Severity Of Incontinence Symptoms Research Articles

The effect of incontinence after radical prostatectomy on quality of life and frailty

AbstractThis study aimed to determine the effect of incontinence after radical prostatectomy on quality of life and level of frailty. It is a descriptive study conducted with 107 radical prostatectomy patients who were hospitalized in the Urology Clinic of a training and research hospital in Istanbul between March–August 2021, and met the inclusion criteria. Data were collected using the Patient Identification Form, the International Consultation on Incontinence Questionnaire – Male Lower Urinary Tract Symptoms (ICIQ‐MLUTS), and the Edmonton Frail Scale (EFS). The mean fragility score of the patients was 7.82 ± 2.63, and 27% of them were ‘Mildly Frail’ and 25.2% were ‘Moderately Frail’. The ICIQ‐MLUTS voiding complaints sub‐dimension score of the patients was 8.62 ± 3.48, and the voiding complaints bother score was found to be 24.8 ± 9.85. The ICIQ‐MLUTS storage complaints sub‐dimension score was 12.13 ± 3.05, and the storage complaints bother score was 36.25 ± 9.02. The ICIQ‐MLUTS daytime urinary frequency subdimension score was 2.35 ± 0.93, and the daytime urinary frequency bother score was 6.94 ± 2.17. The ICIQ‐MLUTS nocturnal urinary frequency sub‐dimension score was 2.79 ± 0.88, and the nocturnal urinary frequency discomfort level score was found to be 7.37 ± 2.19. In this study, it was observed that patients' complaints regarding lower urinary tract symptoms and their quality of life were at a moderate level and the frailty levels increased with the increasing severity of incontinence symptoms after radical prostatectomy.

Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design.

Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women's access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes.

Faecal incontinence with concurrent disorders of gut-brain interaction: A worse outcome.

Faecal incontinence is a common debilitating condition associated with poor quality of life that generates substantial economic strain on healthcare systems. We aimed to evaluate, in a tertiary referral population presenting with faecal incontinence, the impact of suffering additional disorders of gut-brain interaction (DGBI) on symptom severity, anxiety, depression and quality of life. Design: Retrospective cohort study. Tertiary referral Neurogastroenterology centre. All patients presenting with faecal incontinence from 2007 to 2020 were included. The results from structured medical and surgical questionnaires including Rome III Integrative Questionnaire, Faecal Incontinence Severity Index, Hospital Anxiety and Depression Scale, SF-36, and anorectal physiology were analysed using Stata version 17. Patients were categorised into 3 groups: 0-1 additional DGBI, 2 DGBIs, and 3+ DGBI. Statistical significance was defined as p<0.05 (two-tailed). Faecal incontinence patients (n=249; mean age 63.4±12.6years; 93.6% female, 48.1% urge subtype) met diagnostic criteria for mean 2.2 additional DGBI each, mostly affecting bowel (n=231, 42.4%) and anorectal (n=150, 27.5%) regions. A greater number of DGBIs was associated with higher faecal incontinence symptom severity (p<0.001), higher anxiety (p=0.002) and depression (p=0.003), and worse quality of life in areas of mental health (p=0.037) and social effect (p<0.001). Patients with a greater number of concurrent DGBI demonstrated a greater family history of gastrointestinal problems (p=0.004). There were no associations found between a greater amount of DGBIs and anorectal physiology. A greater number of additional DGBIs in faecal incontinence patients was associated with worse faecal incontinence symptoms, higher anxiety and depression scores, and worse quality of life but was unrelated to physiology. This highlights the need to proactively search for comorbid DGBI in patients presenting with faecal incontinence.

Irritable bowel syndrome worsens faecal incontinence after primary repair of major obstetric anal sphincter injuries.

