Severity Of Urinary Incontinence Research Articles

Current state and influencing factors of social alienation in patients with stress urinary incontinence

ObjectiveTo understand the current level of social alienation among patients with stress urinary incontinence (SUI) and analyse the influencing factors to provide a foundation for better clinical support for patients’...

Preliminary results of the external urinary sphincter Uroflex® on the quality of life of patients with male urinary incontinence after prostate surgery: tolerance, severity of incontinence, and quality of life.

This study aims to establish the ability of the Uroflex® external artificial sphincter to reduce the severity of male urinary incontinence and improve the quality of life of patients with male urinary incontinence. A pre-post pilot study was carried out on a sample of 30 patients with male urinary incontinence. Tolerability and satisfaction were assessed by comparing the results of the Pad test, and EQ-5D and KHQ questionnaires before and after 3months of using Uroflex®. At 3months, 76.6% of patients continued using Uroflex®. The median score for overall satisfaction with the device was 8 out of 10. Pad test showed a significant reduction in the severity of male urinary incontinence at 3months (p < 0.001), with resolution of all symptoms in 31% of patients. The KHQ showed a significant improvement in global quality of life (p = 0.003). This was also significant for five of the nine specific dimensions assessed. There was also an improvement in self-rated health using the EQ-5D questionnaire, although not significant (p = 0.075). The Uroflex® external urinary sphincter seems to improve the severity of urinary incontinence and quality of life of patients with male urinary incontinence after prostate surgery. These encouraging results will need to be confirmed in larger controlled studies.

The effect of electroacupuncture applied to women with stress urinary incontinence on urinary incontinence severity and symptoms: Systematic review and meta-analysis of randomized controlled trials

IntroductionStress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted. ObjectiveThe aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence. MethodsLiterature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool. ResultsThe analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD: −2.37, 95% CI: −3.29 to 1.45, Z = 5.07, p < 0.001), urinary leakage (SMD: −0.79, 95% CI: −1.02 to −0.55, Z = 6.60, p = 0.001) and incontinence episode frequency (SMD: −2.24, 95% CI: −4.17 to −0.32, Z = 2.29, p < 0.02). ConclusionIn women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

The effect of injectable platelet rich fibrin as a nonsurgical treatment of the female stress urinary incontinence.

The complications of surgical treatments of stress urinary incontinence have led to the search for less invasive and safer treatment procedures. We aimed to investigate the efficacy of locally administered injectable platelet-rich fibrin (i-PRF), an autologous material that plays an important role in tissue regeneration, in women with stress urinary incontinence. Thirty-four women were included in this prospective, single-center, and interventional study, suffering from stress urinary incontinence refractory to conservative treatment. Three consecutive i-PRF injections were applied to the mid-urethra localization at anterior vaginal wall with an interval of 1month. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires were used to measure pre‑treatment, 1month and 6months post‑treatment symptom severity and the clinical outcomes were recorded. The mean age of the patients was 51.5 ± 9.8years. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires results revealed significant clinical improvement of stress urinary incontinence severity afer the administration of i-PRF (p < 0.001). The results at 1 and 6months after treatment did not change statistically significantly. This study demonstrated that locally administiration of i-PRF is efective in relieving SUI symptoms with high success rates without any adverse effects reported. i-PRF injection may have the potential to be a novel, minimally invasive, and low-risk procedure, that could be an alternative and simple treatment modality to surgery for female patients with stress urinary incontinence. Additionally, it may create new avenues for research on therapeutic implementation of i-PRF.

El efecto de la electroacupuntura en la gravedad y los síntomas de la incontinencia urinaria de esfuerzo en mujeres: revisión sistemática y metaanálisis de ensayos controlados aleatorizados

IntroductionStress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted. ObjectiveThe aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence. MethodsLiterature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool. ResultsThe analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD:-2.37, 95% CI:-3.29 to 1.45, Z=5.07,p<0. 001), urinary leakage (SMD:-0.79, 95% CI:-1.02 to -0.55, Z=6.60,p=0.001) and incontinence episode frequency (SMD:-2.24, 95%CI:-4.17 to -0.32, Z=2.29,p<0.02). ConclusionIn women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

A Full Bladder Is Not Needed for the Male Stress Incontinence Grading Scale.

