Prevalence and factors of urinary incontinence among postpartum: systematic review and meta-analysis

Psychometric validity and reliability of the Turkish version of the questionnaire for urinary incontinence diagnosis in women with urinary incontinence

BACKGROUND

The aim of this study was to evaluate the psychometric validity and reliability of the Turkish version of the Questionnaire for Urinary Incontinence Diagnosis (QUID), which was developed for women with urinary incontinence.

METHODS

This cross-sectional, methodological study included 600 female participants aged 18 years and above with Turkish reading and writing skills. Psychometric methods comprised correlation analysis, internal consistency (Cronbach's alpha), test-retest reliability, and receiver operating characteristic (ROC) curve analysis. The QUID, King's Health Questionnaire (KHQ), and Incontinence Severity Index (ISI) were administered consecutively to assess construct validity and diagnostic performance. Statistical significance was set at p < 0.05.

RESULTS

The Turkish version of the QUID demonstrated high validity and reliability in distinguishing stress and urge urinary incontinence. The QUID scores were significantly positively correlated with the KHQ and ISI scores, indicating consistency with the established measures (p < 0.05). The test‒retest reliability analysis confirmed that the QUID scale provided consistent results over time, with high internal consistency reflected by a Cronbach's alpha coefficient of 0.858, which suggests the questionnaire's stability and reliability for repeated measurements. Additionally, receiver operating characteristic (ROC) curve analyses revealed area under the curve (AUC) values ranging from 0.886 to 0.996 for each subscale, highlighting the high discriminative power of the QUID in distinguishing different types of urinary incontinence effectively.

CONCLUSIONS

The results of this study indicate that the Turkish version of the QUID is a reliable and valid tool for diagnosing urinary incontinence in clinical practice and may contribute positively to patients' quality of life by providing an accurate diagnosis.

TRIAL REGISTRATION

Not applicable.

Comparison of incontinent characteristics between women with hypothyroid dysfunction and euthyroidism during pregnancy and the first year postpartum: A prospective observational study

The aim of the study was to evaluate the occurrence and severity of gestational and postpartum urinary incontinence (UI) and the negative impact upon quality of life (QoL) among pregnant women with gestational hypothyroidism. After initial selection 522 eligible subjects with gestational UI were enrolled and distributed into the HUI (hypothyroid UI, n = 155) and EUI (euthyroid UI, n = 367) groups, respectively. Their demographic parameters, clinic characteristics and incontinent profiles evaluated by the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) questionnaire were collected during gestational and postpartum follow-ups. Within the present study the overall prevalence rate of gestational UI was 45.4% (522/1150). The three scored items of ICIQ-UI-SF questionnaire including leakage frequency, leakage amount and negative impact upon incontinence-specific QoL of the HUI group, as well as leakage severity evaluated by the validated ICIQ-UI-SF questionnaire and 1 h pad test, were significantly greater than those of the EUI group during pregnancy, 6-7 weeks postpartum and over the first year postpartum (P < 0.05 or 0.001). No intergroup significant difference regarding leakage frequency and leakage amount, negative impact upon incontinence-specific QoL and leakage severity was observed during 3-4 months postpartum follow-up. Gestational hypothyroidism could elevate the leakage frequency, amount and severity of UI and exacerbate the negative impact of UI upon incontinence-specific QoL among subjects within the HUI group during pregnancy and the first year postpartum, which underlines the potential relationship between gestational hypothyroidism and gestational and postpartum UI.

The Examination of the Relationship Between the Number of Births with the Symptoms of Urinary Incontinence and Low Back Pain Postpartum in Greek Women

BACKGROUND

Urinary incontinence and low back pain are often present during pregnancy and after childbirth. The aim of this study was to examine the relationship between the number of children with the occurrence of urinary incontinence and low back pain after pregnancy in the Greek population.

MATERIALS AND METHODS

Seventy-one Greek women (M = 35.0 age, SD = ±4.3) with specific inclusion criteria completed just once the International Consultation on Incontinence Questionnaire and the Oswestry Disability Questionnaire after five years from childbirth.

RESULTS

A total of 28.2% of the participating women experienced urinary incontinence, and 38% experienced low back pain after pregnancy. No relationship has been found between urinary incontinence and the number of births (r = 0.062, p = 0.609) and low back pain with the number of births (r = -0.076, p = 0.529). Statistically significant correlations were found between urinary incontinence and low back pain (r = 0.33, p < 0.01) and the urinary incontinence and the maternal age at first delivery (r = -0.264, p = 0.026) in women who underwent a vaginal delivery in second birth had fewer urinary incontinence symptoms and increased low back pain.

