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Duncan I, Stocking A, Fitzner K, Ahmed T, Huynh N. The Prevalence of Incontinence and Its Association With Urinary Tract Infections, Dermatitis, Slips and Falls, and Behavioral Disturbances Among Older Adults in Medicare Fee-for-Service. J Wound Ostomy Continence Nurs 2024; 51:138-145. [PMID: 38527324 PMCID: PMC11008436 DOI: 10.1097/won.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE The purpose of this study was to examine the prevalence of urinary (UI), fecal (FI), and dual incontinence (DI) in older adults and their association with urinary tract infections, dermatitis, slips and falls, and behavioral disturbances based on Medicare fee-for-service (FFS) claims data. DESIGN Retrospective analysis. SUBJECTS AND SETTINGS Data from administrative claims from the CMS Medicare Limited Data Set (5% sample) for all months in 2018 were reviewed. The analysis was limited to FFS Medicare beneficiaries, with minimum of 3-month enrollment in Parts A and B who were at least 65 years old. This cohort included 1.2 million beneficiaries in the United States. METHODS We used diagnosis codes to identify members with incontinence and grouped these members into 3 categories (UI only, FI only, and DI). We also divided claims based on 4 sites of care (nursing home, skilled nursing facility, home health, and self- or family care). We then determined the prevalence of (1) urinary tract infections (UTIs), (2) dermatitis, (3) slips and falls, and (4) behavioral disturbances for each type of incontinence. RESULTS We found that 11.2% of Medicare members had a claims-based diagnosis of incontinence in 2018. On average, those diagnosed with incontinence experienced 5 times more UTIs, 2 times as many dermatitis events, more than twice as many slips and falls, and 2.8 times more behavior disturbances compared to those without an incontinence diagnosis. For those with DI, the prevalence of the 4 outcomes was significantly higher (between 22% and 185%) compared to those with UI only. CONCLUSIONS Findings show that Medicare beneficiaries diagnosed as incontinent experience a much higher prevalence of UTIs, dermatitis, slips and falls, and behavioral disturbances compared to those without a diagnosis of incontinence. Our results suggest that incontinence may be an important indicator diagnosis for multiple other conditions and, if not well-managed, may challenge the desire for those who are incontinent to age at home.
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Affiliation(s)
- Ian Duncan
- Correspondence: Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara, South Hall 5518, Santa Barbara, CA 93106 ()
| | - Andrew Stocking
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Karen Fitzner
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Tamim Ahmed
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Nhan Huynh
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
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Gao G, Vaughan CP, Markland AD, Reinicke K, Annavaram N, Burningham Z. Leveraging A Clinical Dashboard and Process Mappings to Improve Treatment Access and Outcomes for Women Veterans with Urinary Incontinence. AMIA Annu Symp Proc 2024; 2023:359-368. [PMID: 38222400 PMCID: PMC10785906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
In support of the Improving Primary Care Understanding of Resources and Screening for Urinary Incontinence to Enhance Treatment initiative with the Veterans Health Administration, we developed a clinical dashboard to support primary care providers in identifying underdiagnosed, undertreated women Veterans with urinary incontinence. This paper describes our dashboard development and evaluation. We employed a user-centered design in determining dashboard requirements, interface design, and functionality. We invited early users at three pilot sites to formal usability reviews. We quantified the dashboard usability using the System Usability Scale and administered surveys and interviews for insights on performance. We employed process maps to uncover processes of end-users' dashboard engagements within local environments. User evaluations demonstrated the dashboard as a helpful instrument in identifying women Veterans with good to excellent usability performance. User feedback offers a user-driven pathway to develop our dashboard that supports clinicians to better care for women Veterans with urinary incontinence.
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Affiliation(s)
- Grace Gao
- Atlanta VA Healthcare System, Atlanta, GA
| | - Camille P Vaughan
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA
- Emory University, Atlanta, GA
| | - Alayne D Markland
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Birmingham, AL
- University of Alabama at Birmingham, AL
| | | | | | - Zachary Burningham
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT
- Veterans Affairs Medical Center, Salt Lake City, UT
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Dugan SA, Crawford SL, Wente K, Waetjen LE, Karvonen-Gutierrez C, Harlow SD. The association of urinary incontinence and disability among a diverse sample of midlife Study of Women's Health Across the Nation women. Menopause 2024; 31:18-25. [PMID: 38016162 PMCID: PMC10766380 DOI: 10.1097/gme.0000000000002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The aim of the study is to examine whether urinary incontinence (UI) type, frequency, and amount are associated with self-reported disability in a racially/ethnically diverse cohort of community-dwelling midlife women. METHODS Data were from longitudinal analyses of questionnaires from the multicenter, prospective cohort Study of Women's Health Across the Nation (SWAN). We used multivariable ordinal logistic regression to examine whether urinary incontinence type, frequency, and amount at the 13th follow-up were associated with the World Health Organization Disability Assessment Schedule at the 15th follow-up controlling for other factors (menopause status, body mass index, lifestyle and psychosocial factors, and disability at follow-up 13). RESULTS Urinary incontinence was associated with subsequent reports of disability in participants, particularly in the World Health Organization Disability Assessment Schedule domains of mobility ( P < 0.0001), communication ( P = 0.0057), and life activities ( P = 0.0407). Associations were strongest for mixed UI type compared with stress UI or urgency UI (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.26-2.17, P < 0.001), daily frequency of UI compared with monthly or less than weekly frequency of UI (OR = 1.61, 95% CI = 1.04-2.47, P < 0.001), and larger amounts of urine leakage compared with drops of leakage (OR = 2.98, 95% CI = 1.58-5.62, P < 0.0001) for mobility/getting around domain. CONCLUSIONS Urinary incontinence seems to have a strong association with multiple domains of disability, including mobility and interacting with others, after approximately 3.7 years. Thus, UI may be an important factor limiting social engagement among women. Screening for mixed UI and UI that occurs greater than weekly and in amounts requiring pads may yield better information regarding an individual's future disability risk and may preserve social interaction.
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Affiliation(s)
- Sheila A. Dugan
- Department of Physical Medicine & Rehabilitation, Rush University Medical Center, Chicago, IL
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Sybil L. Crawford
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, MA
| | - Karla Wente
- Department of Physical Medicine & Rehabilitation, Rush University Medical Center, Chicago, IL
- College of Health Sciences, Rush University, Chicago, IL
| | - L. Elaine Waetjen
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA
| | | | - Siobán D. Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Li Q, Cheng Y, Shi H, Xue K, Zhou F. Advances in the natural history of urinary incontinence in adult females. J OBSTET GYNAECOL 2023; 43:2171774. [PMID: 36772931 DOI: 10.1080/01443615.2023.2171774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The aim of this review is to summarise the related characteristics of the natural history of female urinary incontinence (UI) using a narrative descriptive approach. PubMed, EMBASE and Web of Science were searched for articles published from 1 January 2010 to 1 January 2020 on the natural history of female UI, which including incidence, persistence, progression, remission, and regression of a single subtype of UI and the mutual influence of different UI subtypes. This literature review includes 15 articles published, indicates that UI is highly dynamic, with symptoms varying according to disease severity and subtype and influenced by multiple factors at different disease stages. Recent studies have increased our understanding of the natural history of UI. Future research should systematically analyse the progression of each subtype of UI and interactions between subtypes to prevent the progression of UI across females life course.
