaged in Rumba dance and did not receive estrogen replacement therapy. The patients were randomly assigned to the RDBT group (n = 13) or the control group (n = 11). The intervention included 90 min of RDBT three times per week for 16 weeks, and the vaginal resting pressure (VRP), pelvic floor muscle (PFM) strength and endurance, 1-h pad test, International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ—UI SF), and the Incontinence Quality of Life Questionnaire (I—QOL) were measured or completed at baseline and 16 weeks. None of the participants reported adverse events. Results: The mean (±SD) age of the participants was 55.75 ± 5.58 years. After 16 weeks, in the RDBT group, the urine leakage on the 1-h pad test was significantly decreased −2.91 ± 0.49 from the baseline (p = 0.000). The VRP increased from 76.00 ± 16.23 cmH2O to 95.09 ± 18.90 cmH2O (p = 0.000), the PFM endurance of class I (−3.15 ± 1.99% vs. −0.46 ± 0.97%, p = 0.000) and class II (−0.69 ± 0.95% vs. −0.23 ± 0.44%, p = 0.065) increased, and the grades of PFM strength of class I and class II were significantly enhanced (p < 0.01). Finally, the severity of self-reported incontinence (ICIQ—UI SF) significantly decreased from 6.12 ± 2.15 to 3.81 ± 1.68 (p = 0.000), and quality of life (I—QOL) improved from 75.73 ± 11.93 to 83.48 ± 7.88 (p = 0.005). Conclusion: A 16-week RDBT program can increase PFM strength and endurance to reduce the severity of incontinence symptoms and improve the quality of life in patients with SUI, demonstrating the feasibility of recruiting and retaining postmenopausal women with SUI into a RDBT therapeutic program.

Improving the Technique of Pelvic Floor Muscle Contraction in Active Nulliparous Women Attending a Structured High-Low Impact Aerobics Program-A Randomized Control Trial

Learning the correct technique of performing pelvic floor muscle (PFM) exercises is a very important factor influencing the effectiveness of this muscle group training. Correctly performed PFM contractions are involved in the urinary continence mechanism. In this study, we tested the hypothesis that a six-week high-low impact aerobics program, supported by one EMG biofeedback session and pelvic floor muscle training, improves the technique of PFM contraction. Participants were 42 active nulliparous women (age 22 ± 2 years, mean ± SD), randomly allocated into intervention (n = 18) and control (n = 24) groups. We analyzed the technique of PFM contractions, taking into account the order in which selected muscle groups were activated, so called 'firing order'. In both groups, we assessed the PFM contraction technique using surface electromyography (sEMG) and intravaginal probes, before and after six weeks of intervention. The intervention group received one biofeedback session on how to properly contract PFM and afterwards participated in a high-low impact aerobics program supplemented by PFM training. The control group did not receive any intervention. In the pre-test, 67% of the intervention group activated PFM first in order in short, quick contractions. After six weeks of training, this task was correctly performed by 100% of this group (p = 0.04). The proper performance of PFM short contraction in the control group was 75% and 67%, before and after intervention, respectively. In the intervention group we also observed statistically significant improvement in the PFM contraction technique in 10-s contractions. The presented intervention was beneficial for the improvement of PFM contraction. High-low impact aerobics, supplemented by one EMG biofeedback session and pelvic floor muscle training can be recommended for active nulliparous women.

Urinary incontinence, body mass index, and physical activity in young women

BACKGROUND

Current evidence suggests that excess weight and obesity are important risk factors for urinary incontinence in women. However, limited data exist regarding the relationships among body mass index, physical activity, and urinary incontinence in women in their 20s.

OBJECTIVE

This study aimed to (1) compare prevalence rates of urinary incontinence and high body mass index in 2 cohorts of young women, (2) explore associations between changes in body mass index and urinary incontinence using analysis of combined data from the 2 cohorts, and (3) explore the associations between physical activity and urinary incontinence, with adjustment for body mass index.

