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Davenport MH, Nagpal TS, Mottola MF, Skow RJ, Riske L, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Meah VL, Sobierajski F, James M, Nuspl M, Weeks A, Marchand AA, Slater LG, Adamo KB, Davies GA, Barakat R, Ruchat SM. Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis. Br J Sports Med 2018; 52:1397-1404. [PMID: 30337466 DOI: 10.1136/bjsports-2018-099780] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the relationships between prenatal physical activity and prenatal and postnatal urinary incontinence (UI). DESIGN Systematic review with random effects meta-analysis and meta-regression. DATA SOURCES Online databases were searched up to 6 January 2017. STUDY ELIGIBILITY CRITERIA Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [e.g., dietary; "exercise + co-intervention"]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal UI). RESULTS 24 studies (n=15 982 women) were included. 'Low' to 'moderate' quality evidence revealed prenatal pelvic floor muscle training (PFMT) with or without aerobic exercise decreased the odds of UI in pregnancy (15 randomised controlled trials (RCTs), n=2764 women; OR 0.50, 95% CI 0.37 to 0.68, I2=60%) and in the postpartum period (10 RCTs, n=1682 women; OR 0.63, 95% CI 0.51, 0.79, I2=0%). When we analysed the data by whether women were continent or incontinent prior to the intervention, exercise was beneficial at preventing the development of UI in women with continence, but not effective in treating UI in women with incontinence. There was 'low' quality evidence that prenatal exercise had a moderate effect in the reduction of UI symptom severity during (five RCTs, standard mean difference (SMD) -0.54, 95% CI -0.88 to -0.20, I2=64%) and following pregnancy (three RCTs, 'moderate' quality evidence; SMD -0.54, 95% CI -0.87 to -0.22, I2=24%). CONCLUSION Prenatal exercise including PFMT reduced the odds and symptom severity of prenatal and postnatal UI. This was the case for women who were continent before the intervention. Among women who were incontinent during pregnancy, exercise training was not therapeutic.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Taniya S Nagpal
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Rachel J Skow
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Laurel Riske
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Casey E Gray
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Victoria L Meah
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Frances Sobierajski
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marina James
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Nuspl
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ashley Weeks
- School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andree-Anne Marchand
- Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
| | - Linda G Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Kristi B Adamo
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Ruben Barakat
- AFIPE Research Group, Technical University of Madrid, Madrid, Spain
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
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Gon G, Leite A, Calvert C, Woodd S, Graham WJ, Filippi V. The frequency of maternal morbidity: A systematic review of systematic reviews. Int J Gynaecol Obstet 2018; 141 Suppl 1:20-38. [PMID: 29851116 PMCID: PMC6001670 DOI: 10.1002/ijgo.12468] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Estimates of the burden of maternal morbidity are patchy. Objective To conduct a systematic review of systematic reviews of maternal conditions to: (1) make available the most up‐to‐date frequency estimates; (2) identify which conditions do not have reliable estimates; and (3) scrutinize the quality of the available reviews. Search strategy We searched Embase, MEDLINE, and CINAHL, combining terms for pregnancy, frequency (e.g. prevalence, incidence), publication type, and specific terms for each of 121 conditions. Selection criteria We included peer‐reviewed systematic reviews aiming to estimate the frequency of at least one of the conditions in WHO's list of maternal morbidities, with estimates from at least two countries. Data collection and analysis We present the frequency estimates with their uncertainty bounds by condition, region, and pregnancy/postpartum period. We also assess and present information on the quality of the systematic reviews. Main results Out of 11 930 found, 48 reviews were selected and one more was added. From 49 reviews we extracted 34 direct and 60 indirect frequency estimates covering 35 conditions. No review was available for 71% of the conditions on the WHO list. The extracted estimates show substantial maternal morbidity, spanning the time before and beyond childbirth. There were several gaps in the quality of the reviews. Notably, one‐third of the estimates were based only on facility‐based studies. Conclusions Good‐quality systematic reviews are needed for several conditions, as a research priority. This study highlights that substantial maternal morbidity occurs along the pregnancy–postpartum continuum, and that conducting quality systematic reviews is a priority research gap.