Our objectives were to evaluate the Male Stress Incontinence Grading Scale to stratify male patients with stress urinary incontinence for either artificial urinary sphincter or sling using a standing cough test and determine if an emptier bladder at the time of assessment carries increased risk of treatment failure. Retrospective chart review of male patients undergoing sling and artificial urinary sphincter placement. The standing cough test score and bladder scan results were documented at initial evaluation. Forty patients underwent sling and 43 underwent naïve artificial sphincter placement. Median follow-up was 7.11 months. Thirty-six/forty slings had complete incontinence resolution or reduction to a safety pad vs 40/43 after sphincter (90% vs 93%, P = .62). Four sling patients (10%) had persistence or recurrence of incontinence. Cough test scores were similar between sling failure (67% grade 0, 33% grade 1) and success groups (83% grade 0, 3% grade 1, 14% grade 2). Bladder scan mean was 18.5 cc in the sling failure (SD 21.1) and 38.0 cc in the success groups (38.3), with 32% of success patients having bladder scans of 0 cc, and 63% of < 50 cc. Mean for sphincter patients was 45 cc (56.9). Ten patients with scan = 0 and 7 patients with scans < 30 cc demonstrated grade 4 incontinence. Cough test is a noninvasive, reliable tool to assess stress urinary incontinence severity. Our data suggest it is reliable even when bladders are nearly empty and can effectively stratify patients for sling vs artificial urinary sphincter with a high rate of success.

Prevalence of urinary incontinence in middle-aged and elderly adults in 10 areas in China

Objective: To describe the population and area distribution differences in the prevalence of urinary incontinence in middle-aged and elderly adults in 10 areas in China. Methods: A total of 24 913 participants aged 45-95 years who completed the third resurvey of China Kadoorie Biobank during 2020-2021 were included. The prevalence of urinary incontinence was assessed by an interviewer-administered questionnaire, and urinary incontinence was classified as only stress urinary incontinence, only urgency urinary incontinence and mixed urinary incontinence. The prevalence of urinary incontinence and its subtypes were reported by sex, age and area, and the severity of urinary incontinence and treatment were described. Results: The average age of the participants was (65.4±9.1) years. According to the seventh national census data in 2020, the age-standardized prevalence rates of urinary incontinence was 25.4% in women and 7.0% in men. The age-standardized prevalence rates of only stress, only urgency and mixed incontinence were 1.7%, 4.2% and 1.2% in men and 13.5%, 5.8% and 6.1% in women, respectively. The prevalence rates of urinary incontinence and all subtypes in men and the prevalence of urinary incontinence and all subtypes except only stress urinary incontinence in women all increased with age (P<0.001). After adjusting for age, the prevalence of urinary incontinence in both men and women were higher in rural area than in urban area (P<0.001). The treatment rates in men and women with urinary incontinence were 15.4% and 8.5%, respectively. Conclusions: The prevalence of urinary incontinence was high in middle-aged and elderly adults in China, and the prevalence rate was higher in women than in men, but the treatment rate of urinary incontinence was low.