STUDY DESIGN

Data were collected from 2 cohorts of young women in the Australian Longitudinal Study of Women's Health (n=16,065), born 17 years apart: 1973-1978 (cohort 1) and 1989-1995 (cohort 2). The women in both cohorts completed the surveys at age 18 to 23 years (T1), with follow-up 4 years later (age, 22-27 years; T2). Self-reported urinary incontinence and body mass index were assessed in both surveys. As physical activity was measured using different questions in cohort 1 at T1, self-reported physical activity data were from T2 only. A total of 9 body mass index transition categories (based on body mass index status at baseline and follow-up) and 4 physical activity categories were created to assess multivariate-adjusted prevalence ratios for urinary incontinence at T2, using Poisson regression.

RESULTS

Rates of obesity increased in both cohorts over 4 years, from 6.6%% (95% confidence interval, 6.1-7.2) to 10.4% (95% confidence interval, 9.7-11.0) in cohort 1 and from 11.7% (95% confidence interval, 11.0-12.4) to 19.6% (95% confidence interval, 18.7-20.5) in cohort 2. Compared with women who maintained normal body mass index at T1 and T2, the prevalence ratio for urinary incontinence among those with body mass index >30 at age 22 to 27 years was higher, regardless of body mass index category at age 18 to 23 years (prevalence ratio at T1: 1.39 for normal body mass index [95% confidence interval, 1.1-1.76]; 1.44 for overweight [95% confidence interval, 1.27-1.63]; and 1.51 for obese [95% confidence interval, 1.36-1.67]). In cohort 1, there was no relationship between physical activity and urinary incontinence. However, in cohort 2 there was an inverse dose-response relationship between physical activity and urinary incontinence.

CONCLUSION

The strong association between obesity and urinary incontinence in young women is a public health concern, given that obesity rates are likely to increase further with age and parity. The potential mitigating effects of physical activity on the obesity-incontinence relationship merit further investigation.

Habitus and Pelvic Floor Symptoms and Support 1 Year Postpartum

OBJECTIVE

To estimate the association between habitus measures and pelvic floor support and symptoms in primiparous women 1 year after term vaginal delivery.

METHODS

In this cross-sectional study including women enrolled at seven academic and community sites, we assessed pelvic floor support, weight, height, waist circumference, and percent fat using air displacement plethysmography and participants completed questionnaires, all at one year postpartum. We tested the association of quintiles of habitus measure, including body mass index (BMI), waist circumference, percent body fat, and waist/height ratio, with the primary outcomes: anatomic support, dichotomized as maximal vaginal descent less than 0 cm (better support) compared with 0 cm or more (worse support) per the pelvic organ prolapse quantification examination and symptom burden (positive with bothersome symptoms in two or more of six symptom domains), and on five secondary outcomes. The sample size provides 90% power to detect odds ratios (ORs) of 1.78 or greater between women at mean compared with mean+1 SD of habitus measure.

RESULTS

Of 592 participants, 55 (9.3%) demonstrated worse support and 321 (54.2%) symptom burden. In multivariable analyses, habitus measures were not significantly associated with anatomic support or, except for the highest waist/height ratio quintile, with symptom burden. Compared with women in the first quintile of each habitus measure, those in most higher quintiles demonstrated elevated odds of moderate to severe urinary incontinence (UI); increased odds for stress urinary incontinence (SUI) were mainly limited to the highest quintile. After adjusting for percent body fat, the increased odds for BMI on SUI (OR 2.47, 95% CI 1.43-4.28) were no longer significant (OR 1.38, 95% CI 0.54, 3.51).

CONCLUSION

Habitus in primiparous patients at 1 year postpartum was not associated with anatomic support or symptom burden. Habitus was more associated with moderate to severe UI than mild UI. The association of higher BMI with SUI was attenuated by fitness, reflected by fat percentage.

