Urinary incontinence associated with anxiety and depression: the impact of psychotropic drugs in a cross-sectional study from the Norwegian HUNT study

Associations of pelvic floor dysfunction and postnatal mental health: a systematic review

BACKGROUND

Postpartum mental health conditions are common and can have devastating effects for both mother and infant. Adverse birth outcomes increase the risk of postnatal mental health conditions. Pelvic floor dysfunction (PFD) is a common adverse pregnancy outcome that may be a risk factor for postnatal mental health conditions. There are many studies reporting associations between PFD and postnatal mental health conditions, but no reports have synthesised the current literature as it relates to pregnancy and the postpartum period.

METHODS

A research librarian conducted systematic literature searches using terms concerning PFD, postnatal mental health conditions, and pregnancy. Searches were conducted within PubMed, Embase, CINAHL, Cochrane, and Scopus. Two reviewers independently rated each study for inclusion and study quality. No studies were excluded based on quality.

RESULTS

A total of 47 studies were included for review. Articles addressed sexual dysfunction (n = 11), incontinence (n = 21), perineal laceration (n = 13), pelvic organ prolapse (n = 2), and general pelvic floor symptoms (n = 2) and associations with postnatal mental health conditions. Two articles addressed more than one type of PFD. The majority (44 studies) reported associations between PFD and adverse postnatal mental health conditions.

DISCUSSION

Most studies included for review found consistent associations between PFD and adverse mental health conditions. Healthcare providers should screen for PFD and postnatal mental health conditions early in the postpartum period. Future research should investigate whether the treatment of PFD can modify the associations between PFD and postnatal mental health conditions.

Digital Care Program for Urinary Incontinence in Females: A Large-Scale, Prospective, Cohort Study

Female urinary incontinence (UI) is highly prevalent in the US (>60%). Pelvic floor muscle training (PFMT) represents first-line care for UI; however, access and adherence challenges urge new care delivery models. This prospective cohort study investigates the feasibility and safety of a remote digital care program (DCP) combining education and PFMT with real-time biofeedback with an average duration of 10 weeks. The primary outcome was the change in the Urinary Impact Questionnaire-short form (UIQ-7) from baseline to program-end, calculated through latent growth curve analysis (LGCA). Secondary outcomes included the impact of pelvic conditions (PFIQ-7), depression (PHQ-9), anxiety (GAD-7), productivity impairment (WPAI), intention to seek additional healthcare, engagement, and satisfaction. Of the 326 participants who started the program, 264 (81.0%) completed the intervention. Significant improvement on UIQ-7 (8.8, 95%CI 4.7; 12.9, p < 0.001) was observed, corresponding to a response rate of 57.3%, together with improvements in all other outcomes and high satisfaction (8.9/10, SD 1.8). This study shows the feasibility and safety of a completely remote DCP with biofeedback managed asynchronously by a physical therapist to reduce UI-related symptoms in a real-world setting. Together, these findings may advocate for the exploration of this care delivery option to escalate access to proper and timely UI care.

When Bladder and Brain Collide: Is There a Gender Difference in the Relationship between Urinary Incontinence, Chronic Depression, and Anxiety?

In longitudinal and cross-sectional studies, depression and anxiety have been associated with urinary incontinence (UI) in women. However, this association has not been studied in men. Utilizing data from the 2008 Turkish Health Studies Survey conducted by the Turkish Statistical Institute, we analyzed 13,830 participants aged 15 years and above. We investigated the association of UI with psychological discomfort in both sexes using multivariable logistic regression. High psychological discomfort significantly correlated with UI in males (OR 2.30, 95% CI 1.43-3.71) and females (OR 2.78, 95% CI 1.80-4.29). Anxiety increased UI likelihood in females (OR 2.36, 95% CI 1.61-3.46) and males (OR 2.37, 95% CI 1.10-5.13). Depression related significantly to UI in females (OR 2.54, 95% CI 1.81-3.58) but not males (OR 1.63, 95% CI 0.71-3.76). Antidepressant and anxiolytic use was not significantly related to UI in either gender. Anxiety and psychological discomfort contribute to UI in both genders. While depression significantly correlates with UI in females, it does not show the same magnitude and significance in males. Antidepressant and anxiolytic use did not significantly influence the association. These findings underscore the psychological distress-UI link, advocating a holistic approach for managing UI in individuals with mental health conditions.