Obstetric anal sphincter injuries (OASIS) occur in approximately 3%-6% of vaginal deliveries and are the leading risk factor for late-onset faecal incontinence, which is an underdiagnosed pathology. The aim of this work was to use a validated scoring system to quantify the effect of irritable bowel syndrome (IBS) on the severity of faecal incontinence symptoms after primary repair of major OASIS (Grade IIIb-IV). A prospective cohort study was performed on all women who underwent primary repair of major OASIS over a 6-year period. They were assessed with ultrasonography within 12 weeks. Two control groups (who did not have OASIS) were women who underwent elective caesarean section and primigravid women. Questionnaires were sent at least 12 months after delivery, or at first consultation for primigravids, which generated the main outcome measures: Cleveland Clinic faecal incontinence severity scores and the presence of IBS based on Rome III criteria. There was a total of 211 patients included in the three groups and the mean follow-up time was 26 months after sphincter repair. Ultrasonographic sphincter defects were detected in 37% but did not affect the faecal incontinence score (p = 0.47), except in patients with IBS. Within each group, patients with IBS had significantly worse faecal incontinence than those without. Women with both OASIS and IBS had the most severe faecal incontinence scores. OASIS has a limited negative effect on faecal incontinence, independent of whether residual ultrasonographic sphincter defects are present. However, the presence of IBS has a significant compounding effect on faecal incontinence in OASIS patients. The effect of IBS on faecal incontinence is also notable in caesarean section patients and primigravids, suggesting that IBS is an independent risk-factor that should have its place in predelivery assessment and counselling.

Digital physical therapy intervention to treat female urinary incontinence: a semi-experimental study

Background: Urinary incontinence affects 15-40% Brazilians in rural areas, indicating the necessity of treatment for people in remote regions. Digital technology could be an option, but the evidence-based digital health intervention remains untapped. Objective: To assess whether a group intervention by synchronous video call reduces the severity of female urinary incontinence symptoms and to assess woman’s perception on this modality. Methods: Incontinent women who had digital access were invited to this semi-experimental study. An 8-week protocol was conducted through video calls once a week. Lifestyle counseling and exercises were performed. Pre- and post-evaluations were done exclusively by phone call. Results: 48 women were enrolled in the study and 40 concluded the protocol. They were 56.5 years (±12.0) and most of them had mixed urinary incontinence. The impact on quality of life and the severity of urinary incontinence symptoms was significantly improved and most of the participants were completely satisfied with the intervention. A large effect size was observed (Glass’s delta = 0.83) Conclusion: Our findings support a digital group approach for the treatment of female urinary incontinence as an alternative to be further explored. Combining digital service with group assistance brought satisfaction and clinical results for the participants and it can be promising for public health services.

Pelvic Floor Muscle Training and Its Benefits for Multiple Sclerosis Patients Suffering From Urinary Incontinence and Sexual Dysfunction.

Several reports have been published during the last decade studying the effect of pelvic floor muscle training (PFMT) in treating urinary incontinence and sexual dysfunction in multiple sclerosis (MS) patients. The aim of the current study is to bring up-to-date findings of earlier systematic reviews, taking into account data published up till June 2023. Databases such as PubMed, Scopus, and EBSCOhost were screened for randomized controlled studies, clinical trials, and systematic reviews. The keywords for the current review were MS, urinary incontinence, sexual function, and PFMT. The implementation of predetermined eligibility criteria permitted an appropriate and convenient study selection. English language publications alone were considered. After removing duplicates and screening the initially recovered articles, an initial search within the present review identified 19 studies. Finally, 10 randomized control trials and two systematic reviews were eligible for evaluation and included in the current review. The outcome measures were the severity of incontinence or overactive bladder, leakage episodes, sexual dysfunction, health-related quality of life, and adherence to PFMT. PFMT is a convenient and effective treatment tool that can significantly improve health-related quality of life and reduce the severity of urinary incontinence and overactive bladder symptoms in people with MS. The present review confirms the effectiveness of specific exercises on leakage episodes, pad usage, sexual dysfunction, compliance to treatment, and treatment satisfaction. Further research is needed to strengthen the reported results.