Progress in studies on pathological changes and future treatment strategies of obesity-associated female stress urinary incontinence: a narrative review

With the increasing prevalence of obesity worldwide, obesity-related female stress urinary incontinence (FSUI) has become a key health problem. Recent studies indicated that FSUI is primarily caused by obesity-related pathological changes, such as fat droplet deposition, and results in pelvic floor nerve, vascular, and urethral striated muscle injury. Meanwhile, treatments for obesity-associated FSUI (OA-FSUI) have garnered much attention. Although existing OA-FSUI management strategies, including weight loss, pelvic floor muscle exercise, and urethral sling operation, could play a role in symptomatic relief; they cannot reverse the pathological changes in OA-FSUI. The continued exploration of safe and reliable treatments has led to regenerative therapy becoming a particularly promising area of researches. Specifically, micro-energy, such as low-intensity pulsed ultrasound (LIPUS), low-intensity extracorporeal shock wave therapy (Li-ESWT), and pulsed electromagnetic field (PEMF), have been shown to restore the underlying pathological changes of OA-FSUI, which might be related by regulation endogenous stem cells (ESCs) to restore urine control function ultimately in animal experiments. Therefore, ESCs may be a target for repairing pathological changes of OA-FSUI. The aim of this review was to summarize the OA-FSUI-related pathogenesis, current treatments, and to discuss potential therapeutic options. In particular, this review is focused on the effects and related mechanisms of micro-energy therapy for OA-FSUI to provide a reference for future basically and clinical researches.

The effects of obesity on the human body part III: Cardiovascular, digestive, excretory, endocrine, and reproductive

This third installment of The Effects of Obesity on the Human Body discusses the endocrine, digestive, reproductive, cardiovascular, and excretory systems. Obesity is known to upset hormonal balance, leading to widespread metabolic disorders involving organs such as the liver and pancreas. Furthermore, the hypersecretion of leptin from adipose tissue triggers various responses from the cardiovascular and gastrointestinal systems, with implications for energy and nutrient balance and uptake.

Prevalence of urinary incontinence in women powerlifters: a pilot study

INTRODUCTION AND HYPOTHESIS

Increased intra-abdominal pressure is associated with urinary incontinence (UI) as is increasing age, obesity, and participating in sport at an elite level. We aimed to determine the prevalence of UI in competitive women powerlifters and establish if commonly cited risk factors affect the incidence of UI.

METHODS

The authors developed a 17-item questionnaire to investigate the prevalence of UI and the relationship of UI with age, body mass, resistance training experience, and competition grade in competitive women powerlifters. The questionnaire was distributed through three major powerlifting federations in Australia for 16 months. The data of 134 competitive women powerlifters were collected anonymously using Qualtrics, and were analysed using multivariate analysis.

RESULTS

In combination, the age of lifters, resistance training experience, body weight categories, and competition grade accounted for a significant 28% of the variability in the Incontinence Severity Index (ISI) (p < 0.01). However, the ISI was not significantly different among age groups, body weight categories, or competition grade. Approximately, 41% of women powerlifters had experienced UI at some stage in life, and 37% of women powerlifters currently experienced UI during training, competition, or maximum effort lifts. However, the rate of UI experienced during daily life activities was approximately 11%.

CONCLUSIONS

This study showed that competitive women powerlifters experience a higher rate of UI during lifting-related activities than in daily life and that the rate of UI correlates positively with age, body weight categories, resistance training experience, and competition grade.

Overweight and obesity as major, modifiable risk factors for urinary incontinence in young to mid-aged women: a systematic review and meta-analysis

The purpose of this review and meta-analysis was to evaluate overweight and obesity as risk factors for urinary incontinence in young to mid-aged women. Understanding these relationships during this life stage is important as early onset increases the risk for developing severe and persistent incontinence. A systematic search resulted in 497 citations, 14 of which were retained for review. Data were analysed by overweight and obesity and by subtype of urinary incontinence - stress, urge, mixed and severe. When compared with 'normal' body mass index, overweight was associated with a one-third increase in risk of urinary incontinence (relative risk = 1.35, 95% confidence interval = 1.20-1.53), while the risk was doubled in women with obesity (relative risk = 1.95, 95% confidence interval = 1.58-2.42). When estimates were pooled according to urinary incontinence subtype, there was no statistical difference in risk. Overweight and obesity are strong predictors of urinary incontinence, with a significantly greater risk observed for obesity. Clinical advice to young women at risk of, or presenting with, obesity should not be limited to metabolic health only but should emphasize the role of excess weight on pelvic floor weakening and subsequent risk of incontinence.