Association of urinary incontinence with depression among men: a cross-sectional study

OBJECTIVE

Depression and urinary incontinence (UI) are both troubling symptoms that severely impact quality of life. The aim of this study is to evaluate the association between UI (including UI types and severity) and depression among men.

POPULATION AND METHODS

The analyzed data was collected from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) data. A total of 16,694 male participants aged ≥ 20 years with complete information about depression and UI were included in this study. Logistic regression was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) to determine the association between depression and UI by adjusting for relevant covariables.

RESULTS

The prevalence of depression was 10.91% among participants with UI. Urge UI was the main type of UI and accounts for 50.53% of all UI types. The adjusted ORs for the association between depression and UI were 2.69 (95%CI, 2.20-3.28). Compared with slight UI, the adjusted ORs were 2.28 (95% CI, 1.61-3.23) for moderate UI, 2.98 (95% CI, 1.54-5.74) for severe UI, and 3.85 (95% CI, 1.83-8.12) for very severe UI. Compared with no UI, the adjusted ORs were 4.46 (95% CI, 3.16-6.29) for mixed UI, 3.15 (95% CI, 2.06-4.82) for stress UI, and 2.43 (95% CI, 1.89-3.12) for urge UI. The subgroup analyses also showed similar correlation about depression and UI.

CONCLUSION

Among men, depression was positively associated with UI status, severity and types. For clinicians, it's necessary to screen depression in patients with UI.

The impact of urinary incontinence on multiple health outcomes: an umbrella review of meta-analysis of observational studies

BACKGROUND AND AIM

We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses.

METHODS

We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV).

RESULTS AND DISCUSSION

From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10^-6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV).

CONCLUSIONS

UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.

Pilates Method and/or Photobiomodulation Therapy Combined to Static Magnetic Field in Women with Stress Urinary Incontinence: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

This clinical trial aims to provide evidence about the effectiveness of the Pilates method on stress urinary incontinence (SUI), as well as to elucidate the effects of photobiomodulation therapy associated with static magnetic field (PBMT/sMF) alone or associated with the Pilates Method on Pelvic floor muscle (PFM) in women affected by SUI. For that, a three-arm, parallel randomized, double-blinded, placebo-controlled trial was conducted (NCT05096936). We recruited thirty-three women diagnosed with SUI, randomly allocated to three groups: placebo PBMT/sMF plus method Pilates, PBMT/sMF active plus method Pilates and only PBMT/sMF active. The evaluation consisted of anamnesis and physical examination, muscle strength, completion of the ICIQ-SF questionnaire, and urinary loss. The evaluation of muscle strength and filling the ICIQ-SF were performed on the first and last days, while the Pad test was applied in baseline, one month, two months, and three months of intervention. We observed an increase in strength (p < 0.01), tone (p < 0.01), and quality of life (p < 0.01), in addition to a decrease in urinary lost (p < 0.01) for all groups comparing the pre and post-intervention. The PBMT/sMF alone, the Pilates, and the combination of the two therapies proved to be effective in improving the signs and symptoms of women with SUI.

Sport-related risk factors for moderate or severe urinary incontinence in master female weightlifters: A cross-sectional study

BACKGROUND

Urinary incontinence (UI), defined as the involuntary loss of urine, is a common, multifactorial condition. It is unclear whether physical activities, their intensity or frequency, may affect the potential for UI in addition to known risk factors in the general population. Higher prevalence of UI has been observed when engaging in high-impact sports, but research is sparse regarding UI in strength sports. Since the Olympic-style weightlifting has seen an unprecedented increase in women's participation in recent years, this study provides much-needed data to investigate whether weightlifting predisposes women to UI.