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Affiliation(s)
- Giorgia Gon
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andreia Leite
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Calvert
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Susannah Woodd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Wendy J Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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103
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Dornowski M, Sawicki P, Wilczyńska D, Vereshchaka I, Piernicka M, Błudnicka M, Worska A, Szumilewicz A. Six-Week Pelvic Floor Muscle Activity (sEMG) Training in Pregnant Women as Prevention of Stress Urinary Incontinence. Med Sci Monit 2018; 24:5653-5659. [PMID: 30106065 PMCID: PMC6104548 DOI: 10.12659/msm.911707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/16/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pelvic floor muscle exercises are a widely used and well-established form of stress incontinence treatment, with success rates varying from 21% to 84%, although with a better subjective than objective outcome. MATERIAL AND METHODS "Incontinence Impact Questionnaire" (IIQ), PFM EMG assessment was done at the beginning and after the 6-week training program. RESULTS Statistically significant differences appeared in the BASE and R values. In the symptomatic group (with SUI symptoms), the value of BASE was 3.26 µV, and after training it was 3.95 µV. The R values before and after training were 4.55 µV and 4.25 µV. In the symptomatic group (without SUI symptoms), the value of BASE was 2.88 µV and 3.52 µV and R values were 7.16 µV and 3.92 µV. In the control group, BASE was 3.05 µV and 4.11 µV and R was 7.82 µV and 4.39 µV. CONCLUSIONS The results indicate that a 6-week training process influences PFM EMG activity in pregnant women. During Q, the value of PFM activity after a training session tended to increase in the symptomatic and control groups, but in the symptomatic group it remains practically unchanged. Our results show the probable process of decreasing control of PFM activity during long-lasting contractions in symptomatic and control women. The comparison of BASE before and after training averaged the values of R after five 10-s contractions and showed an increase in the Base and decrease in the R.
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Affiliation(s)
- Marcin Dornowski
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Piotr Sawicki
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Dominika Wilczyńska
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Inna Vereshchaka
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Magdalena Piernicka
- Department of Universal Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Monika Błudnicka
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Aneta Worska
- Department of Universal Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Anna Szumilewicz
- Department of Universal Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
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104
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Chen L, Luo D, Yu X, Jin M, Cai W. Predicting stress urinary incontinence during pregnancy: combination of pelvic floor ultrasound parameters and clinical factors. Acta Obstet Gynecol Scand 2018; 97:966-975. [PMID: 29754393 DOI: 10.1111/aogs.13368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 04/29/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to develop and validate a predictive tool that combines pelvic floor ultrasound parameters and clinical factors for stress urinary incontinence during pregnancy. MATERIAL AND METHODS A total of 535 women in the first or second trimester of pregnancy were included for an interview and transperineal ultrasound assessment from two hospitals. Imaging data sets were analyzed offline to assess for bladder neck vertical position, urethra angles (α, β and γ angles), hiatal area and bladder neck funneling. All significant continuous variables at univariable analysis were analyzed by receiver operating characteristics. Three multivariable logistic models were built on clinical factors, and combined with ultrasound parameters. The final predictive model with best performance and fewest variables was selected to establish a nomogram. Internal and external validation of the nomogram was performed by both discrimination represented by C-index and calibration measured by Hosmer-Lemeshow test. A decision curve analysis was conducted to determine the clinical utility of the nomogram. RESULTS After excluding 14 women with invalid data, 521 women were analyzed. β angle, γ angle and hiatal area had limited predictive value for stress urinary incontinence during pregnancy, with area under curves of 0.558-0.648. The final predictive model included body mass index gain since pregnancy, constipation, previous delivery mode, β angle at rest, and bladder neck funneling. The nomogram based on the final model showed good discrimination with a C-index of 0.789 and satisfactory calibration (p = 0.828), both of which were supported by external validation. Decision curve analysis showed that the nomogram was clinically useful. CONCLUSIONS The nomogram incorporating both the pelvic floor ultrasound parameters and clinical factors has been validated to show good discrimination and calibration, and could be an important tool for stress urinary incontinence risk prediction at an early stage of pregnancy.