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Affiliation(s)
- Qianqian Li
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Yun Cheng
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, China
| | - Hongli Shi
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Kaikai Xue
- Jiangsu College of Nursing, Huai'an, China
| | - Fang Zhou
- Dean of School of Nursing, Xuzhou Medical University, Xuzhou, China
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Gan ZS, Smith AL. Women Who Avoid or Stop Exercise Due to Lower Urinary Tract Symptoms: Prevalence, Symptom Profile, and Associated Factors. Urology 2023; 178:48-53. [PMID: 37247694 DOI: 10.1016/j.urology.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine the prevalence of women who report avoiding exercise or stopping a workout due to lower urinary tract symptoms (LUTS) in a community population, characterize symptoms in these women, and identify clinical and demographic factors associated with exercise cessation due to LUTS. METHODS A cross-sectional online survey was administered to community-based women. The prevalence of having avoided exercise or stopped a workout due to LUTS was calculated. Clinical and demographic variables along with comprehensive urinary symptoms assessed by the Lower Urinary Tract Research Network-Symptom Index (LURN-SI 29) were compared between women with and without the outcome. Multivariable logistic regression and random forest models were used to identify variables associated with the outcome. RESULTS Out of 1707 women who completed the survey, 18.9% reported avoiding exercising or stopping a workout due to LUTS. For these women, multiple domains of LUTS were noted, including incontinence, pain, voiding difficulty, urgency, and nocturia. Multivariable logistic regression identified LURN SI-29 score, White race, and prior vaginal delivery as significantly associated with the outcome, while the random forest model identified LURN SI-29 score, age, and body mass index (BMI) as most important. CONCLUSION In a population-based study, 1 in 5 women reported avoiding exercise or stopping a workout due to LUTS. Their reported LUTS span multiple symptom domains, and factors associated with stopping exercise include symptom severity, older age, higher BMI, White race, and prior vaginal delivery. Addressing LUTS may improve the resumption and continuation of exercise in women.
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Affiliation(s)
- Zoe S Gan
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Lane GI, Erekson E, Austin A, Carmichael D, Minassian VA, Grodstein F, Bynum JP. Treatment for Urinary Incontinence in Women Older Than 65 Years. Urogynecology (Phila) 2023; 29:687-695. [PMID: 37490708 DOI: 10.1097/spv.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Urinary incontinence (UI) is common among women older than 65 years and negatively affects quality of life. However, the prevalence of UI treatment and determinants of treatment are largely unknown. OBJECTIVES The aim of this study was to identify rates of UI treatment and factors associated with treatment in older women with self-reported UI. STUDY DESIGN This is a retrospective cohort analysis of a data set linking UI symptoms from the Nurses' Health Study to Medicare claims. We evaluated use of pharmacotherapy, noninvasive, and procedural treatments for UI within 1 year before symptom survey. For pharmacotherapy, we used multivariable logistic regression to estimate odds ratios (ORs) of UI treatment. RESULTS Of the 67,587 Nurses' Health Study respondents, 15,088 had linkage to Medicare, subscribed to part D, and answered UI questions. Of these, 8,332 (55.2%) women reported UI, and 10.9% with UI had a Medicare claim for treatment; pharmacotherapy represented 94.6% of all treatments.On regression analysis, women with more severe and longer-term UI had higher odds of treatment (severe vs slight UI: OR, 3.1; 95% confidence interval [CI], 2.2-4.3) (longer vs new UI: OR, 1.9; 95% CI, 1.5-2.3). Women with mixed (OR, 2.5; 95% CI, 1.9-3.2) or urgency UI (OR, 3.0; 95% CI, 2.2-3.9) had greater odds of treatment compared with women with stress UI. CONCLUSIONS We estimate that only approximately 1 in 9 older women with self-reported UI underwent treatment within the year before reporting symptoms, of which pharmacotherapy was the most common UI intervention, and women with more severe and longer duration of symptoms were most often treated.
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Affiliation(s)
- Giulia I Lane
- From theDepartment of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Elisabeth Erekson
- Department of Obstetrics and Gynecology at Maine Medical Center, Portland, ME
| | - Andrea Austin
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Donald Carmichael
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Vatche A Minassian
- Division of Urogynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
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Zhang X, Li M, Dong W, Lv X, Li L, Yang X, Cao Y. Prevalence and influencing factors of lower urinary tract symptoms in female nurses: a cross-sectional study based on TARGET. Front Public Health 2023; 11:1201184. [PMID: 37404267 PMCID: PMC10315681 DOI: 10.3389/fpubh.2023.1201184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Background Even though occupational women have a high incidence of lower urinary tract symptoms (LUTS), which seriously affect their daily work life, few large scale sample studies have provided empirical evidence to support this phenomenon among female nurses in China. Consequently, this article investigated female nurses who was presupposed to have a high prevalence of LUTS, which adversely exposes their health and patient safety to these risks. Additionally, it is considered important to explore the factors associated with LUTS in female nurses for patient care safety and nurse bladder health practice. Objectives The purpose of this study was to assess the incidence of LUTS and symptoms-related risk factors among female nurses, to provide evidence for the prevention and control of LUTS. Methods An online survey recruiting 23,066 participants was carried out in a multicenter cross-sectional study in 42 hospitals from December 2020 to November 2022. Stepwise multivariate logistic regression analysis and nomogram were used to identify the factors associated with lower urinary tract symptoms. Besides, SPSS version 26.0, R version 4.2.2, and GraphPad Prism Version 8.3 software packages were used for statistical analysis. Results Based on the completion rate of the questionnaire which was 84.1% (n = 19,393), it was found that among 19,393 female nurses, the prevalence of LUTS was 67.71% and this rate was influenced by age, Body Mass Index (BMI), marital status, years of working, menstrual status, mode of delivery, history of breastfeeding, history of miscarriage, history of alcohol and coffee or tea consumption (p < 0.05). Interestingly, we also find that in addition to the above mentioned factors, anxiety, depression, and perceived stress were also related to LUTS in female nurses (p < 0.05). Conclusion Given the high prevalence of LUTS among female nurses and their potential influencing factors, female nurses should focus on their reproductive health and develop good lifestyle habits. Thus, nursing managers should provide a warm and harmonious work environment and sensitize female nurses to increase their awareness about the importance of drinking clean water and urinating during work in a hygienic environment.
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Affiliation(s)
- Xinyue Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Mengli Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Wenshuo Dong
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Xiaoyan Lv
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
| | - Li Li
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
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Li Q, Huang Y, Wang Q, Xue K, Zhou F. The prevalence and risk factors of different degrees of stress urinary incontinence in Chinese women: A community-based cross-sectional study. Nurs Open 2023. [PMID: 37052184 DOI: 10.1002/nop2.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/11/2022] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
AIM To investigate the prevalence of SUI and explore the factors that could influence the severity of SUI in adult females. DESIGN A cross-sectional study. METHODS A total of 1178 subjects were assessed using a risk-factor questionnaires and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and then divided into no SUI group, mild SUI group and moderate-to-severe SUI group according to the ICIQ-SF score. Univariate analysis between adjacent groups and ordered logistic regression models in three groups were then performed to analysis the possible associated factor with the progressive of SUI. RESULTS The prevalence of SUI among adult women was 22.2% of them; 16.2% and 6% had mild SUI and moderate-to-severe SUI, respectively. Moreover, logistic analysis revealed that age, BMI, smoking, position preference for urination, urinary tract infections, urinary leaks during pregnancy, gynaecological inflammation and poor sleep quality were independent risk for the severity of SUI. CONCLUSION SUI symptoms were mostly mild among Chinese females, specific risk factors such as unhealthy living habits and urination behaviours increased the risk of SUI and the aggravation of symptoms. Therefore, targeted interventions should be formulated for women to delay disease progression.