The Influence of Anxiety Levels Facing Medical Exams to Urinary Incontinence in YARSI University Medical Students Class of 2019 and 2020, and A Review Through Islamic Perspectives

Background: Urinary incontinence is the involuntary excretion of urine at any given condition. Medical exams experienced by medical students could induce anxiety, which could lead to urinary incontinence. Through an Islamic viewpoint, individuals suffering from urinary incontinence are constantly unclean and require certain ways to practice worship. This study aims to determine the relationship between anxiety levels and age; anxiety levels and gender; the correlation between anxiety levels and urinary incontinence; identifying anxiety levels; and the severity of urinary incontinence symptoms within YARSI University Medical Students Class of 2019 and 2020, as well as how to pray and ablute for individuals with urinary incontinence.Method: This study is qualitative research done as an analytical observational study with cross-sectional study design. The research instrument used the Urogenital Distress Inventory questionnaire (UDI-6) and the Hamilton Anxiety Rating Scale (HARS). The research was conducted on YARSI University Medical Students Class of 2019 and 2020 with a sample size of 209 participants. Data analysis utilized Kruskal Wallis, Kolmogorov-Smirnov, and Spearman Correlation statistical tests.Results: The level of anxiety experienced by most students is a mild level of anxiety. The highest severity of urinary incontinence symptoms was experienced by students with moderate to severe anxiety levels. No significant relationship was found between age and gender with anxiety levels. There is a positive correlation with moderate strength between the level of anxiety and urinary incontinence.Conclusion: No relationship was found between anxiety levels facing medical exams with age nor gender and a positive correlation with moderate strength was found between anxiety levels medical exams and urinary incontinence within YARSI University Medical Students Class of 2019 and 2020.

Feasibility of Telerehabilitation-Based Pelvic Floor Muscle Training for Urinary Incontinence in People With Multiple Sclerosis: A Randomized, Controlled, Assessor-Blinded Study.

Urinary incontinence is a common symptom in people with multiple sclerosis. The primary aim was to investigate feasibility of telerehabilitation-based pelvic floor muscle training (Tele-PFMT) and compare its effects on leakage episodes and pad usage with home exercise-based pelvic floor muscle training (Home-PFMT) and control groups. Forty-five people with multiple sclerosis with urinary incontinence were randomized into 3 groups. Tele-PFMT and Home-PFMT groups followed the same protocol for 8 weeks, but Tele-PFMT performed exercises 2 sessions/week under a physiotherapist's supervision. The control group did not receive any specific treatment. Assessments were made at baseline, weeks 4, 8, and 12. Primary outcome measures were feasibility (compliance to exercise, patient satisfaction, and number of participants included in the study), number of leakage episodes, and pad usage. Secondary outcomes included severity of urinary incontinence and overactive bladder symptoms, sexual function, quality of life, anxiety, and depression. Participant eligibility rate was 19%. Patient satisfaction and compliance to exercise were significantly higher in Tele-PFMT than in Home-PFMT ( P < 0.05). No significant differences in the change of leakage episodes and pad usage were found between Tele-PFMT and Home-PFMT. No significant differences in secondary outcomes were found between PFMT groups. Participants in both the Tele-PFMT and Home-PFMT groups had significantly better scores for some measures of urinary incontinence, and overactive bladder and quality of life in compared with the control group. Tele-PFMT was feasible and acceptable in people with multiple sclerosis, and this mode of delivery was associated with greater exercise compliance and satisfaction compared with Home-PFMT. However, Tele-PFMT did not exhibit superiority in terms of leakage episodes and pad usage compared with Home-PFMT. A large trial comparing Home-PFMT and Tele-PFMT is warranted.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A440 ).

Effect of monopolar capacitive resistive radiofrequency in treating stress urinary incontinence: A pilot randomized control trial.