CONCLUSIONS

Few correlations emerged in the present study. Future research is necessary to be conducted to examine the relationship between postpartum women's demographic data, urinary incontinence, and low back pain.

Prevalence, determinants and impact of urinary incontinence on quality of life among Palestinian postpartum women: a cross-sectional study

OBJECTIVES

Urinary incontinence (UI) is prevalent among women, particularly during the postpartum period, impacting various aspects of quality of life (QoL). The objectives of this study are to determine the prevalence of postpartum UI among Palestinian women, explore its relationship with delivery mode, identify associated risk factors and assess its impact on QoL.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

The study targeted postpartum women attending primary healthcare centres in the North West Bank of Palestine. Data were collected using interviewer-administered questionnaires. The primary outcome was the prevalence of postpartum UI, and the secondary outcomes included risk factors associated with UI and its impact on QoL. We used multivariate logistic regression analysis to identify factors associated with UI while adjusting for confounding variables. The Institutional Review Board of An-Najah National University approved the study.

RESULTS

Out of 507 participants, 13.6% (95% CI 10.8% to 16.9%) experienced postpartum UI, with 78.3% reporting moderate-to-severe symptoms. Maternal body mass index (BMI) (adjusted OR (aOR) 1.98; 95% CI 1.1 to 3.7; adjusted p=0.033) and experiencing UI during the last pregnancy (aOR 2.25; 95% CI 1.3 to 3.8; adjusted p=0.003) were significant risk factors for postpartum UI. No significant association was found between the normal vaginal delivery and postpartum UI compared with caesarean section (aOR 1.5; 95% CI 0.90 to 1.5; adjusted p=0.284). Postpartum UI severity significantly correlated with QoL, particularly in social embarrassment (p=0.005), psychosocial impact (p≤0.001) and avoidance and limiting behaviours (p≤0.001).

CONCLUSION

The prevalence of postpartum UI in Palestinian women is consistent with global findings. Experiencing UI during the last pregnancy and higher maternal BMI were identified as key risk factors for postpartum UI. These results highlight the need for early detection, intervention and preventive strategies to mitigate the impact of postpartum UI on QoL.

Online vs. Supervised Training in Relieving Urinary Incontinence and Diastasis Recti Abdominis in Early Postpartum

Background/Objectives: The postpartum period is marked by numerous physical changes, often leading to pelvic floor disorders (PFD) such as urinary incontinence (UI) and diastasis recti abdominis (DRA). This study aimed to assess the occurrence of UI and DRA in postpartum women and evaluate the effectiveness of physiotherapy in managing UI and DRA. Methods: A total of 396 women, between the 3rd and 5th postpartum day, were randomized into three groups: control (GrCon), online exercise group (GrOnl), and supervised group (GrSup). GrCon received only education, whereas GrOnl and GrSup had three sessions with exercises with physiotherapist-online or supervised. Data were collected through questionnaires, ICIQ FLUTS, body posture assessments, and DRA measurements. Results: The results showed a significant reduction in UI and DRA symptoms across all groups, with the GrSup group showing the greatest improvement. UI symptoms decreased from 49% during pregnancy to 36.9% postpartum, with GrSup women reporting fewer urological complaints compared to the GrOnl and GrCon groups (p < 0.001). DRA incidence dropped from 76.2% in the early postpartum days to 23.4% at six weeks, with GrSup showing the lowest rates (9.8%). Notably, supervised physiotherapy resulted in a higher frequency (94.7%) and correct performance of PFME (72.2%) compared to the online and control groups. Conclusions: The study concludes that supervised physiotherapy is more effective than online sessions in managing postpartum UI and DRA, emphasizing the importance of guided exercise for better outcomes.

Pressure-Mediated Biofeedback With Pelvic Floor Muscle Training for Urinary Incontinence: A Randomized Clinical Trial

Importance

Supervised pelvic floor muscle training (PFMT) has been recommended as the first-line treatment for women with stress urinary incontinence (SUI), but more evidence on whether adjunctive methods would provide additional benefits is needed.

Objective

To compare the efficacy of PFMT with or without a home-based pressure-mediated biofeedback (BF) device.