Application of Kegel Motion Combined With Warming Acupuncture at the Eight Acupuncture Points in Patients With Urinary Incontinence After Radical Prostatectomy

Purpose To study the effect of Kegel exercise combined with Baliao warming acupuncture in the treatment of urinary incontinence after radical prostatectomy. Methods A single-center, retrospective cohort study was conducted on patients with clinically localized prostate cancer. This study involved 200 patients through a specific exclusion criterion admitted to the Department of Urology of our hospital, including 100 cases in the control group (single Kegel Motion) and 100 cases in the experimental group (Kegel Motion combined with acupuncture) from July 2017 to November 2020. Time from catheter removal to full recovery of urinary continence was recorded by 1 month, 3 months, and 6 months after surgery. The International Consultation on Incontinence Questionnaire-Short Form, the “1-hour diaper test,” and the Quality of Life Incontinence Questionnaire were used to evaluate the frequency and severity of urinary incontinence, the efficacy of urinary incontinence and the patients’ qualities of life, respectively. An independent sample t test, rank sum test, and χ2 test were adopted for comparison between groups. Results None of the frequency, severity, and efficacy of urinary incontinence nor the patients’ qualities of life showed a difference between the experimental group and the control group at 1 month after surgery (P &amp;gt; 0.05) but showed significant differences at 3 months and 6 months postoperatively (P &amp;lt; 0.05). Conclusions The Kegel Motion combined with warming acupuncture at the 8 acupuncture points can reduce the incidence of urinary incontinence, improve urinary control ability, and improve the quality of life of patients with urinary incontinence after radical prostatectomy.

The Role of the Supine Empty Stress Test in the Evaluation of Women with Stress Urinary Incontinence: A Retrospective Cohort Study.

The International Continence Society recommends the supine empty stress test (SEST) as an accessory test in the evaluation of women with urinary incontinence, especially for the presence of intrinsic sphincter deficiency (ISD). The aim of this study was to investigate the relationship between the SEST and clinical findings in women diagnosed with stress urinary incontinence with single voiding cycle ambulatory urodynamics (AUM). AUM tracings of patients with lower urinary tract symptoms (LUTS = Lower urinary tract symptoms) (n = 513) were retrospectively reviewed, and 364 charts with urodynamic SUI were analyzed. Demographics, examination findings, scores of the Sandvik Incontinence Severity Index and validated questionnaires, and AUM findings were compared between SEST-positive and -negative groups. Additionally, the diagnostic accuracy of the SEST in the diagnosis of low abdominal leak point pressure (ALPP ≤ 60 cm H2O) in women with pure urodynamic SUI was calculated. The SEST was positive in 41.8% (n = 152) of the cohort. Women with a positive SEST had higher scores on the Sandvik severity index (9.2 ± 3.6 vs. 7.5 ± 3.8, p = 0.003) and lower ALPP (79.6 ± 29.3 vs. 98.4 ± 31.3, p < 0.001). The negative predictive value of the SEST for ISD was found to be 92.4%. Thus, the SEST seems to be an objective clinical test reflecting urinary incontinence severity while excluding the presence of ISD.

Effect of Nursing Interventions on Reducing Severity of Stress Urinary Incontinence among Adult Women

Effect of Nursing Interventions on Reducing Severity of Stress Urinary Incontinence among Adult Women

Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development.

Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented. We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group. Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP. We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.

The effect of trunk-stabilizing muscle training in women with stress urinary incontinence: A randomized controlled trial.

There is little evidence regarding the effect of trunk-stabilizing muscle training on the improvement of stress urinary incontinence (SUI) symptoms. To investigate the effect of trunk-stabilizing muscle training on transabdominal ultrasonography (TAUS) and clinical urological indices, and on the quality of life (QoL) in women with SUI. Randomized controlled trial. A university hospital. Forty-six women with SUI, ages 20-55 years, were randomly assigned to an experimental (n = 23) and control group (n = 23). The experimental group performed trunk-stabilization exercises according to the Sapsford protocol, whereas the control group performed pelvic floor muscle (PFM) exercises for 8 weeks. The primary outcome measure was bladder base displacement (BBD), assessed by TAUS during PFM contraction (PFMC), Valsalva, and abdominal curl. The secondary outcome measures were PFM strength, the severity of urinary incontinence (UI), voiding diary, and QoL, assessed by the Modified Oxford Grading System, the severity index, frequency chart, and lower urinary tract symptoms-QoL questionnaire, respectively. All variables were assessed at baseline and after 8 weeks of intervention. The interaction of group and time was not significant for BBD during PFMC (p = .98), Valsalva (p = .28), abdominal curl (p = .34), and secondary variables (p > .05). The main effect of time was significant in both groups for BBD during PFMC, PFM strength, the severity of UI, voiding diary, and QoL (p < .001), with effect size (d) of 0.30, 0.80, 2.05, 1.07, and 1.03 in the control; and 0.49, 0.52, 1.75, 0.66, and 0.88 in the experimental group, respectively. The main effect of the group was not significant for BBD during PFMC (p = .68), Valsalva (p = .22), abdominal curl (p = .53), and secondary variables (p > .05). Trunk-stabilizing muscle training and PFM exercise are equally effective in the improvement of PFM function, UI symptoms, and QoL in women with SUI. Both methods can be used interchangeably by physical therapists.