To assess the effectiveness of 448 kHz monopolar capacitive resistive radiofrequency (MCRR) in the treatment of females with stress urinary incontinence (SUI). Forty females with SUI complaints were separated randomly into two equal groups. Group A with 20 females received the MCRR therapy for 20 min and performed pelvic floor exercises for 20 min. Group B with 20 females received placebo treatment by applying the same application as in Group A without emitting any waves for 20 min, three times a week, for 4 weeks. The patients in both groups were instructed to pause the treatment during their menstruation; the patients were instructed to maintain home pelvic floor exercises. Both groups were assessed by a perineometer that was used to assess the strength of the pelvic floor muscles (PFM), the visual analogue scale (VAS), and the Incontinence Symptom Severity Index to assess the frequency of urinary incontinence symptoms as described by each patient before treatment and after 4 weeks of treatment. There was a significant reduction (p < 0.05) in VAS and the Incontinence Symptom Severity Index and a significant increase in the strength of the PFM in both groups post-treatment compared with the pre-treatment. Regarding between-subject effects, there was a significant difference in VAS, the Incontinence Symptom Severity Index, and the perineometer between both groups (p < 0.05), and this significant improvement favored Group A. MCRR and pelvic floor exercises are more effective methods for the treatment of SUI than just pelvic floor exercises of females with SUI. ClinicalTrials.gov. Identifier: NCT04612205.

The burdens of incontinence: Quantifying incontinence product usage and costs in women.

Urinary incontinence is a common condition in women, who often use incontinence containment products to self-manage. Few studies have sought to quantify use and costs of incontinence products associated with subtypes of incontinence and severity, therefore this study aimed to quantify incontinence product use and personal costs to women. This is a secondary analysis from a sample of adult women recruited electronically via ResearchMatch for a study on urinary symptoms and social determinants of health. Participants completed validated questionnaires on urinary symptoms, and were asked about daily numbers and types of incontinence products used and weekly costs, along with demographic and baseline clinical information, and information about unmet social needs. Descriptive statistics were performed, in addition to Wilcoxon rank sum and Kruskal-Wallis tests to compare incontinence product usage and cost based on type of incontinence, symptom severity, and other demographics, in addition to multivariable linear regression. A total of 702 women who reported using weekly incontinence products were included in the final analytic sample. Overall, women reported using a mean of 1.8 ± 2.1 incontinence products in 24 h (median: 1, interquartile range [IQR]: 1), with a maximum of 32. Mean weekly cost of was $5.42 ± $8.59 (median: $3, IQR: $4), with cost up to $100. Nonwhite women trended towards having higher product usage and cost, with significant cost increase seen among non-Hispanic Black women and Hispanic women. Usage and cost were higher in women who had less education, had household income below the poverty line, were on disability, were using Medicaid or were uninsured, had more unmet social needs, and in those with mixed incontinence. Additionally, daily product use and weekly costs increased with incontinence symptom severity, with the biggest increase between those with severe and very severe symptoms. In this study, we were able to quantify the number of incontinence products used daily and the weekly costs in incontinent women across types and severity of incontinence. Costs were even greater and may be prohibitive, in women with more unmet social needs, Medicaid or no insurance, less than a college education, lower income, or on disability.

Effectiveness of physiotherapeutic techniques in urinary incontinence: a review of the literature

Introduction and purpose : Urinary incontinence is a common condition characterized by involuntary urine leakage from urethra. It particularly affects elderly women and is a serious medical, social and economic problem. As a result of recently observed population ageing, the incidence of this anomaly is expected to rise. Due to multifactorial etiology, several types of incontinence are distinguished. Proper diagnostic procedures lead to diagnosis confirmation and allow appropriate therapeutic intervention. Both conservative and surgical methods are used in management of urine incontinence. In addition to pharmacological therapy, physiotherapeutic methods have an important meaning in conservative approach. The aim of this article is a review presenting the results of recent studies on the effectiveness of physiotherapy procedures in treatment of various types of urine incontinence. Description of the state of knowledge: In the study 33 articles which published physiotherapy techniques in 2004-2021 regarding the role of physiotherapeutic methods in the treatment of urinary incontinence were analyzed. The results of studies assessing the effectiveness of physiotherapy techniques (acupuncture, behavioral therapy, yoga, magnetic stimulation, pelvic floor muscle training, vaginal cones, vibration therapy, kinesiotheraphy techniques, stimulation) in reducing the severity of urinary incontinence symptoms and improving the quality of patients’ life were presented on the basis of analyzed literature. Conclusions: Physiotherapy is an effective method of treatment of urinary incontinence and it supports other types of therapy. Therapy should be interdisciplinary approached and the choice of physiotherapeutic methods should be dependent on the individual needs of the patient.