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Affiliation(s)
- Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Dan Luo
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Xiajuan Yu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China.,Department of Neonatology, Shenzhen Maternity & Child Health Care Hospital, Shenzhen, Guangdong, China
| | - Mei Jin
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
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105
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Okunola TO, Olubiyi OA, Omoya S, Rosiji B, Ajenifuja KO. Prevalence and risk factors for urinary incontinence in pregnancy in Ikere-Ekiti, Nigeria. Neurourol Urodyn 2018; 37:2710-2716. [DOI: 10.1002/nau.23726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Temitope O. Okunola
- Department of Obstetrics and Gynaecology; State Specialist Hospital; Ikere-Ekiti Nigeria
| | - Olaolu A. Olubiyi
- Department of Family Medicine; State Specialist Hospital; Ikere-Ekiti Nigeria
| | - Sunday Omoya
- Department of Obstetrics and Gynaecology; State Specialist Hospital; Ikere-Ekiti Nigeria
| | - Babatunde Rosiji
- Department of Obstetrics and Gynaecology; State Specialist Hospital; Ikole-Ekiti Nigeria
| | - Kayode O. Ajenifuja
- Department of Obstetrics; Gynaecology and Perinatology Obafemi Awolowo University; Ile-Ife Nigeria
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106
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Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study. Taiwan J Obstet Gynecol 2018; 57:340-345. [DOI: 10.1016/j.tjog.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
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107
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Barbosa L, Boaviagem A, Moretti E, Lemos A. Multiparity, age and overweight/obesity as risk factors for urinary incontinence in pregnancy: a systematic review and meta-analysis. Int Urogynecol J 2018; 29:1413-1427. [PMID: 29754281 DOI: 10.1007/s00192-018-3656-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/08/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Multiparity, age and high body mass index (BMI) are the most widely investigated factors associated with urinary incontinence (UI) during pregnancy. We hypothesized that multiparity, age 35 years or older and high BMI (prepregnancy and during pregnancy) are risk factors for the occurrence of UI in pregnant women. METHODS Searches were done on MEDLINE/PubMed (1966-2017), LILACS/BIREME (1982-2017), CINAHL/Ebsco (1981-2017) and Scopus/Elsevier (1950-2017). The following criteria were used for study eligibility: (1) population: low-risk pregnant women in any trimester and without age restriction; (2) exposure factors: multiparity (≥ 2 deliveries), age 35 years or older and high BMI (overweight and obesity); (3) outcome: UI during pregnancy; (4) study design: cohort, case-control or cross-sectional studies that used multivariate logistic analysis. Two independent reviewers performed the entire systematic review process. Data extraction of each article was done and, when possible, included in a meta-analysis. Risk of study bias was assessed by NOS and quality of evidence by GRADE. A significance level of p ≤ 0.05 was adopted. The PROSPERO registration number was CRD42014013193. RESULTS Of 1176 articles identified through searches, 13 were included after screening and application of eligibility criteria. Very low quality of evidence shows that multiparity (OR = 2.09; 95% CI: 1.07 to 4.08), age 35 years or older (OR = 1.53; 95% CI: 1.45 to 1.62) and overweight and obesity during pregnancy (OR = 1.53; 95% CI: 1.28 to 1.83) are risk factors for UI in pregnancy. CONCLUSIONS The exposure factors investigated are risk factors for UI in pregnancy based on a very low quality of evidence.
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Affiliation(s)
- Leila Barbosa
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Av Prof. Moraes Rego, 1235 Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil
| | - Alessandra Boaviagem
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Av Prof. Moraes Rego, 1235 Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil
| | - Eduarda Moretti
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Av Prof. Moraes Rego, 1235 Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil
| | - Andrea Lemos
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Av Prof. Moraes Rego, 1235 Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil.
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108
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Roth JD, Casey JT, Whittam BM, Szymanski KM, Kaefer M, Rink RC, Schubert FP, Cain MP, Misseri R. Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction. Urology 2018; 114:236-243. [PMID: 29305940 DOI: 10.1016/j.urology.2017.11.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. METHODS We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. RESULTS We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3% term births). Thirteen of 15 patients (86.7%) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2%) underwent nephrostomy tube placement. Eight of 15 patients (53.3%) developed difficulty catheterizing (66.7% via native urethra, 44.4% via catheterizable channel); 50.0% of patients required an indwelling catheter. Five of 15 patients (33.3%) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7%) had a urinary tract infection (30.0% febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0% (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0%) developed urinary fistulae after emergent CD. CONCLUSIONS Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.