Quality of life and sexual functıon in obese women with pelvic floor dysfunction

This prospective study was conducted in the urogynecology and gynecology outpatient clinics of Istanbul Faculty of Medicine from December 2014 to March 2015. The objective was to identify the association between obesity and sexual function and quality of life in women with pelvic floor dysfunction (PFD). A total of 387 sexually active women diagnosed with urinary incontinence and/or pelvic organ prolapse were included and categorized as obese (n = 200) or nonobese (n = 187). Mean body mass indexes were 25.7 ± 2.41 kg/m² for nonobese women and 34.9 ± 3.92 kg/m² for obese women. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 total score was significantly lower in obese (27.66 ± 7.12) than in nonobese women (30.18 ± 6.54) (p < .05). Quality of life mean scores were higher in obese women for both the Incontinence Impact Questionnaire total score (67.24 ± 26.8 versus 49.12 ± 27.5) and Urogenital Distress Inventory total score (65.02 ± 21.4 versus 55.07 ± 24.7) (p < .001). Obese women with PFD had symptoms for longer durations, had more frequent urinary incontinence, and worse sexual function and quality of life than nonobese women. Health-care professionals caring for obese women should be aware of the coexistence of obesity and PFD. Future studies should evaluate whether obesity-associated PFD can be reduced through successful weight reduction interventions.

Normal values for assessment of anal sphincter morphology, anorectal motion, and pelvic organ prolapse with MRI in healthy women

BACKGROUND

Endoanal MRI and MR defecography are used to identify anal sphincter injury and disordered defecation. However, few studies have evaluated findings in asymptomatic healthy people. The effects of BMI and parity on rectoanal motion and evacuation are unknown.

METHODS

In 113 asymptomatic females (age 50 ± 17 years, Mean ± SD) without risk factors for anorectal trauma, anal sphincter appearance, anorectal motion, and pelvic organ prolapse were evaluated with MRI. The relationship between age, BMI, and parity and structural findings were evaluated with parametric and non-parametric tests.

RESULTS

The anal sphincters and puborectalis appeared normal in over 90% of women. During dynamic MRI, the anorectal angle was 100 ± 1º (Mean ± SEM) at rest, 70 ± 2° at squeeze, and 120 ± 2° during defecation. The change in anorectal angle during squeeze (r = -.25, P < .005), but not during evacuation (r = .13, P = .25) was associated with age. In the multivariable models, BMI (P < .01) and parity (P < .01) were, respectively, independently associated with the intersubject variation in the anorectal angle at rest and the angle change during squeeze. Ten percent or fewer women had had descent of the bladder base or uterus 4 cm or more below the pubococcygeal line or a rectocele measuring 4 cm or larger. Only 5% had a patulous anal canal.

CONCLUSIONS

In addition to age, BMI and parity also affect anorectal motion in asymptomatic women. These findings provide age-adjusted normal values for rectoanal anatomy and pelvic floor motion.

Association of General Obesity and Abdominal Obesity with the Prevalence of Urinary Incontinence in Women: Cross-sectional Secondary Data Analysis

BACKGROUND

Urinary incontinence is prevalent among older adults worldwide and associated with lower quality of life. Obesity is highly associated with development or exacerbation of urinary incontinence. We examined the impact of different types of obesity (general obesity and abdominal obesity) on urinary incontinence.

METHODS

We employed 2007-2009 Korean National Health and Nutrition Examination Survey (KNHANES) with 4648 females over 19 yr of age. Body mass index, waist circumstance, total body fat percentage, trunk fat percentage, demographic variables, and potential confounding factors were assessed. Chi-square tests and logistic regression analysis were used.

RESULTS

There were significant trends of increasing risk of urinary incontinence with increasing body mass index (P =.002), waist circumstance (P = .001), percent total body fat (P =.029) and percent trunk fat (P =.005). Regarding the association of urinary incontinence prevalence with different types of obesity, nonobese women with abdominal obesity had the highest odds ratio of urinary incontinence, followed by obese women with abdominal obesity (odds ratio = 1.59 and 1.55, respectively).