Impact of pulsed electromagnetic field on mixed incontinence in parous women a prospective randomized study

Background: This study was conducted to determine the impact of a pulsed electromagnetic field (PEMF) on mixed incontinence. This condition can have a significant impact on women’s quality of life and social relationships. Methods: Parous females (n = 40) with mixed incontinence were randomly assigned to one of two groups. Group A received PEMF and pelvic floor muscle training in addition to general advice for 12 sessions. Group B received the same program but without PEMF. Pelvic floor muscle strength and the severity of urinary incontinence were assessed using a perineometer and the incontinence symptom severity index (ISSI), respectively. Results: Within groups comparison show statistically significant improvement in priniomter and severity index after treatment in comparison to pre treatment values. Between groups comparison after treatment showed better improvement in group A (p &lt; 0.05) in pelvic floor muscle strength and a significant decrease (p &lt; 0.05) in the severity of urinary incontinence compared to group B. Conclusions: PEMF combined with pelvic floor muscle training is an effective, convenient, and acceptable way to manage mixed incontinence.

Intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles: a randomised trial.

In women who are unable to contract their pelvic floor muscles voluntarily, what is the effect of an intravaginal electrical stimulation regimen on their ability to contract the pelvic floor muscles and on self-reported urinary incontinence? Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. Sixty-four women with pelvic floor muscle function assessed by bi-digital palpation to be grade 0 or 1 on the Modified Oxford Scale. For 8 weeks, participants randomised to the experimental group received weekly 20-minute sessions of intravaginal electrical stimulation with instructions to attempt pelvic floor muscle contractions during the bursts of electrical stimulation in the final 10 minutes of each session. The control group received no intervention. The primary outcome was ability to voluntarily contract the pelvic floor muscles, evaluated through vaginal palpation using the Modified Oxford Scale. Secondary outcomes were prevalence and severity of urinary incontinence symptoms assessed by the International Consultation on Incontinence Questionnaire on Urinary Incontinence-Short Form (ICIQ-UI-SF) score from 0 to21. Sixty-one participants provided outcome data. After the intervention, the ability to contract the pelvic floor muscles was acquired by 36% of the experimental group and 12% of the control group (absolute risk difference 0.24, 95% CI 0.02 to 0.43). The experimental group also improved by a mean of 2 points more than the control group on the ICIQ-UI-SF score (95% CI 0.02 to 3.97). In women who are unable to contract their pelvic floor muscles voluntarily, 8 weeks of intravaginal electrical stimulation with voluntary contraction attempts improved their ability to contract their pelvic floor muscles and reduced the overall severity and impact of urinary incontinence on quality of life. Although the main estimates of these effects indicate that the effects are large enough to be worthwhile, the precision of these estimates was low, so it is not possible to confirm whether the effects are trivial or worthwhile. NCT03319095.

Vaginal Electrical Stimulation for Postpartum Neuromuscular Recovery: A Randomized Clinical Trial.

The aim of this study was to compare 3-month postpartum anal incontinence symptoms in women who sustain obstetric anal sphincter injuries and begin immediate vaginal electrical stimulation versus sham therapy. In this double-blind randomized controlled trial, women who sustained obstetric anal sphincter injuries were randomized to receive self-administered vaginal electrical stimulation using a commercial device or sham therapy with an identical device. Anal incontinence symptom severity was assessed at 1 week (baseline) and again at 13 weeks postpartum using the Fecal Incontinence Severity Index. The primary outcome was anal incontinence symptom severity measured by the total Fecal Incontinence Severity Index score at 13 weeks postpartum. Between February 2016 and September 2018, 48 women completed a 13-week follow-up. At 13 weeks postpartum, median Fecal Incontinence Severity Index scores were higher (more severe) in the vaginal electrical stimulation group (12; interquartile range, 0-23) than in the sham group (4; interquartile range, 0-10) (P = 0.04). Unlike the vaginal electrical stimulation group, the improvement in Fecal Incontinence Severity Index scores in the sham group (vaginal electrical stimulation: 12 [interquartile range, 8-22] to 12 [interquartile range, 0-23] [P = 0.12] vs sham: 12 [interquartile range, 6-18] to 4.0 [interquartile range, 0-11] [P < 0.001]) met the threshold for clinical significance based on the minimum important difference of the Fecal Incontinence Severity Index. At 13 weeks postpartum, women who underwent postpartum vaginal electrical stimulation reported more anal incontinence symptoms compared with those receiving sham therapy. Vaginal electrical stimulation after obstetric anal sphincter injury was not beneficial in reducing anal incontinence symptoms and may impede recovery.