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Affiliation(s)
- Qianqian Li
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Obstetrics Department, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, Jiangsu, China
| | - Yanwei Huang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qingyan Wang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Kaikai Xue
- Jiangsu College of Nursing, Xuzhou, Jiangsu, China
| | - Fang Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Leng S, Jin Y, Vitiello MV, Zhang Y, Ren R, Lu L, Shi J, Tang X. Self-reported insomnia symptoms are associated with urinary incontinence among older Indian adults: evidence from the Longitudinal Ageing Study in India (LASI). BMC Public Health 2023; 23:552. [PMID: 36959651 PMCID: PMC10037814 DOI: 10.1186/s12889-023-15472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Insomnia and urinary incontinence (UI) are both diseases burdening older adults. However, the association between them has not been well elucidated. The purpose of this study is to assess the correlation between insomnia symptoms and UI in a large community-dwelling sample of older Indian adults. METHODS Data were from Wave 1 (2017-2018) of the Longitudinal Ageing Study of India (LASI). Male and female participants aged ≥ 60 years who provided complete information on insomnia symptoms, UI, stress UI (SUI), and covariates were included. Insomnia symptoms were identified by a report of: trouble falling asleep, waking up at night, or waking too early, ≥ 5 times/week. UI was defined by self-reported diagnosis. SUI was identified by self-report of involuntary urine leakage when sneezing, coughing, laughing, or lifting weights. Multivariable logistic regression analyses evaluated the associations between insomnia symptoms and UI and SUI. Stratified linear regression evaluated for interactions in prespecified subgroups. RESULTS Twenty-six thousand eight hundred twenty-one LASI participants met entry criteria. 2979 (11.11%) reported insomnia symptoms, 976 (3.64%) UI, and 2726 (10.16%) SUI. After full adjustment, insomnia symptoms were associated with both UI and SUI among males (OR 1.53; 95%CI 1.20-1.96 and OR 1.51; 95%CI 1.25-1.83) and females (OR 1.53; 95% CI 1.21-1.92 and OR 1.50; 95% CI 1.31-1.73). A significant interaction effect by age was observed between insomnia symptoms and SUI among both males (p = 0.048) and females (p = 0.042). CONCLUSIONS Insomnia symptoms were associated with UI and with SUI in both male and female older Indian adults. Further prospective study is called for to better characterize these associations and to explore underlying mechanisms.
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Affiliation(s)
- Siqi Leng
- Sleep Medicine Center, Department of Urology, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Yuming Jin
- Sleep Medicine Center, Department of Urology, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ye Zhang
- Sleep Medicine Center, Department of Urology, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Rong Ren
- Sleep Medicine Center, Department of Urology, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Lin Lu
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Jie Shi
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Urology, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China.
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Onishi A, Shibata A. Prevalence and sociodemographic correlates of urinary incontinence in Japanese women: A web-based cross-sectional study. Womens Health (Lond) 2023; 19:17455057231207754. [PMID: 37899609 PMCID: PMC10617297 DOI: 10.1177/17455057231207754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Epidemiological studies on urinary incontinence that used a validated international standard questionnaire are limited in Japan, and few studies have examined the sociodemographic and behavioral correlates of urinary incontinence. OBJECTIVE The aim of this study was to estimate the prevalence of urinary incontinence according to the Japanese version of the International Consultation on Incontinence Questionnaire-Short Form, and its sociodemographic and behavioral correlates among Japanese women. DESIGN A web-based cross-sectional study. METHODS A randomly sampled cross-sectional Internet survey was conducted in Japan among 3030 women aged 20-64 years. The International Consultation on Incontinence Questionnaire-Short Form score, sociodemographic, body mass index, medical and childbirth history, practice of pelvic floor muscle training, and medical care use were obtained. Descriptive statistics, the chi-square test, and forced-entry logistic regression analysis were used in data analysis. RESULTS Participants' average age was 43.4 years, and the response rate was 32.9%. The prevalence of urinary incontinence was 25.5%, and it increased with age. Stress urinary incontinence was the most common subtype (57.4%), followed by urge urinary incontinence (20.3%) and mixed urinary incontinence (16.7%). Less than 5% of those with urinary incontinence had experience with pelvic floor muscle training and medical care use. Middle-aged and older (p < 0.001), overweight and obesity (p < 0.001), vaginal delivery status (p < 0.001), low back pain (p = 0.008), and previous pelvic floor muscle training engagement (p < 0.001) were significantly associated with urinary incontinence. CONCLUSION Increasing population awareness of urinary incontinence from an early age and developing effective interventions for the identified at-risk groups, such as the middle-aged and older, those with overweight and obesity, and those with previous pregnancies, are urgently needed.
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Affiliation(s)
- Aki Onishi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ai Shibata
- Institute of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
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Meister MR, Sutcliffe S, Ghetti C, Chu CM, Spitznagle TM, Lowder JL. A pilot trial of movement-based pelvic floor physical therapy to address pelvic floor myofascial pain and lower urinary tract symptoms. Int Urogynecol J 2022. [PMID: 36125508 DOI: 10.1007/s00192-022-05353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor myofascial pain (PFMP) is associated with lower urinary tract symptoms (LUTS). The objective of this study was to test movement-based pelvic floor physical therapy (PT) for patients with PFMP and LUTS. We hypothesized that movement-based PT designed to target PFMP would result in significant improvement in both PFMP and concomitant LUTS. METHODS This pilot trial enrolled patients with moderate-to-severe PFMP on palpation who were referred to movement-based PT to diagnose and treat pelvic floor dysfunction in the context of body alignment and movement patterns. The primary outcome was change in Urogenital Distress Inventory (UDI) scores after PT. Factors associated with PT attendance were also measured. We aimed to enroll 55 participants to achieve 80% power to detect a difference in 11 points on the UDI scores with an alpha-level of 0.05, accounting for a 10% loss to follow-up. The sample size was increased to 65 owing to a higher-than-expected loss-to-follow-up rate. RESULTS Sixty-five patients were enrolled and 62 analyzed. Thirty-eight (61.3%) attended PT, and 30 (48.4%) completed a follow-up PT Attendance (PTA) survey. Overall, UDI score and irritative, obstructive, and stress subscales (p<0.0001) improved in participants who attended PT as well as mean myofascial examination scores at each site. CONCLUSIONS Participants who attended movement-based PT demonstrated an improvement in LUTS. Future studies should extend our findings by: first, confirming whether the myofascial pain-directed elements of PT improved LUTS; second, investigating whether movement-based PT improves prolapse symptoms; and third, including a non-PT control arm to rule out the possible influence of a placebo effect and behavioral modifications on LUTS and PFMP.
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Rocha Matos GS, de Souza Andrade E, de Gouveia Santos VLC, Nogueira PC. Prevalencia de incontinencia urinaria en estudiantes universitarias del interior del Amazonas. J Wound Care 2022; 31:19-26. [PMID: 36787942 DOI: 10.12968/jowc.2022.31.latam_sup_6a.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Investigar la prevalencia de la incontinencia urinaria (IU) y sus factores asociados en estudiantes universitarias del interior del estado brasileño del Amazonas. Método: Estudio transversal, observacional, analítico y cuantitativo. La muestra de conveniencia fue compuesta por 72 estudiantes universitarias de entre 18 y 30 años. Un cuestionario sobre datos sociodemográficos y de salud fue aplicado. La prevalencia y caracterización de las pérdidas urinarias fueron obtenidas por el International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), en su versión adaptada y validada para Brasil. Los datos fueron analizados por estadísticas descriptivas e inferenciales. Se emplearon las pruebas Wilcoxon-Mann-Whitney, Chi-cuadrado de Pearson y Exacto de Fisher, además de regresión logística (intervalo de confianza: 95% p<0,05). Resultados: La prevalencia de IU fue de 36,11% (26/72 estudiantes), predominantemente (80,77%) de urgencia (IUU). La edad difirió (p=0,031) entre los grupos de mujeres continentes (promedio=22,72. Desviación estándar (DE)=2,93 años) e incontinentes (promedio=21,23. DE=2,72 años). La situación predominante de pérdida fue “antes de llegar al baño” (30,77%) y el impacto de la IU sobre las actividades diarias fue considerado bajo. En el modelo de regresión logística, la edad fue un factor asociado a la presencia de IU (odds ratio (0R)=0,68; p=0,006). Conclusión: La IUU fue prevalente en la muestra estudiada, con la menor edad como factor asociado. La IU en mujeres jóvenes necesita ser mejor investigada para identificar otros factores que puedan estar relacionados con la condición encontrada en el interior del Amazonas. Conflicto de interés: Ninguno.