CONCLUSION

Abdominal obesity may be more likely to be associated with urinary incontinence compared to overall obesity. Early screening and identification of abdominal obesity may be needed for older women to prevent or reduce urinary incontinence episodes.

Urinary incontinence in women

Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.

Risk factors for urinary incontinence among postmenopausal Mexican women

INTRODUCTION AND HYPOTHESIS

Previous studies of racial/ethnic variation in urinary incontinence (UI) suggest that population-specific studies of UI risk factors are needed to develop appropriate public health recommendations. We assessed UI risk factors among postmenopausal Mexican women enrolled in the Mexican Teachers' Cohort.

METHODS

We conducted a cross-sectional study among 15,296 postmenopausal women who completed the 2008 questionnaire. UI cases were women who reported experiencing UI during menopause. Self-reported potential UI risk factors included age, reproductive variables, smoking status, adiposity, and several health conditions. We estimated multivariate-adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for UI using multivariable logistic regression.

RESULTS

Among these postmenopausal women, the prevalence of UI was 14 %. Odds of UI were higher among women with ≥4 children vs nulliparous women (OR 1.43, 95 % CI 1.04-1.96) or body mass index (BMI) ≥30 vs <22 kg/m² (OR 2.00, 95 % CI: 1.55-2.57). Age at first birth <20 vs 20-24 years, past or current vs never smoking, larger waist-to-hip ratio, and history of asthma, high blood pressure, or diabetes were also associated with higher odds of UI (OR 1.2-1.3). We found a trend of lower odds of UI with older age.

CONCLUSIONS

Our data suggest that information about UI and UI prevention strategies might be particularly useful for Mexican postmenopausal women with 4 or more children or higher BMI. Further studies with longitudinal UI data, in addition to data on UI severity and subtype, are needed to provide more specific information about UI risk factors to Mexican women.

Obesity with Comorbid Stress Urinary Incontinence in Women: A Narrative Review to Inform Dietetics Practice

Stress urinary incontinence (SUI) is a common problem among women; clinical treatment guidelines include weight reduction as a strategy for controlling urinary leakage. The purpose of this review was to gather evidence on the association between obesity and SUI and to ascertain whether there are any special considerations for implementing medical nutrition therapy with community-dwelling, obese, adult females with comorbid SUI. Five key findings emerged: epidemiologic studies consistently report statistically significant associations between obesity and SUI, randomized control trials found that weight loss appears to ameliorate SUI symptoms, the SUI-activity link may affect weight management, there is a potential interplay between SUI and the obesity-sleep connection, and dietary components are associated with the exacerbation of urinary symptoms. The pathogenesis of SUI and obesity-related contributions to urinary leakage is included in the introductory discussion. Lastly, insights on special considerations for implementing nutrition interventions with this population are offered.

The Health Consequences of Obesity in Young Adulthood

Young adults are gaining weight faster than any age group. This weight gain and the appearance of obesity-related comorbidities often commence in adolescence. Psychosocial distress and mental health issues are common and debilitating, and treatment approaches are likely to be similar to those for adolescents. At the same time, young adults may have physical morbidities which will continue and worsen throughout adulthood, such as hypertension, diabetes and polycystic ovarian syndrome. Health consequences of obesity are challenging to manage in young adults as their symptoms may be minimal, they are less likely to engage with healthcare due to other life priorities and their neurocognitive developmental stage makes therapy adherence difficult. Clinicians who manage young adults with obesity need to be aware of these age-specific challenges, as well as the sexual and reproductive health concerns that are present in this age group.

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.

Lifetime physical activity and female stress urinary incontinence

OBJECTIVE

We sought to estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous, and strenuous activity during the teen years.

STUDY DESIGN

Recruitment for this case-control study was conducted in primary-care-level family medicine and gynecology clinics. A total of 1538 enrolled women ages 39-65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls had no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. In all, 213 cases were frequency matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures.