Mid-term results of the Remeex® readjustable sling for female complex stress urinary incontinence and sonographic hypomobile urethra.

We aimed to evaluate the results of a readjustable sling (Remeex® system) among a selected group of women with complex stress urinary incontinence (SUI) with sonographic hypomobile urethra and assessing failure-related risk factors. Observational, longitudinal, prospective cohort study, including patients who underwent surgery with the Remeex® system. The primary outcome was a binary outcome in change of one level or more of the severity of urinary incontinence symptoms according to the intervals of the Incontinence Questionnaire-Short Form (ICIQ-UI-SF) score (mild, moderate, severe and very severe). Secondary outcomes were postsurgical complications, absolute ICIQ-UI-SF, 24-h pad weight test (24-h PT), urodynamic SUI and Patient Global Impression of Improvement (PGI-I) score to evaluate subjective success. Among 120 women included, after surgery we found a 70% subjective success rate, a 76.7% decrease of urinary incontinence severity and a mean reduction of the 24-h PT of 109.6 ± 291.4g. Women with post-surgical decreased severity of incontinence had lower mean body mass index (BMI) and 24-h PT than those without incontinence severity changes with statistically significant differences (p = 0.028 and p = 0.027, respectively). A logistic regression model demonstrated that a 1-point increase of BMI increased the risk of persistence of incontinence severity after surgery by 19% (OR = 1.19; 95% CI: 1.01-1.41; p = 0.040), and an increase of 10g in the pre-surgical 24-h PT represented a 3% rise of the aforementioned risk (OR = 1.03; 95% CI: 1.01-1.06; p = 0.034). In patients with complex SUI and sonographic hypomobile urethra, use of a readjustable sling (Remeex® system) led to improvement of SUI. Patients with a greater BMI and pre-surgical 24-h PT showed worse results after surgery.

The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy.

The aim of the study was to evaluate the effectiveness of CO₂ fractional laser therapy on perimenopausal urogenital symptoms. This prospective, open-label study included 205 patients who received three CO₂ laser treatments. Clinical assessment was checked at baseline as well as at six weeks and 12 months post-treatment. The following scores were measured Vaginal Health Index Score (VHIS), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and assessment of the severity of selected urogenital symptoms. Significant improvements in dryness, dyspareunia, burning, vaginal laxity, urinary incontinence, as were the results on the VHIS and ICIQ-UI SF at six weeks post-treatment (p < 0.05 for all scores), which were maintained through the follow-up visit at 12 months. No complications were observed either during or after laser therapy. CO₂ ablative laser treatment can be effective in reducing vulvovaginal atrophy symptoms such as vaginal laxity, dryness, painful sexual intercourse, burning, and decreases the severity of stress urinary incontinence and urge incontinence symptoms. Positive results were maintained at 12 months after the laser treatment.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients.

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

Which factors are associated with anal incontinence after obstetric anal sphincter injury?

