Incontinence In Premenopausal Women Research Articles

A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence.

Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.

Does Urodynamic Stress Incontinence Increase After the Menopause?: Results from 2,994 Urodynamic Studies in Australian Women.

Most studies attempting to estimate the age-related prevalence of urinary incontinence (UI) have used questionnaires. In the present study we analysed a consecutive series of urodynamic test results to determine the distribution of the different types of UI in pre- and post-menopausal women. We hypothesised that the prevalence of urodynamic stress incontinence (USI) would be significantly greater in pre-menopausal than in post-menopausal women. All women from a large tertiary urogynaecology department, who underwent urodynamic tests during the years 2000-2015 were included. Patient history and test results were collected. A sample size of 1,475 was calculated, based on the hypothesis that the prevalence of USI will be 20% larger in the pre- versus the post-menopausal group. A total of 2,994 women with UI on urodynamics were available. There was a significant difference between pre- and post-menopausal status for each of the three diagnoses: USI 483 (59.3%) versus 912 (41.8%), detrusor overactivity (DO) 125 (15.4%) versus 399 (18.3%) and USI with concomitant DO 206 (25.3%) versus 869 (39.9%). A bimodal pattern of age was seen in women with USI, with a peak in the 46-50 and 61-65 age group, before decreasing with age. DO generally increased with age. USI with concomitant DO increased steadily after the menopause, becoming the predominant type after the age of 66. In this large cohort of women attending urodynamics, we have shown that USI is the predominant type of incontinence in pre-menopausal women; however, USI with concomitant DO increases after menopause, eventually predominating.

The role of connective tissue metabolism disorders in the genesis of stress urinary incontinence in premenopausal women

Research objectives: to study the pathogenetic links in the development of stress urinary incontinence (SUI) by determining the state of connective tissue (CT), concentrations of trace elements, vitamins and estradiol in premenopausal women.Materials and methods. 189 women aged 45–55 years with SUI were examined. In addition to general clinical examination, concentrations of Total PІNP (type I collagen synthesis marker) and Total PІІІNP (type III collagen synthesis marker) and CT resorption marker Pyriliks-D, ionized magnesium, ionized calcium, total calcium, vitamins D and C, estradiol were studied in the blood serum in order to determine the state of fibrous CT.Results. In the structure of somatic morbidity were conditions defined as phenotypic manifestations of CT undifferentiated dysplasia. A decrease of the Total PІNP by 24.9% was found against the background of an increased Total PІІІNP by 46.7% and an increased Pyriliks-D by 54.1%. Women with SUI were characterized by a significant decrease in the average value of Mg2+ by an average of 16.7%, as well as a significant increase in the average value of Ca2+ by 5.3% and total Ca by 3.9%. The vitamin balance study shows a significant decrease of vitamin D by 40.6% and vitamin C by 37.0%. Estradiol concentration was at the minimum values of the physiological norm.Conclusions. Women in premenopausal age with SUI are characterized by a violation of the CT synthesis and resorption, which are realized by reducing the formation of the Total PІNP against the background of intensification of the Total PІІІNP and Pyriliks-D synthesis, combined with a disbalance of vitamins and trace elements. These features are highly likely to be considered as predictors of the SUI development in women of premenopausal age

Effect of vitamin D supplementation on the severity of stress urinary incontinence in premenopausal women with vitamin D insufficiency: a randomized controlled clinical trial

BackgroundUrinary incontinence, especially stress urinary incontinence (SUI), is one of the problems experienced by premenopausal women. Given the role of vitamin D in enhancing muscle strength and function, this study explored the effect of vitamin D3 supplementation on SUI in premenopausal women.MethodsA randomized controlled trial was performed with 60 premenopausal women referring to Kerman gynecological clinic in 2020 and 2021. Eligible women received a 5000-unit vitamin D supplement or placebo weekly for 3 months. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) was utilized to assess SUI severity before and after the intervention. The t-test, Chi-square test, and repeated measures ANOVA were carried out in SPSS software (version 22) to analyze the data. P-values smaller than 0.05 were considered significant.ResultsBefore the intervention, there was no significant difference between the intervention and control groups in SUI severity (P = 0.652) and the impact of SUI severity on premenopausal women’s lives (P = 0.804). In contrast, after 8-12 weeks of vitamin D supplementation, these scores decreased significantly in the intervention group relative to the control group (P < 0.001). In addition, after vitamin D supplementation, the number of SUI and urinary leakage symptoms decreased in the intervention group (P < 0.001).ConclusionVitamin D supplementation improves SUI in premenopausal women.Trial registrationThis trial was registered with the Iranian Registry of Clinical Trials; https://fa.irct.ir/trial/53474 (IRCT20190724044318N2) on 11/02/2021.