RESULTS

SUI odds increased slightly with overall lifetime activity (odds ratio [OR], 1.20 per 70 additional metabolic equivalent of task-h/wk; 95% confidence interval [CI], 1.02-1.41), and were not associated with lifetime strenuous activity (OR, 1.11; 95% CI, 0.99-1.25). In quintile analysis of lifetime leisure activity, which demonstrated a nonlinear pattern, all quintiles incurred about half the odds of SUI compared to reference (second quintile; P = .009). Greater strenuous activity in teen years modestly increased SUI odds (OR, 1.37 per 7 additional h/wk; 95% CI, 1.09-1.71); OR, 1.75; 95% CI, 1.15-2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/wk during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21-65 years.

CONCLUSION

In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.

Uterine leiomyomata associated with self-reported stress urinary incontinence

AIMS

To investigate the association between the presence and characteristics of uterine leiomyomata (UL) and self-reported stress urinary incontinence (SUI).

METHODS

The study included 836 premenopausal participants (474 African American and 362 Caucasian) in the National Institute of Environmental Health Sciences (NIEHS) Uterine Fibroid Study. UL were characterized at baseline with ultrasound screening, and SUI was assessed at follow-up (after 4 years, on average). Linear risk models were used to estimate adjusted prevalence differences (aPD) and 95% confidence intervals (CI), controlling for age, ethnicity, body mass index (BMI), and number of deliveries.

RESULTS

Compared with women without UL, SUI prevalence was higher among women with any UL (aPD = 7.4%, 95% CI 0.4-14.3) and women with UL 2-4 cm (aPD = 9.6%, 95% CI 1.3-17.9). Marginally significant results were found for the presence of UL > or =4 cm and anterior UL > or =2 cm.

CONCLUSIONS

The observed 7% increase in prevalence of this common condition for women with UL is of clinical importance. Further research is needed before concluding that treatment for larger UL might enhance SUI treatment in some women.

Effect of weight loss on urinary incontinence in women

BACKGROUND

The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence.

METHODS

A literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized.

RESULTS

Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%-70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4-5. The odds of incident urinary incontinence over 5-10 years increase by approximately 30%-60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence.

CONCLUSION

Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence.

Alcohol, tobacco, and mammographic density: a population-based study

Mammographic density (MD), or the proportion of the breast with respect to its overall area that is composed of dense tissue, is a strong risk factor for breast cancer. Studies support a positive association of mammographic density and alcohol drinking. This was a cross-sectional multicenter study based on 3584 women, aged 45-68 years, recruited from seven screening centers within the Spanish breast cancer screening program network. The association between MD, alcohol consumption and tobacco use was evaluated by using ordinal logistic models with random center-specific intercepts. We found a weak positive association between current alcohol intake and higher MD, with current alcohol consumption increasing the odds of high MD by 13% (OR = 1.13; 95% CI 0.99-1.28) and high daily grams of alcohol being positively associated with increased MD (P for trend = 0.045). There were no statistically significant differences in MD between smokers and non-smokers. Nevertheless, increased number of daily cigarettes and increased number of accumulated lifetime cigarettes were negatively associated with high MD (P for trend 0.017 and 0.021). The effect of alcohol on MD was modified by menopausal status and tobacco smoking: whereas, alcohol consumption and daily grams of alcohol were positively associated with higher MD in postmenopausal women and in women who were not currently smoking, alcohol consumption had no effect on MD in premenopausal women and current smokers. Our results support an association between recent alcohol consumption and high MD, characterized by a modest increase in risk at low levels of current consumption and a decrease in risk among heavier drinkers. Our study also shows how the effects of alcohol in the breast can be modified by other factors, such as smoking.

Menopausal transition and the risk of urinary incontinence: results from a British prospective cohort

OBJECTIVE

to investigate the effect of menopausal transition and age on symptoms of urinary incontinence in midlife.

SUBJECTS AND METHODS

the study included a nationally representative cohort of 1211 women followed up since their birth in 1946 and annually from 48-54 years; their menopausal transition status and symptoms of stress, urge, and severe urinary incontinence (UI) at 7 consecutive years from ages 48-54 were assessed.

RESULTS

from Generalized Estimating Equations, women who became perimenopausal ('pre-peri') or those experiencing perimenopause for >1 year ('peri-peri') were more likely to have symptoms of stress UI than were postmenopausal women; the odds ratio (95% confidence interval) was; pre-peri 1.39 (1.11-1.73); and peri-peri 1.39 (1.4-1.71). Menopausal transition status was not associated with urge or severe UI. These relationships were not explained by age, childhood enuresis, reproductive factors, previous health status, body mass index and educational qualifications.