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Affiliation(s)
- Joshua D Roth
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Jessica T Casey
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin M Whittam
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Konrad M Szymanski
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Richard C Rink
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | - Mark P Cain
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Rosalia Misseri
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
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Common errors made in attempt to contract the pelvic floor muscles in women early after delivery: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2017; 220:113-117. [PMID: 29202394 DOI: 10.1016/j.ejogrb.2017.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The ability to perform a correct pelvic floor muscle contraction (PFMC) is necessary to start pelvic floor muscle training after delivery. COMMOV are "c"ontractions of "o"ther "m"uscles (m. rectus abdominus, the gluteal muscles, and the adductors), and other "mov"ements (pelvic tilt, breath holding, and straining) performed in addition to or instead of the PFMC. COMMOV are probably the most common errors in attempt to contract the pelvic floor muscles during the first days after delivery. The aims of this study were to observe the prevalence of COMMOV, to investigate whether COMMOV influence the ability to perform a PFMC, and whether verbal instructions are effective to unlearn the COMMOV postpartum. STUDY DESIGN A Prospective Observational Study was performed in women during the first through sixth day postpartum. PFMC and COMMOV were evaluated with visual observation. Women who did not show correct isolated PFMC received verbal instructions and were re-evaluated. Interobserver variability and agreement were calculated. Chi-square, Kappa, Risk Ratio, and McNemar were used. RESULTS A total of 382 women participated, 2.36 (±1.2) days postpartum. Twohundred sixteen, 57%, CI (52-62%), showed COMMOV. The chance to perform a correct PFMC was 2.65 times higher without COMMOV (p=0.0001). Verbal feedback was effective (57% reduced to 3%) to abandon COMMOV during PFMC. CONCLUSION COMMOV are common errors performed during attempts to contract the pelvic floor muscles after delivery. They can reduce the ability to contract the pelvic floor muscles, but can easily been unlearned with visual observation and verbal feedback.
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Han W, Wang Y, Qi S, Li T, Cao J, Zheng T, Su Y. Observation of the effect of physical rehabilitation therapy combined with the medication on pelvic floor dysfunction. Exp Ther Med 2017; 15:1211-1216. [PMID: 29399117 PMCID: PMC5774529 DOI: 10.3892/etm.2017.5583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/18/2017] [Indexed: 12/13/2022] Open
Abstract
We observed the effects of physical rehabilitation therapy combined with medication on pelvic floor dysfunction (PFD). We collected the medical records of 84 maternal patients with PFD who received treatment at the Affiliated Hospital of Hebei University between May 2015 and October 2016. These patients were randomly divided into two groups, the control group (n=42) and observation group (n=42). In the control group, patients received conventional physical rehabilitation therapy while in observation group, patients received the shixiao powder combined with siwu decoction in addition to the physical rehabilitation. The therapeutic effects were compared between the two groups. The total effective rate of the observation group was 97.6%, which was significantly higher than 78.6% in the control group (P<0.05). In observation group, the index scores of pelvic floor function under rest state, such as electromyo-graphy amplitude, contraction force, coordinate strength and urine flow rate, were significantly higher than those in control group (P<0.05). The rate of Grade II perineal muscle strength in the observation group was 7.32%, which was significantly lower than 47.62% in control group (P<0.05). In observation group, the rates of Grade III and Grade IV muscle strength were respectively 43.91 and 29.26%, which were significantly higher than those in control group (P<0.05). Before the administration of treatment, there were no significant differences in the comparison of the urinary incontinence and sexual life quality of patients between the two groups (P>0.05). In observation group, after treatment, the rehabilitation effects of urinary incontinence and sexual life quality at 3 months post-delivery were significantly better than those in control group (P<0.05). Before treatment, there were no significant differences in the comparison of levels of C-reactive protein (CRP) and interleukin-10 (IL-10) between the two groups (P>0.05), however, after treatment, the levels of CRP and IL-10 of patients in observation group were significantly lower than those in control group (P<0.05). In the observation group, the incidence rate of complications (7.14%) were significantly lower than that in control group (23.81%; P<0.05). Therefore, physical rehabilitation therapy combined with the shixiao powder and siwu decoction exhibits significant efficacy in the treatment of PFD by effectively improving the pelvic floor functions, increasing perineal muscle strength, and decreasing expression levels of inflammatory factors, which can significantly ameliorate life quality and reduce the incidence rate of complications. Thus, this treatment method shows great application value in clinical practice.
