Treatment of urinary incontinence in women with chronic obstructive pulmonary disease\u2014a randomised controlled study

Stacey Haukeland-Parker,Martijn A Spruit,Bente Frisk,Hege Hølmo Johannessen,Signe Nilssen Stafne

doi:10.1186/s13063-021-05816-2

Abstract

BackgroundLittle is known regarding treatment of urinary incontinence (UI) in women with chronic obstructive pulmonary disease (COPD). The aim of the study was to explore the efficacy of pelvic floor muscle training (PFMT) or cough-suppression techniques (CST) on UI in women with COPD.MethodsA three-armed, two-centred, single-blinded, randomised controlled study was performed. Subjects were randomised to (a) PFMT for 16 weeks, (b) 2–3 educational sessions in CST, or (c) written information only. All participants completed questionnaires about UI, cough symptoms, and health status and underwent clinical examinations to evaluate the strength of the pelvic floor muscles and exercise capacity. Daily physical activity levels were measured using an activity monitor and lung function with spirometry. With a significance level of 5% and an 80% chance of detecting a significant difference between groups of 2.5 points on the ICIQ UI SF score, our sample size calculation showed that a total of 78 women, 26 in each group, was required to complete the study.ResultsDuring the period 2016 to 2018, 95 women were invited to the study. A total of 42 were recruited, three were excluded and 10 (24%) dropped out during the follow-up period. Mean ICIQ-UI SF total baseline score was 9.6 (range: 1–17) and 7.0 (range: 0–16) at follow-up. Changes in subjective UI as measured with the ICIQ-UI SF questionnaire were seen in the PFMT group and control group, but not in the CST group.ConclusionDue to the low number of available participants and recruitment difficulties including practical issues such as travel distance, lack of interest, poor state of health, and high number of comorbidities, our results are inconclusive. However, reduced subjective UI was observed in the PFMT and control groups with a trend towards best effect in the PFMT group. Screening for UI is advisable in all women with COPD to be able to identify and treat these women to reduce symptom burden and improve quality of life. Future studies should focus on barriers to recruitment as well as randomised controlled studies with larger sample sizes.Trial registrationClinicalTrials.gov NCT02614105. 25th November 2015.

Highlights

Little is known regarding treatment of urinary incontinence (UI) in women with chronic obstructive pulmonary disease (COPD)
UI severity was significantly correlated with UI duration, but we found no other correlations between UI and age, lung function, parity, cough symptoms, VPFM
Our results support previous evidence that pelvic floor muscle training (PFMT) is the primary choice of treatment for UI in the general female population, as our findings suggest that PFMT may be an effective treatment for women with COPD and coexisting UI

Summary

Introduction

Little is known regarding treatment of urinary incontinence (UI) in women with chronic obstructive pulmonary disease (COPD). Stress urinary incontinence (SUI) is associated with activities involving increased intraabdominal pressure such as physical exertion, sneezing, coughing or laughing [5]. Respiratory disease is considered a risk factor for UI due to coughing and dyspnoea [6] which increase intra-abdominal pressure increasing stress on the bladder. This may in turn lead to leakage if the pelvic floor muscles (PFM) are weak. Dyspnoea and chronic cough are common symptoms in patients with chronic obstructive pulmonary disease (COPD) [8] and a significant number of women with COPD suffer from UI [6, 9,10,11,12,13]. UI is associated with lower healthrelated quality of life (HRQL) in people with COPD, especially amongst women [14]

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