CONCLUSION

this study is unique in being able to disentangle the effects of age, menopausal transitions, and other life-long risk factors on UI. Menopausal transition was only related to stress UI, while increasing age was related to both stress and urge UI. This study suggests that there are both shared and distinct aetiological pathways leading to each type of UI.

Prevalence and related factors of urinary incontinence among Hebei women of China

BACKGROUND/AIMS

The aim of this study was to assess the prevalence and related factors of different types of urinary incontinence (UI) among Hebei women in China.

METHODS

A total of 2,500 women aged 20 years or more were sampled and interviewed face-to-face by well-trained interviewers.

RESULTS

Among these women, 35.2% (862/2,448) had UI. The prevalence of stress, urge, and mixed UI was 26.4% (647/2,448), 1.9% (47/2,448), and 6.9% (168/2,448), respectively. In multivariable logistic regression, age, constipation, pelvic organ prolapse, number of abortions, and cesarean sections were associated with both stress and mixed UI; body mass index, dysmenorrhea, vaginitis and cervicitis, fetal weight, and dystocia were associated with stress UI only; age of menarche and dystocia were associated with urge UI only, and living in a city or countryside, a history of pelvic operation, urinary infection, diseases of the respiratory system, heart disease, and alcohol consumption with mixed UI.

CONCLUSIONS

UI is a highly prevalent condition among women in Hebei Province, PR China. Stress, urge, and mixed UI not only have some related factors in common but also have some different ones. Economic condition and a lack of UI-related knowledge are factors keeping patients from seeing a doctor.

The postmenopausal bladder

The bladder and its surrounding structures are rich in estrogen receptors and there are demonstrable physiological and anatomical changes that occur around and immediately after the menopause. The prevalence of many bladder symptoms, such as frequency, urgency and incontinence, does seem to increase around the menopause, but there is continuing debate over whether these effects are due to ageing, menopause or a combination of the two. The impact of the menopause varies with individual symptoms; stress urinary incontinence being associated more with estrogen deficiency than urge incontinence which seems to be more age-related. Both estrogen and progesterone have a variety of effects on the urogenital tract which are reviewed. Based on these effects, it could be anticipated that estrogen replacement would have a positive effect on bladder symptoms. However, the data are far from clear cut on this issue. It seems that topical estrogens do have some positive effects, particularly on symptoms of urgency, frequency and urge incontinence, the prevention of urogenital atrophy and in the prevention of recurrent urinary tract infections. The role of systemic estrogens is less clear cut with some studies even suggesting they can be associated with a worsening of some symptoms. The possible explanations for this apparent contradiction are explored, but based on current evidence, it would appear preferable to use vaginal estrogens rather than systemic as part of the management of menopause-related bladder problems.

Urinary incontinence and weight change during pregnancy and postpartum: a cohort study

Weight gain during pregnancy may contribute to increased urinary incontinence (UI) during and after pregnancy, but scientific support is lacking. The effect of weight loss on UI postpartum is unclear. From 1999 to 2006, investigators in the Norwegian Mother and Child Cohort Study recruited pregnant women during pregnancy. This study was based on 12,679 primiparous women who were continent before pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and 6 months postpartum. Weight gain greater than the 50th percentile during weeks 0-15 of pregnancy was weakly associated with higher incidence of UI at week 30 compared with weight gain less than or equal to the 50th percentile. Weight gain greater than the 50th percentile during pregnancy was not associated with increased prevalence of UI 6 months postpartum. For each kilogram of weight loss from delivery to 6 months postpartum among women who were incontinent during pregnancy, the relative risk for UI decreased 2.1% (relative risk = 0.98, 95% confidence interval: 0.97, 0.99). Weight gain during pregnancy does not seem to be a risk factor for increased incidence or prevalence of UI during pregnancy or postpartum. However, weight loss postpartum may be important for avoiding incontinence and regaining continence 6 months postpartum.