EP36.07: The onset of fecal incontinence in premenopausal women: differences between women who started symptoms at immediate postpartum or years later

EP36.07: The onset of fecal incontinence in premenopausal women: differences between women who started symptoms at immediate postpartum or years later

ОСОБЛИВОСТІ ОБМІНУ КОЛАГЕНУ У ЖІНОК ПРЕМЕНОПАУЗАЛЬНОГО ВІКУ З СТРЕСОВИМ НЕТРИМАННЯМ СЕЧІ НА ТЛІ КОНСЕРВАТИВНОГО ТА ЛАЗЕРНОГО ЛІКУВАННЯ

Стаття узагальнює аргументи та контраргументи в межах наукової дискусії з питання впливу недиференційованої дисплазії сполучної тканини на розвиток стресового нетримання сечі у жінок пременопаузального віку та підходи до лікування даної патології. Основною метою проведеного дослідження є визначення особливостей обміну колагену у жінок пременопаузального віку зі стресовим нетриманням сечі для удосконалення тактики лікування та розробки диференціального підходу до профілактики розвитку даної патології в майбутньому. Систематизація даних літературних джерел та відсутність єдиного підходу до лікування стресового нетримання сечі у жінок пременопаузального віку засвідчила необхідність пошуку нових підходів до лікування даного захворювання, які впливатимуть на етіопатогенетичні ланки виникнення стресового нетримання сечі у даної категорії гінекологічних пацієнток. Актуальність дослідження даної патології полягає у тому, що стресове нетримання сечі – це проблема, яка суттєво знижує якість життя жінок в пременопаузі, стає причиною замкненості та невпевненості в собі, а в певних випадках може призводити й до психологічних порушень. Методика проведення дослідження полягала в проспективному клініко-статистичному обстеженні, до якого було залучено 133 пацієнтки пременопаузального віку зі стресовим нетриманням сечі, яких в залежності від призначеної терапії було розподілено на дві групи. До основної групи увійшли 57 жінок зі стресовим нетриманням сечі пременопаузального віку, яким з метою корекції проявів захворювання була запропонована лазерна терапія. Групу порівняння сформували 76 пацієнток пременопаузального віку зі стресовим нетриманням сечі, які отримували консервативне лікування. Всім пацієнткам обстежених груп, крім загально-клінічного обстеження, проводилось визначення маркерів синтезу (Total P1NP, Total P3NP) та резорбції (дезоксипіридинолін Pyriliks – D) сполучної тканини на початковому рівні, одразу після лікування та через 6 місяців лікування, тривалість дослідження становила десять місяців. Результати клінічного дослідження продемонстрували, що у даної категорії пацієнток на тлі застосування лазерної терапії відмітився достовірно-позитивний ефект, отриманий в результаті лікування, спрямованого на підвищення середнього рівня маркеру синтезу колагену I типу та зниження середнього рівня маркеру синтезу колагену III типу, а також нормалізації середнього рівня маркера резорбції сполучної тканини. Дослідження емпірично підтверджує та теоретично доводить, що використання лазерної терапії є патогенетично-обумовленим, адже його позитивний ефект реалізується шляхом впливу на сполучну тканину сечо-статевої діафрагми, стимуляцію вироблення колагену І типу та синергічне пригнічення продукції колагену ІІІ типу та Pyriliks-D. Результати проведеного дослідження можуть бути корисними для лікарів гінекологічних стаціонарів, лікарів загальної практики і сімейної медицини та лікарів жіночих консультацій.

Depression, Neuroticism and Urinary Incontinence in Premenopausal Women: A Nationwide Twin Study – Corrigendum

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Urinary Incontinence in Premenopausal Women: Prevalence, Risk Factors and Impact on Quality of Life.

To determine the prevalence and risk factors of urinary incontinence (UI), and assess its impact on the quality of life (QOL) in premenopausal women. In this cross-sectional study, 690 women aged from 18 to 53 were interviewed using a demographic questionnaire and the International Consultation on Incontinence Questionnaire Short Form. The overall prevalence of any UI was 27.2%. Of the 188 women reporting UI the types were: stress 36.7%, urgency 32.4% and mixed 30.9%. The mean value of the age and body mass index (BMI) of the cases with UI was statistically significantly higher than the group without UI (P < 0.01). In the premenopausal women of similar age and BMI the incontinence rate was significantly higher in those who had a normal vaginal delivery than those who had a Cesarean section (P < 0.01). In the logistic regression analysis it was determined that the effect on the occurrence of incontinence was as follows in terms of age, education and number of pregnancies; age > 35 years had an odds ratio of 1.896 (95% confidence interval [CI]:1.29-2.80); the effect of the status of not attending a school or only attending primary school had an odds ratio 1.839 (95% CI: 1.23-2.75) and the number of pregnancies > 2 had an odds ratio 1.495 (95% CI:1.00-2.26). Being older than 35, having a low educational level and a gravida greater than two are the independent risk factors in terms of the occurrence of UI in premenopausal women.