OBJECTIVES

The aim was to conduct a survey of female Master athletes in countries that are members of the International Weightlifting Federation using a validated incontinence severity index and to study (1) whether known risk factors in the general population increase the odds of UI in female competitive weightlifters and (2) whether sport-related factors are associated with UI after adjusting for known risk factors. The outcomes of interest were moderate or more severe UI and incontinence during lifts specific to weightlifting competitions.

RESULTS

Respondents consisted of 824 female competitive weightlifters from 29 countries, ages 30 to 79, median 41 years. Prevalence of moderate or more severe incontinence was 32%. Higher BMI, prior pregnancies, and depressive mood increased the odds, but age was not associated. Athletes who had engaged in high-impact sports prior to starting weightlifting training were at a higher risk of UI, but participation in prior strength sports was not associated with UI. The predictive probability of moderate or more severe UI increased with more hours per week of weightlifting training.

CONCLUSIONS

Our findings indicate that while female weightlifters had a higher prevalence of moderate or severe UI than in a general population according to the National Health and Nutrition Examination Survey, and that athletes who had engaged in high-impact sports prior to starting weightlifting were at a higher risk of UI.

Effect of single doses of citalopram and reboxetine on urethral pressure: A randomized, double-blind, placebo- and active-controlled three-period crossover study in healthy women

AIMS

Urethral closure function is essential for urinary continence in women and decreased urethral pressure is associated with stress urinary incontinence (SUI). For decades, the effects of serotonergic drugs on central neural control of urethral closure have been investigated and discussed. Epidemiological studies suggest that the use of selective serotonin reuptake inhibitors (SSRIs), such as citalopram, is associated with SUI. However, the literature findings are conflicting. This study aimed to evaluate citalopram's effect on opening urethral pressure (OUP) in healthy women.

METHODS

We conducted a randomized, double-blind, placebo- and active-controlled crossover study in 24 healthy women. On three study days, which were separated by 8 days of washout, the subjects received single doses of either 40 mg citalopram (and placebo_reboxetine ), 8 mg reboxetine (and placebo_citalopram ), or two placebos. Study drugs were administered at a 1-h interval due to a difference in estimated time to peak plasma concentration (t_max ). We measured OUP with urethral pressure reflectometry under both resting and squeezing conditions of the pelvic floor at estimated t_max for both study drugs (one timepoint).

RESULTS

Compared to placebo, citalopram increased OUP by 6.6 cmH₂ 0 (95% confidence interval [CI] 0.04-13.1, p = 0.048) in resting condition. In squeezing condition, OUP increased by 7.1 cmH₂ 0 (95% CI: 1.3-12.9, p = 0.01). Reboxetine increased OUP by 30.0 cmH₂ 0 in resting condition compared to placebo (95% CI: 23.5-36.5, p < 0.001), and 27.0 cmH₂ 0 (95% CI: 21.2-32.8, p < 0.001) in squeezing condition.

CONCLUSION

Citalopram increased OUP slightly compared to placebo suggesting that SSRI treatment does not induce or aggravate SUI.

Multidisciplinary treatment for functional urological disorders with psychosomatic comorbidity in a tertiary pelvic care center-A retrospective cohort study

Background

Functional urological disorders are highly prevalent, frequently interrelated, and characterized by a chronic course and considerable treatment resistance. From our point of view, poor treatment outcomes are often attributable to underlying but undetected mental disorders.

Objective

To investigate the effect of integrated outpatient care by a urologist and a psychiatrist on the symptomatology of patients with functional urological disorders in a tertiary referral Pelvic Care Centre.

Setting

Retrospective observational cohort study in functional urological disorders in combination with psychosomatic co‐morbidity. When treatment by a urologist alone was not sufficient, the suitability for a multidisciplinary approach was considered i) if there was a susceptibility for psychiatric comorbidity, ii) if diagnostic procedures did not reveal a treatable somatic cause, or iii) if multiple failed somatic treatments did not relieve complaints. Patients underwent urological treatments before, without reduction of complaints, no treatable somatic cause could be found after diagnostic procedures; or patients suffered from psychiatric comorbidity.