Correlation between the female pelvic floor biomechanical parameters and the severity of stress urinary incontinence

BackgroundStress urinary incontinence (SUI) is a common condition that requires proper evaluation to select a personalized therapy. Vaginal Tactile Imaging (VTI) is a novel method to assess the biomechanical parameters of the pelvic floor.MethodsWomen with SUI were enrolled in this cross-sectional study. Participants completed the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire and the Patient Global Impression of Severity Question (PGI-S) and underwent a VTI examination. Based on the MESA and PGI-S questionnaires, participants were divided into mild, moderate, and severe SUI groups. Fifty-two biomechanical parameters of the pelvic floor were measured by VTI and compared between the groups (mild vs. moderate and severe). SUI Score and Index were calculated from the MESA questionnaire. Pearson correlation was used to determine the strength of association between selected VTI parameters and the MESA SUI Index and MESA SUI Score.ResultsThirty-one women were enrolled into the study. Significant differences were observed in the VTI parameters 16, 22–24, 38, 39 when the difference between mild and severe subgroups of SUI based on the PGI-S score was examined. Parameter 16 refers to the maximum gradient at the perineal body, parameter 22–24 refers to the pressure response of the tissues behind the vaginal walls, and parameter 38, 39 refers the maximum pressure change and value on the right side at voluntary muscle contraction. VTI parameter 49, describing the displacement of the maximum pressure peak in the anterior compartment, showed a significant difference between the mild SUI and the moderate-severe SUI according to the MESA SUI score (mean ± SD 14.06 ± 5.16 vs. 7.54 ± 7.46, P = 0.04). The MESA SUI Index and SUI Score displayed a positive correlation concerning VTI parameters 4 (the maximum value of the posterior gradient) and 27 (the displacement of the maximum pressure peak in the anterior compartment) (VTI4 vs. MESA SUI Index r = 0.373, P = 0.039; VTI4 vs. MESA SUI Score r = 0.376, P = 0.037; VTI27 vs. MESA SUI Index r = 0.366, P = 0.043; VTI27 vs. MESA SUI Score r = 0.363, P = 0.044).ConclusionsFemale pelvic floor biomechanical parameters, as measured by VTI, correlate significantly with the severity of SUI and may help guide therapeutic decisions.