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Affiliation(s)
| | | | | | - Paula C Nogueira
- Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
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Rocha Matos GS, de Souza Andrade E, de Gouveia Santos VLC, Nogueira PC. Prevalencia de incontinencia urinaria en estudiantes universitarias del interior del Amazonas. J Wound Care 2022; 31:19-26. [PMID: 36789900 DOI: 10.12968/jowc.2022.31.latam_sup_6.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Investigar la prevalencia de la incontinencia urinaria (IU) y sus factores asociados en estudiantes universitarias del interior del estado brasileño del Amazonas. Método: Estudio transversal, observacional, analítico y cuantitativo. La muestra de conveniencia fue compuesta por 72 estudiantes universitarias de entre 18 y 30 años. Un cuestionario sobre datos sociodemográficos y de salud fue aplicado. La prevalencia y caracterización de las pérdidas urinarias fueron obtenidas por el International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), en su versión adaptada y validada para Brasil. Los datos fueron analizados por estadísticas descriptivas e inferenciales. Se emplearon las pruebas Wilcoxon-Mann-Whitney, Chi-cuadrado de Pearson y Exacto de Fisher, además de regresión logística (intervalo de confianza: 95% p<0,05). Resultados: La prevalencia de IU fue de 36,11% (26/72 estudiantes), predominantemente (80,77%) de urgencia (IUU). La edad difirió (p=0,031) entre los grupos de mujeres continentes (promedio=22,72. Desviación estándar (DE)=2,93 años) e incontinentes (promedio=21,23. DE=2,72 años). La situación predominante de pérdida fue “antes de llegar al baño” (30,77%) y el impacto de la IU sobre las actividades diarias fue considerado bajo. En el modelo de regresión logística, la edad fue un factor asociado a la presencia de IU (odds ratio (0R)=0,68; p=0,006). Conclusión: La IUU fue prevalente en la muestra estudiada, con la menor edad como factor asociado. La IU en mujeres jóvenes necesita ser mejor investigada para identificar otros factores que puedan estar relacionados con la condición encontrada en el interior del Amazonas. Conflicto de interés: Ninguno.
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Affiliation(s)
| | | | | | - Paula C Nogueira
- Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
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Scime NV, Hetherington E, Metcalfe A, Chaput KH, Dumanski SM, Seow CH, Brennand EA. Association between chronic conditions and urinary incontinence in females: a cross-sectional study using national survey data. CMAJ Open 2022; 10:E296-E303. [PMID: 35383034 PMCID: PMC9259416 DOI: 10.9778/cmajo.20210147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Urinary incontinence affects up to half of women, yet few speak to their health care provider about or receive treatment for the condition. To aid with identifying subpopulations at risk for urinary incontinence, we examined the associations between 10 chronic health conditions and urinary incontinence among Canadian adult females. METHODS We conducted a cross-sectional analysis of survey data from the Canadian Community Health Survey (2013-2014) involving female respondents aged 25 years or older living in a private dwelling. Presence of chronic conditions and urinary incontinence were measured by self-report. We used logistic regression modelling with sampling weights, controlling for age, income, ethnicity, body mass index and smoking. Multiple imputation and probabilistic bias analysis were used to address missing covariate data and unmeasured confounding from parity. RESULTS Our analysis included 60 186 respondents representing more than 12 million Canadian females, of whom 45.8% (95% confidence interval [CI] 45.0%-46.6%) reported at least 1 chronic condition. Chronic conditions were associated with more than twice the odds of urinary incontinence (adjusted odds ratio [OR] 2.42, 95% CI 2.02-2.89). Associations were largest for bowel disorders (adjusted OR 2.92, 95% CI 2.44-3.49); modest for chronic obstructive pulmonary disease (adjusted OR 2.00, 95% CI 1.63-2.45), asthma (adjusted OR 1.82, 95% CI 1.52-2.19), arthritis (adjusted OR 1.98, 95% CI 1.74-2.24) and heart disease (adjusted OR 1.73, 95% CI 1.48-2.02); and smallest for diabetes (adjusted OR 1.20, 95% CI 1.02-1.41) and high blood pressure (adjusted OR 1.27, 95% CI 1.12-1.44). Results slightly attenuated but did not substantively change after imputation and bias analysis. INTERPRETATION We found that chronic conditions are associated with significantly higher odds of comorbid urinary incontinence among Canadian adult females, which is consistent with previous research. Our findings support routine inquiry regarding urinary incontinence symptoms among women accessing health care for chronic conditions.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin Hetherington
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Amy Metcalfe
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Kathleen H Chaput
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Sandra M Dumanski
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Cynthia H Seow
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin A Brennand
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta.
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Weinstein MM, Dunivan G, Guaderrama NM, Richter HE. Digital Therapeutic Device for Urinary Incontinence: A Randomized Controlled Trial. Obstet Gynecol 2022; 139:606-15. [PMID: 35271539 DOI: 10.1097/AOG.0000000000004725] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Abstract
To evaluate whether pelvic floor muscle training using a motion-based digital intravaginal device is more effective than home pelvic floor muscle training for treatment of stress or stress-predominant mixed urinary incontinence (UI).
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Markland AD, Vaughan C, Huang A, Kim E, Bubes VY, Tangpricha V, Buring J, Lee IM, Cook N, Manson JE, Grodstein F. Effect of vitamin D supplementation on urinary incontinence in older women: ancillary findings from a randomized trial. Am J Obstet Gynecol 2022; 226:535.e1-535.e12. [PMID: 34678177 PMCID: PMC8983596 DOI: 10.1016/j.ajog.2021.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Observational studies among older women have associated vitamin D insufficiency with a greater prevalence and incidence of urinary incontinence. However, little is known about the effect of vitamin D supplementation in reducing urinary incontinence. OBJECTIVE This study aimed to evaluate the effects of vitamin D supplementation in reducing the frequency of urinary incontinence in older women. STUDY DESIGN We conducted an ancillary study of women aged ≥55 years in the Vitamin D and Omega-3 Trial, a randomized trial with a 2×2 factorial design. Recruitment of participants started from 2011 to 2014 across 50 US states, and the follow-up of participants ended in January 2018. Randomized treatments in the parent study included (1) vitamin D3 (cholecalciferol) at a dosage of 2000 IU/d, (2) marine omega-3 fatty acids at a dosage of 1 g/d, and (3) matching placebo. Here, we analyzed women according to their randomization to vitamin D supplementation or placebo, regardless of treatment with omega-3 fatty acid supplementation. Validated frequency of urinary incontinence questions were added in year 2 of the study and were used again in year 5 at the end of trial. Prespecified ancillary outcomes included the prevalence of urinary incontinence at years 2 and 5, along with incident incontinence and progression of incontinence (from lower to higher frequency) from year 2 to year 5. Preplanned subgroup analyses examined the following outcomes: prerandomization of low serum levels of vitamin D (serum 25-hydroxyvitamin D<20 ng/mL), incontinence types, weight categories, and African American race. RESULTS Among the randomized women who provided urinary incontinence data, 11,646 women at year 2 and 10,527 women at year 5, the mean age was 70 years at year 2, with 29% racial and ethnic minorities. The prevalence of urinary incontinence that occurred at least weekly was 29% at year 2 and increased to 37% at year 5. Vitamin D supplementation compared to with placebo was not associated with lower odds of urinary incontinence occurring at least weekly at year 2 (odds ratio, 1.08; 95% confidence interval, 0.99-1.19) or year 5 (odds ratio, 1.04; 95% confidence interval, 0.94-1.15). Vitamin D supplementation compared to placebo was not associated with lower incidence or progression of urinary incontinence from year 2 to year 5: incidence (odds ratio, 1.06; 95% confidence interval, 0.83-1.35) or progression (odds ratio, 0.94; 95% confidence interval, 0.82-1.08). Women with prerandomization of low serum levels of vitamin D (n=836) did not have lower odds of the prevalence, incidence, or progression of urinary incontinence. The findings were null in subgroups according to incontinence type, women with obesity, and African American women. Only women with healthy weight randomized to vitamin D had lower odds of progression of urinary incontinence (odds ratio, 0.78; 95% confidence interval, 0.63-0.95; P=.01). CONCLUSION Vitamin D supplementation compared to placebo for 2 to 5 years was not associated with differences in the prevalence, incidence, or progression of urinary incontinence in older women with and without adequate serum vitamin D levels, with inconsistent differences among subgroups. The findings showed that the broad use of moderate doses of vitamin D supplementation did not reduce urinary incontinence in older women.