Obstetric anal sphincter injury (OASI) is an important factor in the etiology of anal incontinence. This study aimed to evaluate whether anal sphincter defects, levator avulsion or levator ballooning after OASI are associated with severity of anal incontinence. Furthermore, we evaluated whether factors such as constipation and altered stool consistency are associated with symptoms of incontinence after OASI. In this multicenter prospective observational cohort study, women with OASI were invited to participate at least 3 months after primary repair. All women completed validated questionnaires, including St Mark's incontinence score, Bristol stool scale (BSS) and Cleveland clinic constipation score (CCCS), and underwent four-dimensional (4D) transperineal ultrasound for assessment of the levator ani muscle and anal sphincter. In total, 220 women were included. Median follow-up was 4 months (range, 3-98 months). Univariate linear regression analysis showed an association of St Mark's incontinence score with a residual defect of the external anal sphincter (EAS) (β, 1.55 (95% CI, 0.04-3.07); P = 0.045), higher parity (β, 0.85 (95% CI, 0.02-1.67); P = 0.046), BSS (β, 1.28 (95% CI, 0.67-1.89); P < 0.001) and CCCS (β, 0.36 (95% CI, 0.18-0.54); P < 0.001). However, multivariate linear regression found an association of St Mark's incontinence score only with BSS (β, 1.50 (95% CI, 0.90-2.11); P < 0.001) and CCCS (β, 0.46 (95% CI, 0.29-0.63); P < 0.001). Residual defects of the EAS, detected on 4D transperineal ultrasound, are associated with severity of anal incontinence symptoms measured using St Mark's incontinence score 4 months after OASI repair. Furthermore, clinical factors such as constipation and altered stool consistency appear to influence this association and may therefore play a more important role in clinical management. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Can the inability to contract the pelvic floor muscles influence the severity of urinary incontinence symptoms in females?

The objective was to analyze if the inability to perform a maximal voluntary contraction (MVC) of the pelvic floor muscles (PFMs) in a first assessment can influence the severity of urinary incontinence symptoms in women. A cross-sectional study was carried out using the medical records of women with UI who were referred for pelvic floor physiotherapy after undergoing a gynecological evaluation between May 2013 and December 2019. Records included data referring to age, body mass index (BMI), obstetric history, Modified Oxford Scale (MOS), and the final score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) from a baseline assessment. Data were divided into women who were unable and those who were able to voluntarily perform an MVC of the PFMs. Statistical analysis was conducted using SPSS version 21. A total of 498 medical records were analyzed and 36.3% of those women were not able to perform a PFM MVC after verbal command and digital stimulus. Homogeneity was observed among groups and no significant difference was found regarding the severity of UI symptoms when the groups were compared. No association was found between the inability to contract the PFMs and the severity of UI symptoms. Other studies should be developed to better understand why some women are incapable of performing a voluntary PFM contraction. Also, it would be relevant to compare women with PFM dysfunction who are not able to contract the PFMs with healthy women with the same PFM condition to analyze whether this muscle condition could be related to dysfunctions such as UI or pelvic organ prolapse.

Efficacy of pelvic floor muscle training in improving symptoms of urinary incontinence and health related quality of life among parous and nulliparous women

Abstract Objectives To compare pelvic floor muscle strength, severity of urinary incontinence symptoms and health related quality of life between parous and nulliparous women; and to investigate the efficacy of pelvic floor muscle training in improving symptoms of urinary incontinence and health related quality of life in the previously mentioned two groups. Materials and methods Initially, 67 women were included in the study. Pelvic floor muscle strength and endurance were evaluated pre-treatment using the Pelvic floor exerciser. Participants were assessed before and after 10 weeks of pelvic floor muscle training by using The International Consultation of Incontinence Questionnaire – Short Form for symptoms severity, and The King’s Health Questionnaire for health related quality of life. Results The final sample included 32 participants: sixteen parous and sixteen nulliparous women between 18 and 50 years of age. Before the intervention, parous women (75%) were 2 times more likely to report urinary incontinence than nulliparous women (37.5%). They also had significantly lower pelvic floor muscle strength (p=.001), pelvic floor muscle endurance (p=.001), and more severe symptoms related to urinary incontinence (p=.009). Additionally, parous women had poorer disease specific quality of life in all domains. After the intervention, symptoms severity scores decreased significantly among both parous (p=.007) and nulliparous women (p=.038). Regarding quality of life, both groups had major improvements in all domains. Conclusions Our results suggest that urinary incontinence is more common among parous women. They experience more severe symptoms and have lower health related quality of life. Additionally, pelvic floor muscle training seems to be effective for improving symptoms of urinary incontinence and health related quality of life among both parous and nulliparous women.