Depression, Neuroticism, and Urinary Incontinence in Premenopausal Women: A Nationwide Twin Study

Previous studies have found that major depression and neuroticism are positively associated with urinary incontinence (UI). However, the genetic contribution to these associations has never been investigated. In 2005, a total of 14,094 female twins born 1959-1985 in the Swedish Twin Registry participated in a comprehensive survey on common exposures and complex diseases. Structured questions provided information on UI, depressive symptoms, major depression, and neuroticism. A logistic regression model based on generalized estimating equations (GEE) was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Environmental and genetic influences were assessed in co-twin control analyses and quantitative genetic analyses, which were also used to determine the proportion of the phenotypic correlation explained by familial factors. Major depression, depressive symptoms, and neuroticism were positively associated with all UI subtypes (overall, stress, urge, and mixed UI). In a trivariate Cholesky model with neuroticism, depressive symptoms (or depression), and UI a modest genetic correlation was found between indicators of depression and overall, or stress, UI. The majority of this correlation was independent from neuroticism. In contrast, the genetic factors shared between indicators of depression and urge or mixed UI were entirely in common with neuroticism. In conclusion, depression and neuroticism are associated with UI among premenopausal women: the associations are in part determined by genetic factors in common to the disorders.

Associations of Commonly Used Medications with Urinary Incontinence in a Community Based Sample

We examined the association between the use of medications and the prevalence of urinary incontinence in gender specific analyses of a community based, representative sample. A population based epidemiological study was conducted of 5,503 men and women 30 to 79 years old residing in Boston, Massachusetts (baseline data collected from 2002 to 2005). Urological symptoms were ascertained in a 2-hour, in person interview. Urinary incontinence was defined as urine leakage occurring weekly or more often during the last year. Medications used in the last month were considered current use. Associations of 20+ medications and prevalent urinary incontinence were examined using multivariate logistic regression (ORs and 95% CIs) with adjustments for known urinary incontinence risk factors. The prevalence of urinary incontinence in the analysis sample was 9.0% in women and 4.6% in men. For women the prevalence was highest among users of certain antihistamines (28.4%) and angiotensin II receptor blockers (22.9%). For men the prevalence was highest among angiotensin II receptor blocker (22.2%) and loop diuretic (19.1%) users. After final multivariate adjustment there were significant positive associations for certain antihistamines, beta receptor agonists, angiotensin II receptor blockers and estrogens with urinary incontinence in women (all ORs greater than 1.7), and a borderline significant association for anticonvulsants (OR 1.75; 95% CI 1.00, 3.07). Among men only anticonvulsants were associated with urinary incontinence after final adjustments (OR 2.50; 95% CI 1.24, 5.03), although angiotensin II receptor blockers showed an adjusted association of borderline significance (OR 2.21; 95% CI 0.96, 5.10). Although a cross-sectional analysis cannot determine causality, our analysis suggests certain medications should be further examined in longitudinal analyses of risk to determine their influence on urological symptoms.

Oral Contraceptive Use and Incident Urinary Incontinence in Premenopausal Women

Recent data in postmenopausal women indicate that current and past use of exogenous hormones is related to urinary incontinence risk. Little is known about exogenous hormones and risk of urinary incontinence in younger women. We investigated the association between oral contraceptive pills and incident urinary incontinence in premenopausal women enrolled in the Nurses' Health Study II. Participants reported use of oral contraceptive pills from 1989 to 2001. Among 21,864 premenopausal women 37 to 54 years old reporting no urinary incontinence in 2001 we identified 749 with incident urinary incontinence at least weekly between 2001 and 2003. Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression. Women who had ever used oral contraceptive pills had a statistically significant 27% (95% CI 1-59) increased odds of experiencing urinary incontinence at least weekly compared with those who never used oral contraceptive pills. In women with 10 or more years of use the odds ratio increased to 1.48 (95% CI 1.13-1.95). Ever using oral contraceptive pills was specifically associated with urgency urinary incontinence (OR 2.48, 95% CI 1.07-5.76) rather than stress urinary incontinence (OR 1.04, 95% CI 0.78-1.40). Although we had limited information on urinary tract infection, control for urinary tract infection did not alter these findings. Use of oral contraceptive pills may be associated with a modest increase in the odds of urinary incontinence among premenopausal women. However, this is one of the first reports of such an association and, thus, further research is needed to confirm our findings and investigate possible mechanisms.