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Affiliation(s)
- Alayne D Markland
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, and Atlanta, GA; Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL.
| | - Camille Vaughan
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, and Atlanta, GA; Atlanta Veterans Affairs Medical Center, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Alison Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Eunjung Kim
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vadim Y Bubes
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vin Tangpricha
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, and Atlanta, GA; Atlanta Veterans Affairs Medical Center, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Julie Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nancy Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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McKinney JL, Datar M, Pan LC, Goss T, Keyser LE, Pulliam SJ. Retrospective claims analysis of physical therapy utilization among women with stress or mixed urinary incontinence. Neurourol Urodyn 2022; 41:918-925. [PMID: 35353916 PMCID: PMC9311701 DOI: 10.1002/nau.24913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/07/2022] [Indexed: 12/28/2022]
Abstract
Objective To describe the characteristics of women with stress or mixed urinary incontinence (SUI/MUI) receiving physical therapy (PT) services, including referral patterns and PT utilization. Methods Female patients with claims associated with an SUI or MUI diagnosis (International Classification of Disease—Clinical Modification [ICD‐9‐CM]: 625.6, 788.33, or ICD‐10‐CM: N39.3, N39.46) between July 01, 2014 and June 30, 2016 were identified in International business machines (IBM)'s MarketScan Research Database. Inclusion criteria included the absence of pregnancy claims and ≥80% medical and pharmacy enrollment pre‐ and postindex. First SUI/MUI diagnosis claim determined index. Patients were followed for 2 years, and associated UI‐associated PT encounters were identified. Descriptive statistics were calculated for patients with at least one PT visit during the postindex period. Results In a cohort of 103,813 women with incident SUI or MUI diagnosis, 2.6% (2792/103,813) had at least one PT visit in the 2 years following their diagnosis. Mean age at index PT encounter was 50.55 years. A total of 52.36% (1462/2792) women had one to four PT visits; 21.2% (592/2792) had >8 PT visits. In subanalysis of the PT cohort (1345/2792), women who received PT only had the lowest average 2‐year postindex total medical cost (mean: $12,671; SD: $16,346), compared with PT plus medications (mean: $27,394; SD: $64,481), and PT plus surgery (mean: $33,656; SD: $26,245), respectively. Over 40% had their first PT visit ≥3 months after their index date. Conclusions The percentage of women with a PT visit associated with an incident SUI or MUI diagnosis was low (2.6%), and 30% of this group completed three or more PT visits. This suggests poor adherence to clinical guidelines regarding supervised treatment of UI in women. Impact Statement Our study suggests underutilization of PT among insured women with SUI and MUI in the 2 years following diagnosis. Interventions to improve this gap in first‐line care may represent an opportunity for an increased role for PTs in the care of women with UI.
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Affiliation(s)
- Jessica L McKinney
- Physical Therapy, School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia Inc., Boston, Massachusetts, USA
| | - Manasi Datar
- Boston Healthcare Associates, Boston, Massachusetts, USA
| | - Li-Chen Pan
- Boston Healthcare Associates, Boston, Massachusetts, USA
| | - Thomas Goss
- Boston Healthcare Associates, Boston, Massachusetts, USA
| | - Laura E Keyser
- Physical Therapy, School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia Inc., Boston, Massachusetts, USA
| | - Samantha J Pulliam
- Renovia Inc., Boston, Massachusetts, USA.,Obstetrics and Gynecology, Tufts University, Boston, Massachusetts, USA
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Bakre S, Holt SK, Oerline M, Braffett BH, Pop-Busui R, Wessells H, Sarma AV. Longitudinal patterns of urinary incontinence and associated predictors in women with type 1 diabetes. Neurourol Urodyn 2022; 41:323-331. [PMID: 34672384 PMCID: PMC8738144 DOI: 10.1002/nau.24823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
AIMS Urinary incontinence (UI) in women is a dynamic condition with numerous risk factors yet most studies have focused on examining its prevalence at a single time. The objective of this study was to describe the long-term time course of UI in women with type 1 diabetes (T1D). METHODS Longitudinal data in women with T1D were collected from 568 women in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, the observational follow-up of the Diabetes Control and Complications Trial (DCCT) cohort. Over a 12-year period, participants annually responded to whether they had experienced UI in the past year. RESULTS We identified four categories of UI in this population over time: 205 (36.1%) women never reported UI (no UI), 70 (12.3%) reported it one or two consecutive years only (isolated UI), 247 (43.5%) periodically changed status between UI and no UI (intermittent UI), and 46 (8.1%) reported UI continuously after the first report (persistent UI). Compared to women reporting no/isolated UI, women displaying the intermittent phenotype were significantly more likely to be obese (OR: 1.86, 95% CI 1.15, 3.00) and report prior hysterectomy (OR: 2.57, 95% CI: 1.39, 4.77); whereas women with persistent UI were significantly more likely to have abnormal autonomic function (OR: 2.36, 95% CI: 1.16-4.80). CONCLUSIONS UI is a dynamic condition in women with T1D. Varying risk factors observed for the different phenotypes of UI suggest distinctive pathophysiological mechanisms. These findings have the potential to be used to guide individualized interventions for UI in women with diabetes.
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Affiliation(s)
- Shivani Bakre
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Sarah K. Holt
- University of Washington, Department of Urology and Diabetes Research Center, Seattle, WA
| | - Mary Oerline
- University of Michigan, Department of Urology, Ann Arbor, MI
| | | | - Rodica Pop-Busui
- University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI
| | - Hunter Wessells
- University of Washington, Department of Urology and Diabetes Research Center, Seattle, WA
| | - Aruna V. Sarma
- University of Michigan, Department of Urology, Ann Arbor, MI
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Abstract
Overactive bladder (OAB) syndrome is a common condition characterised by urinary
urgency, with or without urgency incontinence, frequency and nocturia, in the
absence of any other pathology. Clinical diagnosis is based upon patient
self-reported symptomology. Currently there is a plethora of treatments
available for the management of OAB. Clinical guidelines suggest treatment
via a multidisciplinary pathway including behavioural
therapy and pharmacotherapy, which can be commenced in primary care, with
referral to specialist services in those patients refractory to these
treatments. Intradetrusor botulinum A and sacral neuromodulation provide safe
and efficacious management of refractory OAB. Percutaneous tibial nerve
stimulation and augmentation cystoplasty remain available and efficacious in a
select group of patients. Unfortunately, there remains a high rate of patient
dissatisfaction and discontinuation in all treatments and thus there remains a
need for emerging therapies in the management of OAB.
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Affiliation(s)
- Christina Fontaine
- Specialist Registrar in Urology, University Hospitals Plymouth, Derriford Road, Devon, PL6 8AU, UK
| | - Emma Papworth
- Bristol Urological Institute, Southmead Hospital, Bristol, Somerset, UK
| | | | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, Somerset, UK
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Nygaard IE, Bardsley T, Sheng X, Murtaugh MA, Shaw JM. Habitus and Pelvic Floor Symptoms and Support 1 Year Postpartum. Obstet Gynecol 2021; 137:821-30. [PMID: 33831903 DOI: 10.1097/AOG.0000000000004349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
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.
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Jarbøl DE, Haastrup PF, Rasmussen S, Søndergaaard J, Balasubramaniam K. Women's barriers for contacting their general practitioner when bothered by urinary incontinence: a population-based cross-sectional study. BMC Urol 2021; 21:99. [PMID: 34247613 PMCID: PMC8273936 DOI: 10.1186/s12894-021-00864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Urinary incontinence (UI) is a frequently occurring condition among women and increases with age. Effective treatments exist but many women hesitate to contact their general practitioner (GP) regarding UI. Therefore, it is important to generate knowledge regarding barriers for healthcare-seeking. Several factors such as age, duration and number of symptoms are associated with healthcare-seeking. How socioeconomic status (SES) is associated with experiencing barriers for healthcare-seeking for UI has not been explored. The objectives of this study were to: (1) analyze frequencies of barriers for healthcare-seeking, and (2) investigate associations between SES and barriers for contacting the GP, among women reporting bothersome UI. Method A cross-sectional web-based questionnaire study of symptoms occurrence among 51,090 randomly selected women. This study investigates reported symptoms of three types of UI (stress UI, urge UI and UI without stress or urge) and reported barriers for GP contact combined with register data on SES. Results A total of 4,051 (16.4%) women reported to be bothered by either stress UI (9.1%), urge UI (4.0%) or incontinence without stress or urge (2.4%) and 76.3%, 70%, and 64% respectively, had not contacted their GP regarding the symptom(s). The most frequently reported barriers were ‘being too embarrassed’ (19.3%) and ‘being too busy’ (18.4%) for stress incontinence, and ‘being too embarrassed (19.0%) or ‘worried about wasting the doctor’s time’ (16.9%) for women with bothersome urge UI or UI without stress or urge. Younger women had higher odds of reporting barriers and the barriers embarrassment and being worried about what the doctor might find were significantly associated with lower educational level. Conclusion Women with lower educational level have an increased risk of not seeking healthcare for UI symptoms. The GP should be aware of identifying women bothered by UI for whom effective treatment options to alleviate the symptoms are available. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00864-x.