Frequency of Urinary Incontinence Among Post COVID Males

Background: Amid the global health challenges posed by the COVID-19 pandemic, an association with urinary system complications has been identified. Urinary incontinence (UI) has become a significant post-COVID sequela among males, with substantial implications for their quality of life. Objective: The study aimed to quantify the frequency and delineate the severity of urinary incontinence in post-COVID male patients, as well as to document the prevalence of associated lower urinary tract symptoms. Methods: A cross-sectional observational study was executed, engaging 400 male post-COVID patients aged between 45 to 64 years from three hospitals in Lahore. Participants were selected via non-probability convenience sampling and provided data through the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Male Lower Urinary Tract Symptoms (ICIQ-MLUTS). Statistical analyses were performed using SPSS version 21. Results: The prevalence of urinary incontinence among the participants was high, with 367 (91.75%) reporting some degree of UI. In terms of severity, moderate UI was the most common, affecting 248 (67.5%) of those with UI, followed by slight UI in 82 (22.5%), and severe UI in 37 (10%) participants. The study identified urgency (reported by 133 participants or 33.3% 'occasionally' and 132 or 33% 'most of the time') and postvoid dribbling (reported by 159 participants or 39.8% 'most of the time') as the most frequent symptoms. Notably, there were no reports of very severe urinary incontinence. Conclusion: The study concludes a high prevalence of urinary incontinence among male patients post-COVID-19, with the majority experiencing moderate severity. These findings underscore the importance of including urinary incontinence assessments in post-COVID patient care and may inform the development of targeted interventions to improve patient outcomes.

Implementation of Physical Therapist Services for Men Undergoing Radical Prostatectomy: An Administrative Case Report.

Prostate cancer is the most commonly diagnosed cancer among men in the USA, and radical prostatectomy (RP) is the primary surgical treatment option. With an increasing number of men undergoing RP and surviving prostate cancer, clinical management strategies have broadened to improve the preoperative and postoperative patient experience and minimize treatment-related functional consequences. Urinary incontinence is a predictable functional consequence of RP. Recent reviews recommend preoperative and postoperative physical therapist services as the standard of care for men undergoing RP to decrease the severity of urinary incontinence and improve patients' quality of life. Despite compelling evidence, the routine provision of physical therapist services preoperatively and postoperatively for men undergoing RP is limited. The purpose of this case report is to describe the implementation of preoperative and postoperative physical therapist services for men undergoing RP in a US health care system using the knowledge-to-action process and the Consolidated Framework for Implementation Research frameworks. The implementation process included 4 steps: (1) development of a preoperative and postoperative physical therapist services program; (2) identification of barriers and enablers for implementation; (3) implementation of the program; and (4) evaluation of the effectiveness of the implemented program. Outcomes from the implementation of a physical therapist services program for men undergoing RP included lower urinary incontinence rates, improved patient satisfaction, and increased physical therapist utilization. This case report documents the implementation of physical therapist services for men undergoing RP. The use of implementation frameworks enabled the identification of unique enablers, barriers, and strategies for the implementation of physical therapist services for men undergoing RP. Implementing preoperative and postoperative physical therapist services for men undergoing RP improves patient outcomes. The implementation process and outcomes can be considered by other health care systems when developing preoperative and postoperative physical therapist services for men undergoing RP.

Urinary microbiome community types associated with urinary incontinence severity in women