Method

Outcome was measured using patient global impression of improvement, hospitality anxiety and depression scale (HADS), global assessment of functioning (GAF), and a health consumption questionnaire.

Results

A significant reduction in HADS‐depression score was found (p = 0.001) after multidisciplinary treatment. The GAF score increased from 61 to 80, leading to no more than slight impairment in social, occupational, or school functioning. Patients reported their situation as better in comparison with before multidisciplinary treatment. An association was found between pelvic pain and anxiety (p = 0.032) and panic disorder (p = 0.040). Psychological trauma was found to be associated with depression (p = 0.044), with an odds ratio of 2.93 (1.01–8.50). Psychological trauma coincided in 62.3% of patients with urological pain syndromes and in 83.3% with pelvic pain.

Conclusion

Overall results indicate that functional urological patients, previously refractory to urological treatment, benefit from an integrated care approach by urologists and psychiatrists. Explanation about the bladder–brain axis and the alarm falsification model enlightens understanding of urological and psychological contributions to functional syndromes and creates an opportunity for integrated care.

Family Physician's Educational Interview with Patients Helps in Early Recognition of Lower Urinary Tract Symptoms

Purpose

Lower urinary tract symptoms (LUTS) can have an etiology outside the lower urinary tract (LUT) and are therefore an important diagnostic indicator for assessing the overall health of a person. However, LUTS is still mainly neglected by primary health care providers as well as by patients. In this study, we assessed the importance of an educational interview (EI) conducted by a GP on the patients’ ability to recognize LUTS. We also investigated other factors that affect the recognition of LUTS: subjects’ personal educational level, number of LUT symptoms and their bothersome level on a scale 0–10.

Patients and Methods

This cross-sectional study was conducted in Croatia (2018–2020) by interviewing 499 subjects. We compared recognized LUT symptoms before and after the EI and determined whether their number, their bothersome level, or the subjects’ personal educational level were associated with LUTS recognition.

Results

EI significantly improved the ability to recognize LUTS (p=0.001). The number of LUT symptoms and bothersome level in subjects before EI was much greater than the number in subjects after EI (p<0.0001, mean>4 and p<0.0001, median>8, respectively). Subjects with higher educational level recognized LUTS with fewer symptoms after the EI (p<0.01), but no difference was observed among subjects who recognized LUTS before the EI.

Conclusion

For subjects to recognize LUTS, their condition had to be severe – more than 4 symptoms and bothersome level >8/10. Personal educational level had little impact on LUTS recognition. However, an EI proved to be an excellent tool for raising awareness about LUTS and its early recognition.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients

Introduction and hypothesis: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. Methods: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. Results: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.

Bladder and bowel symptoms following imprisonment in West Australian female prisons

PURPOSE

The purpose of this paper is to investigate the presence of bladder and bowel symptoms in women recently imprisoned in Western Australian prisons, specifically; stress, urge and mixed urinary incontinence, faecal incontinence, nocturia, nocturnal enuresis and constipation and the impact on the quality of life (QOL).

DESIGN/METHODOLOGY/APPROACH

Over a 12-month period 29 women, recently released from Western Australia's female prisons, were surveyed using a questionnaire previously validated for the prison population. The Short Form King's Health Questionnaire and a modified version of the Manchester Health Questionnaire were used to assess the effects of these symptoms on QOL.

FINDINGS

Of those surveyed only one respondent reported having no bladder or bowel symptoms following release from prison. Trends assessed by Chi-square analysis suggest women imprisoned for any period of time are more likely to develop both bladder and bowel symptoms which persist after release back into the community. A history of substance or alcohol abuse is often concurrent with the presence of symptoms. QOL scores are also lower for those reporting either bladder or bowel symptoms affecting total scores and the domains of both activities of daily living and mental health.

ORIGINALITY/VALUE

Women imprisoned for any length of time developed bladder and bowel symptoms which had a negative impact on their QOL. Larger studies need to be conducted to investigate these trends and whether small changes in conservative measures can influence outcomes.