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Affiliation(s)
- Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 2. Sal, 5000, Odense C, Denmark.
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 2. Sal, 5000, Odense C, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 2. Sal, 5000, Odense C, Denmark
| | - Jens Søndergaaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 2. Sal, 5000, Odense C, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 2. Sal, 5000, Odense C, Denmark
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22
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Batmani S, Jalali R, Mohammadi M, Bokaee S. Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr 2021; 21:212. [PMID: 33781236 PMCID: PMC8008630 DOI: 10.1186/s12877-021-02135-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background Urinary incontinence is a common condition in the general population and, in particular, the older adults population, which reduces the quality of life of these people, so this study aims to systematically examine and meta-analyse the overall prevalence of urinary incontinence in older women around the world and the related and influential factors. Methods This report is a comprehensive systematic review and meta-analysis of the findings of research on urinary incontinence in older adults people across the world through looking for MEDLINE, Cochrane Library Sciencedirect, Embase, Scopus, ProQuest and Persian databases, namely iranmedex, magiran, and SID from January 2000 to April 2020, the heterogeneity of the experiments was measured using the I2 index and the data processing was done in the Systematic Meta-Analysis programme. Results In 29 studies and the sample size of 518,465 people in the age range of 55–106 years, urinary incontinence in older adults’ women in the world based on a meta-analysis of 37.1% (95% CI: 29.6–45.4%) was obtained. The highest prevalence of urinary incontinence was reported in older adults’ women in Asia with 45.1% (95% CI: 36.9–53.5%). Meta-regression also showed that with increasing the sample size and year of the study, the overall prevalence of urinary incontinence in the older adults women of the world decreased and increased, respectively, which were statistically significant differences (P < 0.05). According to studies, the most important factors influencing the incidence of urinary incontinence in older women are women’s age (p < 0.001), obesity (p < 0.001), diabetes (p < 0.001), women’s education (p < 0.001), delivery rank (p < 0.001), hypertension (p < 0.001), smoking (p < 0.001). They also have urinary tract infections (p < 0.001). Conclusion Given the high prevalence of urinary incontinence in older women around the world, health policy makers must consider control and diagnostic measures in older women and prioritize treatment and rehabilitation activities.
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Affiliation(s)
- Sedighe Batmani
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shadi Bokaee
- Faculty of Health and Life Sciences, School of Life Sciences, Coventry University, Coventry, UK
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23
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Lane GI, Hagan K, Erekson E, Minassian VA, Grodstein F, Bynum J. Patient-Provider Discussions About Urinary Incontinence Among Older Women. J Gerontol A Biol Sci Med Sci 2021; 76:463-469. [PMID: 32353111 DOI: 10.1093/gerona/glaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI) is prevalent in women and has been associated with decreased quality of life and institutionalization. Despite this, and the fact that several treatment options exist, few women discuss UI with clinicians. The aim of this study was to examine the proportion of middle aged and older women with urinary incontinence who have discussed UI with clinicians, focusing on female health professionals as a way to examine this question outside of issues of health care access. METHODS Data are from the Nurses Health Studies (NHS), two ongoing observational, prospective, cohort studies. The surveys collected detailed information about UI, including frequency, amount and type. Women were also asked if they had discussed UI with a clinician. We used multivariable-adjusted logistic regression to estimate odds ratios (OR) of participants reporting discussion about UI. RESULTS 94,692 women with UI aged 49-91 years old were included in this study. Of these, 34% reported that they had discussed their incontinence with a clinician. Women with daily UI had 4.4 times greater odds of discussing it with clinicians when compared to those with monthly UI (OR = 4.36, 95% confidence interval [CI] 4.06-4.69). When controlling for severity of symptoms, the oldest women, greater than eighty years, were 20% less likely to have discussed UI with their clinician, compared to the youngest women (OR = 0.81, 95% CI 0.73-0.89). CONCLUSIONS A minority of women with UI, even among health professionals, discuss their symptoms with clinicians. Oldest women were the least likely to discuss their UI with a provider.
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Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor.,Institute of Health Policy and Research, University of Michigan, Ann Arbor
| | - Kaitlin Hagan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Elisabeth Erekson
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland.,Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | - Vatche A Minassian
- Division of Urogynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Francine Grodstein
- Rush Alzheimer's Disease Center, Rush Medical College, Chicago, Illinois
| | - Julie Bynum
- Department of Internal Medicine, University of Michigan, Ann Arbor.,Institute of Health Policy and Research, University of Michigan, Ann Arbor
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24
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Abstract
Pelvic floor disorders are common in the postpartum period. These disorders can significantly affect one's quality of life during a period that is already filled with emotional and physiologic change. This review focuses on the presentation, diagnosis, and treatment of the 3 major pelvic floor disorders in postpartum women, namely, urinary incontinence, fecal incontinence, and pelvic organ prolapse.
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Affiliation(s)
- Ana Rebecca Meekins
- Department of Obstetrics and Gynecology, Division of Urogynecology, Duke University School of Medicine, 5324 McFarland Drive Suite 310, Durham, NC 27707, USA.
| | - Nazema Y Siddiqui
- Department of Obstetrics and Gynecology, Division of Urogynecology, Duke University School of Medicine, 5324 McFarland Drive Suite 310, Durham, NC 27707, USA
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25
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Ferrante KL, Gantz MG, Sridhar A, Smith A, Rahn DD, Ellington DR, Weidner AC, Wohlrab K, Mazloomdoost D, Moalli P, Lukacz ES; NICHD Pelvic Floor Disorders Network. Do Women Who Self-report More Exercise Have Increased Rates of Symptomatic Stress Urinary Incontinence After Midurethral Slings? Female Pelvic Med Reconstr Surg 2021; 27:e202-7. [PMID: 32898050 DOI: 10.1097/SPV.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is a paucity of data on postoperative exercise and how it relates to surgical failure, specifically after midurethral sling (MUS) surgery. We aimed to assess if women with higher self-reported activity levels as measured by strenuous exercise are more likely to experience stress urinary incontinence (SUI) symptoms after MUS than women with lower self-reported activity. METHODS This is a secondary analysis of Operations and Pelvic Muscle Training in the Management of Apical Support Loss: the OPTIMAL Trial, a randomized trial comparing sacrospinous ligament suspension versus uterosacral ligament suspension, both with concomitant retropubic MUS. Participants completed a validated assessment of activity preoperatively and postoperatively. Women in the upper quartile for strenuous exercise (≥90 minutes per week) were compared with the remaining participants. Symptomatic SUI was defined as retreatment or reoperation for SUI and/or any positive response to Pelvic Floor Disorders Inventory stress incontinence questions 20 to 22. RESULTS A total of 351 participants in the OPTIMAL study received MUS along with their prolapse repair and had postoperative exercise and Pelvic Floor Disorders Inventory data. At 2 years, 87 (29%) of 305 exercised strenuously for at least 90 minutes per week, and 63 (23%) of 277 experienced SUI. Women who were less active at 2 years were significantly more likely to experience SUI than women who were more active (26.6% vs 12.8%, P = 0.0138). CONCLUSIONS In this study, symptomatic SUI occurred more frequently in women with lower self-reported exercise levels 2 years after MUS surgery.