BackgroundUrinary microbiome (urobiome) studies have previously reported on specific taxa and community differences in women with mixed urinary incontinence compared to controls. Therefore, we hypothesized that higher urinary and vaginal microbiome diversity would be associated with increased urinary incontinence severity. ObjectivesTo test if specific urinary or vaginal microbiome community-types are associated with urinary incontinence severity in a population of women with mixed urinary incontinence. Study DesignThis planned secondary, cross-sectional analysis evaluated associations between the urinary/vaginal microbiomes and urinary incontinence severity in a subset of ESTEEM trial participants with urinary incontinence. Incontinence severity was measured using bladder diaries and Urinary Distress Inventory (UDI) questionnaires collected at baseline. Catheterized urine samples and vaginal swabs were concurrently collected prior to treatment at baseline to assess the urinary and vaginal microbiomes.16S rRNA V4-V6 variable regions were sequenced, characterizing bacterial taxa to the genus level using the DADA2 pipeline and SILVA database. Using Dirichlet multinomial mixture methods, samples were clustered into community-types based on core taxa. Associations between community-types and severity measures (UDI total, UDI subscale scores, and the number of urinary incontinence episodes (total, urgency, and stress) from bladder diary) were evaluated using linear regression models adjusted for age and body mass index. Alpha diversity measures for richness (total taxa numbers) and evenness (proportional distribution of taxa abundance) were also analyzed for associations with urinary incontinence episodes and community-type. ResultsSix urinary microbiome community-types were identified, characterized by varying levels of common genera (Lactobacillus, Gardnerella, Prevotella, Tepidomonas, Acidovorax, Escherichia, and others). Analysis of urinary incontinence severity in 126 participants with MUI identified a Lactobacillus-dominated reference group with the highest abundance of Lactobacillus (76% mean relative abundance). A community characterized by fewer Lactobacilli (19% mean relative abundance) and greater alpha diversity, was associated with higher total urinary incontinence episodes (2.67 daily leaks, 95% CI: 0.76 - 4.59, p=0.007) and urgency urinary incontinence episodes (1.75 daily leaks, 95% CI: 0.24 - 3.27, p=0.02) compared to the reference group. No significant association was observed between community-type and stress urinary incontinence episodes or UDI total or subscores. The composition of vaginal community-types and urinary community-types were similar but comprised of slightly different bacterial taxa. Vaginal community-types were not associated with urinary incontinence severity, as measured by bladder diary or UDI total and subscale scores. Alpha diversity indicated that greater sample richness was associated with more incontinence episodes (observed genera p=0.01) in urine. Measures of evenness (Shannon/Pielou) were not associated with incontinence severity in the urinary or vaginal microbiomes. ConclusionsIn the urobiome of women with mixed urinary incontinence, a community-type with fewer Lactobacilli and more diverse bacteria was associated with more severe urinary incontinence episodes (total and urgency) compared to a community-type with high predominance of a single genus, Lactobacillus. Whether mixed urinary incontinence severity is due to lesser predominance of Lactobacillus, greater presence of other non-Lactobacillus genera, or the complement of bacteria comprising urobiome community-types, remains to be determined.

Prevalence and Quality of Life among Overweight and Obese Women with Different Severity and Types of Urinary Incontinence

Objective: Urinary incontinence (UI) is an involuntary leakage of urine and affects the social, physical, and psychological aspects of many individuals worldwide. The purpose of our study was to examine the prevalence, quality of life (QoL), severity, and different types of UI in overweight and obese women. Methods: We conducted a cross-sectional study of 1,351 consecutive patients, who were recruited between June 2021 and May 2022. Results: The mean age of the patients was 39.7 ± 14.2 years with less than a half in the 19–35-year age group (46.9%); 65% of the subjects were overweight or obese. The overall prevalence of UI was 61.2%. Overweight and obesity accounted to 70.2% of patients with mild to very severe UI. The risk estimates to have UI were 1.84 in overweight and 5.4 in obese group. The risk estimate for severe and very severe UI was 2.33 in overweight and 10.34 in obese group. When considering all subtypes, 67.9% of women with overweight and obesity had any of the subtypes, urge UI, stress UI, and mixed UI. Overweight and obesity were significantly associated with poor QoL in women with UI (p < 0.0001). Among 36.1% of all patients with poor QoL, 79.9% were overweight and obese. Conclusions: Overweight and obesity are important risk factors of UI affecting daily activity and QOL considerably. As the number of people with obesity is increasing, the prevalence of UI with increased severity is likely to increase in young to mid-aged women. Weight loss should be considered as first-line treatment for this patient population.

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.

Physiotherapy in Patients with Stress Urinary Incontinence: A Systematic Review and Meta-analysis.