Prevalence and determinants of fecal incontinence in premenopausal women in an Arabian community

Objectives The aim of this study was to determine the prevalence, awareness and determinants of fecal incontinence among Qatari women.Method In the cross-sectional community-based study in primary health-care centers, using a multistage sampling design, a representative sample of randomly selected 776 Qatari women aged from 40 to 48 years were approached from January to August 2007; only 596 women, with a response rate of 76.8%, gave consent and were included in the analysis. Participants completed a questionnaire assessing fecal incontinence in the previous 12 months and health care-seeking behavior for fecal symptoms. Fecal incontinence, determined by self-report, was categorized by frequency. Females reported the level of bother of fecal incontinence and their general quality of life. Potential risk factors were assessed by self-report, interview, physical examination, and record review.Results Of the studied Qatari women, 62 (10.4%) were found to have fecal incontinence. There was a significant difference between fecal incontinent and continent groups with regard to menopause (p < 0.0001), surgical repair of genital prolapse (p < 0.0001) and constipation (p < 0.0001). Only 31 incontinent patients (50%) had sought medical advice. Of the fecal incontinent women, 77.4% felt embarrassment in consulting a doctor and 77.4% believed their condition was worth reporting to a doctor. Aging (51.6%) was the major cause of fecal incontinence in women, followed by childbirth (40.3%), then menopause (25.8%) and lastly paralysis (14.5%). Most of the sufferers were troubled by their inability to pray (64.5%). Their relationship with their husband (41.9%) was the significant consequence for fecal incontinent Qatari women (p = 0.02); 37.1% isolated themselves from social activities and going out to shop.Conclusions The study findings revealed that fecal incontinence is a common symptom among women in the community. There was a correlation between fecal incontinence and menopause. Overall, most of the fecal incontinent women reported that fecal incontinence significantly affected quality of life and only half of the studied women had consulted a physician for the symptom.

Menstrual cycle, female hormone use and urinary incontinence in premenopausal women

Our aim was to study the association between menstrual cycle characteristics, the use of female hormones and urinary incontinence (UI) in an age-stratified random population sample of 2158 premenopausal women who answered a questionnaire on urinary incontinence. Episodes of UI during 1997 were reported by 18.3% and one or more episodes of UI the preceding year by 3.9%. Based on multiple logistic regression, self-reported UI the day before answering the questionnaire was found to be associated with current hormone use for menstrual disorders (OR 2.7, 95% CI 1.2-6.6), a recent decrease in bleeding duration (OR 2.2, 95% CI 1.3-3.7), being on days 11-15 before the expected end of the menstrual cycle the preceding day (OR 2.6, 95% CI 1.3-5.0), and with general UI risk factors, i.e. vaginal childbirth, childhood enuresis, BMI >/=530 and exposure to abdominal and/or gynecologic surgery. The findings are in accordance with a hypothesis of hormonal variation being a risk indicator of UI in premenopausal women.

Pelvic floor exercise alone or with vaginal cones for the treatment of mild to moderate stress urinary incontinence in premenopausal women

The authors compared intensive pelvic floor exercise alone (A) with intensive pelvic floor exercise plus vaginal cones (B) in premenopausal women with mild to moderate stress urinary incontinence. Forty-six patients (mean 43±6 years) were randomized into two training groups and treated for 3 months. Pre- and post-therapy urethral pressure profiles at rest and under stress and subjective results were obtained from 29 patients. The subjective improvement rate of the compliant patients after 12 weeks was 85% in group A and 84% in group B. When the dropouts (9 in group A and 8 in group B) were included in the subjective results an overall improvement rate of 48% in group A and 52% in group B was obtained. In group A one pressure transmission ratio (PTR) improved significantly at 6 weeks and the position of maximum urethral closure pressure was shifted proximally at 12 weeks. In group B one PTR in the midurethra was improved significantly at 6 weeks. The other urodynamic parameters were unchanged. There were no differences between groups A and B in subjective results or urodynamic findings. These results suggest that intensive pelvic floor exercise with or without vaginal cones improves the symptoms of mild to moderate stress incontinence in about 85% of premenopausal women, but that it has little effect on urodynamic parameters. Vaginal cones provided no additional benefit but may be useful for women for whom closely supervised pelvic floor exercise is not available.