Obesity and reproductive hormone levels in the transition to menopause

OBJECTIVE

The aim of this study was to estimate associations of obesity with reproductive hormone levels as women progress from premenopausal to postmenopausal status.

METHODS

This was a longitudinal study conducted in the population-based Penn Ovarian Aging Cohort (N = 436). At cohort enrollment, the women were premenopausal, ages 35 to 47 years, with equal numbers of African Americans and whites. Anthropometric measures, menopause status, and reproductive hormone measures were evaluated for 12 years. Associations of the anthropometric measures with estradiol, follicle-stimulating hormone, and inhibin B in the menopausal transition were estimated using generalized linear regression models for repeated measures.

RESULTS

Associations between obesity and hormone levels differed by menopause status as indicated by significant interactions between each hormone and menopausal stage. Premenopausal obese and overweight women had significantly lower estradiol levels compared with nonobese women, independent of age, race, and smoking (obese: 32.8 pg/mL [95% CI, 30.6-35.2] vs nonobese: 39.8 pg/mL [95% CI, 37.0-42.8], P < 0.001). The associations reversed postmenopause, with obese women having the highest estradiol levels (obese: 20.6 pg/mL [95% CI, 17.2-24.7] vs nonobese: 12.2 pg/mL [95% CI, 10.1-14.8], P < 0.001). Inhibin B levels were significantly lower in premenopausal obese compared with nonobese women but reversed in the late transition stage. Follicle-stimulating hormone levels were lowest in postmenopausal obese compared with nonobese women (P < 0.001). Measures of waist circumference (central adiposity) and waist-to-hip ratio paralleled the body mass index results.

CONCLUSION

Obesity is an important factor in hormone dynamics independent of age, race, and smoking in midlife women, although the mechanisms remain unclear.

Impact of obesity on gynecology

Rising obesity rates around the world have had a profound impact on female reproductive health. Childhood obesity is associated with early onset of puberty, menstrual irregularities during adolescence and polycystic ovary syndrome. Women of reproductive age with high BMIs have a higher risk of ovulatory problems and tend to respond poorly to fertility treatment. Strategies for fertility control can also be complex since the efficacy and safety of hormonal contraceptives can be compromised by increased body weight. Obesity can aggravate symptoms of pelvic organ prolapse, stress urinary incontinence and increase the risk of endometrial polyps and symptomatic fibroids. Weight reduction enhances reproductive outcomes, diminishes symptoms of urinary incontinence and reduces morbidity following gynecological surgery. Sustained and substantial weight loss is difficult to achieve with the lifestyle and dietary measures that are currently available. A number of pharmacological treatment options are available, and there are emerging data on reproductive outcomes following surgical treatment for obesity.

Obesity and urinary incontinence: epidemiology and clinical research update

PURPOSE

We reviewed the epidemiological literature on the association of obesity and urinary incontinence, and summarized clinical trial data on the effect of weight loss on urinary incontinence.

MATERIALS AND METHODS

We systematically searched for published community based prevalence studies with bivariate or multivariate analysis of the association of urinary incontinence and overweight/obesity in women. Case series and randomized controlled trials of the effect of surgical, behavioral and pharmacological weight loss on urinary incontinence are summarized.

RESULTS

Epidemiological studies showed that obesity is a strong independent risk factor for prevalent and incident urinary incontinence. There was a clear dose-response effect of weight on urinary incontinence with each 5-unit increase in body mass index associated with about a 20% to 70% increase in the urinary incontinence risk, and the maximum effect of weight rarely exceeded an OR of greater than 4 to 5 on well controlled analyses. The odds of incident urinary incontinence during 5 to 10 years increased by approximately 30% to 60% for each 5-unit increase in body mass index. There may be a stronger association of increasing weight with prevalent and incident stress incontinence, including mixed incontinence, than with urge incontinence and overactive bladder syndrome. Weight loss studies indicated that surgical and nonsurgical weight loss led to significant improvements in urinary incontinence symptoms.

CONCLUSIONS

Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by surgical and more conservative approaches is effective to decrease urinary incontinence symptoms and should be strongly considered a first line treatment in this patient population.