Physiotherapy is the most commonly used treatment for stress urinary incontinence including pelvic floor muscle training, biofeedback, and electrical stimulation. This systematic review evaluated the effects of physiotherapy in patients with stress urinary incontinence compared with no treatment, placebo, sham, surgery, or other inactive control treatments. MEDLINE (via PubMed), The Cochrane Library (CENTRAL), Embase, Scopus, Web of Science, PEDro, and Trip Database were explored using applicable vocabularies for all English and Persian language investigations released from inception to January 2021. On one side, trials including physiotherapy of pelvic floor muscle training, biofeedback, and electrical stimulation and on the other, either no treatment, placebo, sham, surgery, or other inactive control treatments were included. Studies were assessed for appropriateness and methodological excellence. Two authors extracted data. Disagreements were resolved by a third opinion. Data were processed as described in the Joanna Briggs Institute Handbook. Twenty-nine trials with 2601 participants were found, but only 16 were included because of data heterogeneity. The results showed that physiotherapy interventions are better than no treatment in terms of urine leakage, but no difference was found for urinary incontinence severity. Also, physiotherapy showed favorable results over comparison groups for International Consultation on Incontinence Questionnaire, pad test, pelvic floor muscle function, and improvement outcomes. This systematic review supports the widespread use of pelvic physiotherapy as the first-line treatment for adult patients with stress urinary incontinence.

Financial strain across 25 years and women’s bladder health: a life course perspective

A small number of cross-sectional studies have found that financial insecurity-a social determinant of health-is associated with lower urinary tract symptoms. This study aimed to examine (1) whether women in the Coronary Artery Risk Development in Young Adult Study with higher levels of financial strain, assessed at 7 time points across 25 years beginning in 1985-1986, were more likely to report lower urinary tract symptoms and impact after the 2010-2011 financial strain assessment and (2) whether healthcare access and comorbidities mediated potential associations. This prospective cohort study recruited Black and White participants aged 18 to 30 years at baseline (1985-1986) from the populations of 4 US cities. The analytical sample was composed of women with complete data for analyses involving financial strain trajectories across 7 assessments (n=841) and mediation tests of data collected at 4 assessments (n=886). The outcome variable was previously developed through a cluster analysis of urinary incontinence severity, urinary incontinence impact, other lower urinary tract symptoms severity, and their impact in 2012-2013, which yielded 4 lower urinary tract symptoms and impact cluster categories: women with no symptom or very mild symptoms and no impact vs women with mild, moderate, or severe symptoms and impact. Financial strain was defined as finding it "very hard," "hard," or "somewhat hard" (vs "not very hard") to pay for the very basics, such as food, heating, and medical care. Using proportional odds logistic regression, cluster categories were regressed on the financial strain trajectory group, adjusting for age, race, education, and parity. For mediation analyses, separate financial strain variables (difficulty paying for the very basics, such as food and heating, and difficulty paying for medical care) were created by combining 1995-1996 and 2000-2001 values. Two healthcare access variables (difficulty receiving care and underutilization of care) and a single comorbidity index (smoking, physical inactivity, body mass index, hypertension, diabetes mellitus, and depressive symptoms) were created by combining 2005-2006 and 2010-2011 values. Regression analyses and structural equation modeling were used to test whether healthcare access and comorbidities mediated associations between financial strain and lower urinary tract symptoms and impact cluster categories. In comparison to women who were consistently not financially strained, women who were consistently strained (odds ratio, 2.10; 95% confidence interval, 1.13-3.91), shifted into being strained (odds ratio, 2.00; 95% confidence interval, 1.29-3.10), or experienced >1 shift in strain (odds ratio, 1.99; 95% confidence interval, 1.46-2.71) had roughly twice the odds of reporting greater lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities mediated the association between difficulty paying for medical care and lower urinary tract symptoms and impact. In the structural equation model, difficulty paying for medical care and underutilization of care were associated (β=.31; P<.01), as was underutilization of care and greater lower urinary tract symptoms and impact (β=.09; P<.01). Moreover, difficulty paying for medical care and the comorbidity index were associated (β=.34; P<.01), as was the comorbidity index and greater lower urinary tract symptoms and impact (β=.24; P<.01). Collectively, these mediation pathways eliminated a direct association between difficulty paying for medical care and lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities explained an association between financial strain (difficulty paying for medical care) and lower urinary tract symptoms and impact. Research is needed to confirm the findings and examine other mechanisms that may further explain the association. Accumulated evidence may inform future policies and practices.