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26
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Örsal Ö, Duru P, Ünver G. The Relationship between Urinary Incontinence Quality of Life and Sleep Quality in Women Over the Age of 60 Years. Florence Nightingale Hemsire Derg 2020; 28:155-163. [PMID: 34263194 PMCID: PMC8152158 DOI: 10.5152/fnjn.2020.19079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022] Open
Abstract
Aim The study aimed to investigate the relationship between urinary incontinence quality of life and sleep quality in women over the age of 60 years. Method This cross-sectional study was conducted between May 15 and July 5, 2013. Data were collected from a total of 332 women including 68 women from 3 nursing homes in a provincial center of Eskisehir and 269 women living alone or with family in their own homes in a street of that city. Women’s urinary incontinence quality of life was assessed using the incontinence quality of life scale and sleep quality was assessed using the Pittsburgh sleep quality index. Results Mean age of the participating women was 71.00±7.42 years. Only 10.8% of the women had incontinence diagnosis; prevalence of anamnesis-based incontinence was 87.7%. Those who lived in their own homes, who had a urinary incontinence diagnosis, who experienced urinary incontinence according to their anamnesis, who were smokers, and who had a poor sleep quality had lower Incontinence Quality of Life Scale scores. Additionally, their quality of life was negatively affected (p<0.05). Poor sleep quality and diagnosis of urinary incontinence were important predictors of the Incontinence Quality of Life Scale of women over 60 years of age and explained 18% of the total variance. The Incontinence Quality of Life Scale scores of the women decreased by 5.67 points in the presence of poor sleep quality and 6.48 points in the presence of urinary incontinence diagnosis. Conclusion Urinary incontinence is a common problem seen in older women, is considered as a usual problem due to aging, and is ignored or not taken care of. It also has a negative impact on the quality of life and sleep.
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Affiliation(s)
- Özlem Örsal
- Department of Public Health Nursing, Eskişehir Osmangazi University Faculty of Health Sciences, Eskişehir, Turkey
| | - Pınar Duru
- Department of Public Health Nursing, Eskişehir Osmangazi University Faculty of Health Sciences, Eskişehir, Turkey
| | - Gamze Ünver
- Department of Internal Medicine Nursing, Kütahya Health Sciences University Faculty of Health Sciences, Kütahya, Turkey
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27
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Khullar V, Rahnama'i MS, Veit-Rubin N, Cardozo L, Wein AJ. Can we harness the placebo effect to improve care in lower urinary tract dysfunction? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S80-S87. [PMID: 32311166 DOI: 10.1002/nau.24351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/09/2022]
Abstract
The proposal "Can we harness the placebo effect to improve care in lower urinary tract dysfunction?" was discussed at the International Consultation on Incontinence-Research Society (ICI-RS) 2019 meeting. The placebo effect can change the treatment outcome whether the treatment is an active treatment or placebo. The total active treatment outcome is a combination of the placebo and the active treatment effect which is seen in placebo-controlled trials. The placebo effect plays an important role in the treatment of lower urinary tract dysfunction in overactive bladder, bladder pain syndrome, and stress urinary incontinence. In clinical practice, a number of factors can be employed to use the placebo effect to maximize its effect on patients receiving an active treatment, such as having the same environment for review such as the same appointment time, same room, and same clinician. Clinicians should also be aware of the nocebo effect which is increased with an overemphasis on side effects or negative outcomes.
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Affiliation(s)
- Vik Khullar
- Urogynaecology Department, St Mary's Hospital, Imperial College London, London, UK
| | - Mohammad S Rahnama'i
- Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Linda Cardozo
- Department of Urogynaecology, Kings College Hospital, London, UK
| | - Alan J Wein
- Department of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Abstract
Urinary incontinence (UI) is common among women and contributes to decreased quality of life. Several effective treatment options are available for the most common types of UI (stress, urge, and mixed), including lifestyle and behavioral therapy, drug therapy, and minimally invasive procedures. Most women improve with treatment, and UI is not an inevitable part of aging. To maximize the opportunity for successful treatment, it is critical to align the treatment approach with patient goals and expectations for care, including an assessment of patient-driven priorities regarding potential adverse effects, costs, and expected benefit of different treatment approaches.
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Affiliation(s)
- Camille P Vaughan
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center and Emory University, Atlanta, Georgia (C.P.V.)
| | - Alayne D Markland
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center and University of Alabama at Birmingham, Birmingham, Alabama (A.D.M.)
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29
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Minassian VA, Hagan KA, Erekson E, Austin AM, Carmichael D, Bynum JP, Grodstein F. The natural history of urinary incontinence subtypes in the Nurses' Health Studies. Am J Obstet Gynecol 2020; 222:163.e1-163.e8. [PMID: 31449803 DOI: 10.1016/j.ajog.2019.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/16/2019] [Accepted: 08/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence subtypes often differ by symptom severity and treatment profiles; in particular, mixed urinary incontinence is generally associated with worse symptoms and less successful treatment. Yet, limited information exists on the natural history of different urinary incontinence subtypes, which could help to better identify and treat patients prior to development of more intractable disease. OBJECTIVE To evaluate the onset of urinary incontinence subtypes, and transitions between subtypes over 8 years, using 2 large cohorts of middle-aged and older women with incident urinary incontinence. MATERIALS AND METHODS We identified 10,349 women with incident urinary incontinence (stress, urgency, and mixed subtypes) from the Nurses' Health Study and the Nurses' Health Study II who were 41-83 years of age, using repeated mailed questionnaires. We defined stress urinary incontinence as leakage with coughing, sneezing, or activity; urgency urinary incontinence as urine loss with a sudden feeling of bladder fullness or when a toilet was inaccessible; and mixed urinary incontinence when women reported that stress and urgency symptoms occurred equally. In subsequent questionnaires 4 and 8 years later, we continued to track symptom severity and subtypes. In addition, to obtain predicted probabilities of urinary incontinence subtypes 4 years and 8 years after urinary incontinence onset, we used multivariable-adjusted generalized estimating equations with a multinomial outcome. RESULTS At urinary incontinence onset in 2004-2005, 56% of women reported stress urinary incontinence symptoms, 23% reported urgency urinary incontinence symptoms, and 21% reported mixed urinary incontinence symptoms. Women with stress urinary incontinence or urgency urinary incontinence at onset were likely to report the same urinary incontinence type 4 and 8 years later (stress urinary incontinence at onset: 70% and 60% reported stress urinary incontinence at years 4 and 8, respectively; urgency urinary incontinence at onset: 68% and 64% reported urgency urinary incontinence at years 4 and 8, respectively). Nonetheless, for both stress and urgency urinary incontinence, women with more severe symptoms at onset were more likely to progress to mixed urinary incontinence. Women with mixed urinary incontinence at onset had more variation over time, although the largest subset continued to report mixed urinary incontinence (45% reported mixed urinary incontinence at year 4; 43% reported mixed urinary incontinence at year 8). Few women across all urinary incontinence subtypes reported resolution of symptoms over 4-8 years of follow-up (4-12%). When considering the likelihood of remaining with or progressing to mixed urinary incontinence over follow-up, according to age, body mass index, and urinary incontinence severity, we found that older and younger women had similar predicted probability of remaining with or progressing to mixed urinary incontinence (eg, women <60 years of age at onset with severe mixed urinary incontinence had a 54% (95% confidence interval, 53-55) probability of mixed urinary incontinence 8 years later, vs 57% (95% confidence interval, 56-58) of women ≥70 years of age with severe mixed urinary incontinence at onset). Obese women were somewhat more likely to progress to mixed urinary incontinence regardless of urinary incontinence type at onset (eg, women with body mass index <25 kg/m2 at onset with severe stress urinary incontinence had a 30% predicted probability of mixed urinary incontinence 8 years after onset, vs 36% of women with body mass index of 30+ kg/m2 at onset with severe stress urinary incontinence). CONCLUSION Most women with incident stress and urgency urinary incontinence continued to experience similar subtype symptoms over 8 years. However, obese women and those with more severe symptoms were more likely to remain with or progress to mixed urinary incontinence.