Design, Setting, and Participants

This multicenter assessor-blinded randomized clinical trial was conducted in the obstetric clinics of 5 participating tertiary hospitals in China. Participants included eligible women with new-onset postpartum SUI who were enrolled from March 28, 2022, to October 13, 2023.

Intervention

All participants received 3 months of supervised PFMT and were randomized to either the intervention (PFMT with a home-based pressure-mediated BF device) or the control group (home-based PFMT).

Main Outcome and Measures

The primary outcome was the severity of urinary incontinence evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form after 3 months of supervised PFMT. The secondary outcomes included the cure and improvement rates, PFM strength, quality of life, self-efficacy, and adherence.

Results

A total of 452 participants (median age, 34 [IQR, 31-36] years; median body mass index [calculated as the weight in kilograms divided by the height in square meters], 23.71 [IQR, 21.37-25.97]; median time since delivery, 50 [IQR, 43-61] days) were included in the analysis, with 223 in the intervention group and 229 in the control group. Compared with the control group, the intervention group achieved a significantly greater reduction in incontinence severity (median, 3.00 [IQR, 1.00-6.00] vs 2.00 [IQR, 0-4.00] points; z = -3.05; P = .002), significantly increased cure rate (45 of 223 [20.2%] vs 20 of 229 [8.7%]; z = 12.02; P = .001) and improvement (132 of 223 [59.2%] vs 102 of 229 [44.5%]; z = 9.71; P = .002), significantly greater pelvic floor muscle strength (median, 26.00 [IQR, 17.00-38.00] vs 21.00 [IQR, 13.50-33.50] cm H2O; z = -2.28; P = .02), and a significantly greater correlation between subjective and objective adherence (r = 0.825 vs r = 0.627).

Conclusion and Relevance

In this randomized clinical trial, the efficacy of pressure-mediated BF combined with PFMT was superior to that of PFMT alone. These findings support the use of pressure-mediated BF devices for improving treatment outcomes for patients with SUI.

Trial Registration

ClinicalTrials.gov Identifier: NCT05115864.

Obstetric Perineal Tears, Birth Characteristics and the Association with Urinary Incontinence Among Primiparous Women 12 Months Postpartum: A Prospective Cohort Study

INTRODUCTION AND HYPOTHESIS

Postpartum urinary incontinence (UI) is common and a concern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women.

METHODS

A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI.

RESULTS

A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95% CI 0.92-4.50; episiotomy: RR 2.22, 95% CI 0.99-4.96; third- or fourth-degree tear: RR 2.73, 95% CI 1.18-6.28). The same was found for SUI, but with wider confidence intervals.

CONCLUSIONS

A higher prevalence of any UI and SUI was found among women with perineal tears involving any perineal muscles, compared with women with no, labia, or first-degree tears.

Association of socioeconomic status and overactive bladder in US adults: a cross-sectional analysis of nationally representative data

Background

Socioeconomic status inequality is an important variable in the emergence of urological diseases in humans. This study set out to investigate the association between the prevalence of overactive bladder (OAB) and the poverty income ratio (PIR) that served as a more influential indicator of socioeconomic status compared to education and occupation.

Method

Data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2020 were used in this cross-sectional study. The association between the PIR and OAB was examined using weighted multivariate logistic regression and weighted restricted cubic splines (RCS). Additionally, interaction analysis was used for investigation to the connections between PIR and OAB in various covariate groups in order to confirm the stability of the results.

Results

We observed a noteworthy inverse association between PIR and OAB after adjusting for potential confounding variables (OR = 0.87, 95% CI, 0.84-0.90, p < 0.0001). PIR was transformed into categorical variables, and the association held steady after that (1.0 < PIR <4.0 vs. PIR ≤ 1.0, OR = 0.70, 95% CI =0.63-0.77, p < 0.0001; PIR ≥ 4.0 vs. PIR ≤ 1.0, OR = 0.56, 95% CI =0.48-0.65, p < 0.0001). Additionally, RCS analysis showed that PIR and OAB had a negative nonlinear response relationship. Subgroup analyses showed that the inverse association between PIR and prevalence of OAB was stronger in obese than in nonobese individuals (P for interaction < 0.05).

Conclusion

In our study, we observed a significant negative association between the PIR and the prevalence of OAB. In the future, PIR could be used as a reference standard to develop strategies to prevent and treat OAB.