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30
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Paolucci T, Bellomo RG, Pezzi L, Frondaroli F, Frondaroli S, Santarelli A, Barbato C, Porreca A, Saggini R. A Novel Rehabilitative Protocol in the Treatment of Mixed Urinary Incontinence in Women: The Effects of Focused Mechano-Acoustic Vibration. Biores Open Access 2019; 8:219-228. [PMID: 32042506 PMCID: PMC6931011 DOI: 10.1089/biores.2019.0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dysfunctions of the pelvic floor related to mixed urinary incontinence in women are pathologies extremely limiting for patients bodily and psychosocial conditions, altering their quality of life. The aim of this study was to determine the effects of focal mechanical vibrations in mixed urinary incontinence. In this retrospective observational case-control study, 65 patients were randomized and divided into 2 groups: treatment group by focal mechanical vibrations (VISS-10 sessions) (N = 33) and a control group in waiting list (N = 32). Also, both groups received home-based postural ergonomic instructions to reinforce pelvic floor. Data were collected at T0 (baseline), T1 (end of treatment), and T2 (follow-up = after 1 month): rheological muscle parameters were assessed by MyotonPRO respect to evaluate the gluteus maximus muscle. Then, to measure the general disability of the pelvic floor and the impact of urogenital problems on daily activities the Pelvic Floor Disability Index (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were used. Groups were matched perfectly before treatment for age (58.20 ± 4.37 vs. 58.73 ± 5.19) and BMI (26.15 ± 2.22 vs. 25.85 ± 2.11); for the two-way ANOVA analysis, a difference in gluteus variables over time and between groups except for GMDR (group p-value = 0.60) was showed. The two-way ANOVA shows statistically significant effects of treatment and time for PDFI-20 and PFIQ-7 (p-value <0.001). An improvement in incontinence symptoms and quality of life in the PDFI-20 and PFIQ-7 scores were reported and VISS may favor muscles stiffness for exercises by improving the normalization of basal tone. Our results were encouraging and suggested the use of focal mechanical vibration as a novel tool for treating mix urinary incontinence in women to complete and help the rehabilitative therapeutic protocol.
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Affiliation(s)
- Teresa Paolucci
- Unit of Physical Medicine and Rehabilitation, Department of Medical and Oral Sciences and Biotechnologies (DSMOB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Rosa Grazia Bellomo
- Department of Biomolecular Science, Physical Medicine and Rehabilitation, Carlo Bo University Study of Urbino, Urbino, Italy
| | - Letizia Pezzi
- Unit of Physical Medicine and Rehabilitation, Department of Medical and Oral Sciences and Biotechnologies (DSMOB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Franco Frondaroli
- Obstetric-Gynecological Clinic (Maternal-Infant Department), University Hospital of "SS. Annunziata", Chieti, Italy
| | - Serena Frondaroli
- Complex Gynecological Operative Unit, "Floraspe Renzetti" Hospital, Lanciano, Italy
| | - Alessandro Santarelli
- Obstetric-Gynecological Clinic (Maternal-Infant Department), University Hospital of "SS. Annunziata", Chieti, Italy
| | - Claudia Barbato
- Department of Biomolecular Science, Physical Medicine and Rehabilitation, Carlo Bo University Study of Urbino, Urbino, Italy
| | - Annamaria Porreca
- Department of Economic Science, G. d'Annunzio University, Chieti-Pescara, Italy
| | - Raoul Saggini
- Unit of Physical Medicine and Rehabilitation, Department of Medical and Oral Sciences and Biotechnologies (DSMOB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
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31
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Maturana AP, Palos CC, Ghersel FR, Fernandes CE, Oliveira E. Randomized controlled trial comparing mini-sling with transobturator sling for the treatment of stress urinary incontinence. Int Urogynecol J 2019; 31:1925-1931. [PMID: 31784809 DOI: 10.1007/s00192-019-04145-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is the involuntary loss of urine on effort and is a condition that negatively interferes with various aspects of a woman's life. This study aimed to demonstrate the non-inferiority of the less invasive single-incision mini-sling (SIMS) method in objective and subjective cures in relation to tension-free transobturator tape (TOT) in two analyses, per protocol and intention to treat, and secondarily to evaluate complications and quality of life. METHODS This study was a randomized controlled trial (RCT). Participants in this study included 105 women with a clinical diagnosis of stress predominant urinary incontinence and urodynamic results demonstrating SUI and absence of detrusor overactivity. Patients were evaluated pre- and postoperatively through anamnesis, physical examination, urinalysis, urine culture and susceptibility testing, simplified pad test, the Urinary Incontinence-Specific Quality of Life Instrument (I-QOL) and Urogenital Distress Inventory Short Form (UDI-6). RESULTS Regarding the objective cure, SIMS was non-inferior to TOT (p < 0.05). However, the same was not found for the subjective cure (p > 0.05). There were no differences in the complication rates (p > 0.05). However, in the TOT group, bladder perforation (2.4%), tape exposure (2.4%) and urinary retention occurred, lasting > 7 days (2.4%). In both groups, there was improvement in quality of life after surgery, without significant differences (p > 0.05). CONCLUSIONS The non-inferiority of SIMS in relation to TOT was only demonstrated in the objective cure. There were no significant differences between groups regarding complications and quality of life.
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Affiliation(s)
- Ana P Maturana
- Department of Urogynecology and Vaginal Surgery within the Discipline of Gynecology, ABC Medical School, Av. Lauro Gomes, 2000-Vila Sacadura Cabral, Santo André, SP, 09060-650, Brazil. .,Rua Conselheiro Lafayette, 450 apto 64-Santa Paula, São Caetano do Sul, SP, 09550-000, Brazil.
| | - Claudia C Palos
- Department of Urogynecology and Vaginal Surgery within the Discipline of Gynecology, ABC Medical School, Av. Lauro Gomes, 2000-Vila Sacadura Cabral, Santo André, SP, 09060-650, Brazil
| | - Frederico R Ghersel
- Department of Urogynecology and Vaginal Surgery within the Discipline of Gynecology, ABC Medical School, Av. Lauro Gomes, 2000-Vila Sacadura Cabral, Santo André, SP, 09060-650, Brazil
| | - Cesar E Fernandes
- Department of Urogynecology and Vaginal Surgery within the Discipline of Gynecology, ABC Medical School, Av. Lauro Gomes, 2000-Vila Sacadura Cabral, Santo André, SP, 09060-650, Brazil
| | - Emerson Oliveira
- Department of Urogynecology and Vaginal Surgery within the Discipline of Gynecology, ABC Medical School, Av. Lauro Gomes, 2000-Vila Sacadura Cabral, Santo André, SP, 09060-650, Brazil
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Erekson E, Hagan KA, Austin A, Carmichael D, Minassian VA, Grodstein F, Bynum JPW. Outpatient Evaluation and Management Visits for Urinary Incontinence in Older Women. J Urol 2019; 202:333-8. [PMID: 30865568 DOI: 10.1097/JU.0000000000000223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this investigation were to examine how often outpatient visits addressing urinary incontinence in women with self-reported incontinence symptoms occur and to explore characteristics associated with an outpatient visit for incontinence. MATERIALS AND METHODS We studied the records of 18,576 women from the Nurses' Health Study who were 65 years old or older, reported prevalent incontinence symptoms in 2012 on a mailed questionnaire and were linked with Medicare utilization data. We compared demographic, personal and clinical characteristics in women with and without claims for outpatient visits for urinary incontinence. In logistic regression models we controlled for potential confounding factors, including age, race, parity, body mass index, medical comorbidities, smoking status, health seeking behavior, disability, physical function and geographic region. RESULTS In this linkage between symptom report and insurance claims data we found that only 16% of older women with current incontinence symptoms also had an outpatient visit addressing incontinence in the prior 2 years. In multivariable adjusted models severe vs slight incontinence (OR 3.75, 95% CI 3.10-4.53) and urgency vs stress incontinence (OR 1.80, 95% CI 1.56-2.08) were the strongest predictors of undergoing outpatient evaluation. CONCLUSIONS Overall only a small percent of women who report urinary incontinence symptoms also have medical outpatient visits for incontinence, which is a marker of care seeking. Our study highlights the discordance between the high prevalence of incontinence in older women and the lack of clinical assessment despite symptoms even among nurses with high health care literacy.
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