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Affiliation(s)
- Wei Han
- Maternity and Child Care Among Perinatal Care Clinic, Tangshan, Hebei 063000, P.R. China
| | - Yongmei Wang
- Department of Gynecology and Obstetrics, The Fourth Hospital of Hebei Medical University (Tumor Hospital of Hebei) Shijiazhuang, Hebei 050011, P.R. China
| | - Shengbo Qi
- Hospital of Gastrointestinal Surgery, Weifang, Shandong 261042, P.R. China
| | - Tingting Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Jiang Cao
- Hospital of Gastrointestinal Surgery, Weifang, Shandong 261042, P.R. China
| | - Tinghua Zheng
- Maternity and Child Care Department of Obstetrics and Gynecology, Tangshan, Hebei 063000, P.R. China
| | - Yan Su
- Maternal and Child Health Care Medicine, Tangshan, Hebei 063000, P.R. China
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Barbosa L, Cruz T, Carvalho A, Torres E, Porto I, Nascimento K, Lemos A. Urinary incontinence in pregnant adolescents: A case series. Neurourol Urodyn 2017; 37:1329-1335. [PMID: 29095509 DOI: 10.1002/nau.23441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/04/2017] [Indexed: 11/10/2022]
Abstract
AIMS Determine the severity of urinary incontinence (UI) and its effect on the quality of life (QoL) of pregnant adolescents, as well as explore the strategies used to manage UI and the reporting/investigation of this condition by healthcare professionals. METHODS A case series was conducted in three Brazilian public hospitals that offer prenatal care. Inclusion criteria were: age between 10 and 19 years, gestational age of 27 weeks or more, and reported UI in the third trimester of pregnancy. All volunteers responded to the Incontinence Severity Index (to assess severity of UI) and the International Consultation on Incontinence Questionnaire for Urinary Incontinence-Short Form (to evaluate the effect of UI on QoL). A descriptive analysis of data were done. RESULTS A total of 329 incontinent pregnant adolescents with mean age of 17.09 years (95%CI 16.92-17.26), who reported voiding urgency (72.0%), increased daytime urinary frequency (75.1%), nocturia (96.7%), and mixed UI (44.1%) were included in the study. UI was considered moderate to severe (79.3%) and had a moderate effect on QoL (mean 9.84; 95%CI 9.40-10.28). The volunteers used UI management strategies (66.6%), with bladder emptying prior to activities (56.8%) and the use of sanitary pads (29.5%) most frequently reported. UI is not disclosed voluntarily (89.1%) or explored by healthcare professionals (91.2%). CONCLUSION UI can be moderate to severe and has a moderate effect on QoL in incontinent pregnant adolescents, who use strategies to manage this condition. Healthcare professionals do not identify this urinary symptom during prenatal care.
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Affiliation(s)
- Leila Barbosa
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
| | - Thamiris Cruz
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
| | - Amanda Carvalho
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
| | - Elise Torres
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
| | - Isabel Porto
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
| | - Kaylla Nascimento
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
| | - Andrea Lemos
- Physical Therapy Department, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
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Establishing and monitoring of urethral sphincter deficiency in a large animal model. World J Urol 2017; 35:1977-1986. [PMID: 28940030 DOI: 10.1007/s00345-017-2088-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Different methods for induction and monitoring of urethral sphincter deficiency were explored in a large animal model. METHODS Sphincter deficiency was established in female pigs by dilatation and cauterization, and amount and frequencies of voiding were monitored and explored by pad test. Sphincteric closure pressures were recorded prior to and immediately after treatment of each animal, and on day 21 by two techniques: standard urethral pressure profilometry (s-UPP) and high-definition urethral pressure profilometry (HD-UPP). Tissue samples of the urethrae were analyzed by histochemistry (AZAN- and Sirius Red staining) and by immunohistochemistry detecting desmin and fast-myosin to depict muscular tissues. RESULTS After 3 weeks of observation animals treated by dilatation plus electrocautery presented with sphincter deficiency: measurements by both, s-UPP and HD-UPP demonstrated the maximal closure pressure reduced to baseline levels and a diminished area under the curve. Histological analyses documented, that dilatation yielded a pitted connective tissue and cauterization lead to muscle damage. Animals treated by either dilatation only or proximal injury only recovered within 3 weeks. By pad test no significant differences between untreated and treated animals or between the differently treated groups were recorded. CONCLUSION Significant urethral sphincter deficiency can be induced in female pigs by a combination of urethral dilatation and distal electrocautery. Sphincter deficiency can be measured by standard and high-definition urethral pressure profilometry. It was maintained over 21 days after induction and correlated with visible changes in the tissue structure of the distal urethra.
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Beksac AT, Aydin E, Orhan C, Karaagaoglu E, Akbayrak T. Gestational Urinary Incontinence in Nulliparous Pregnancy- A Pilot Study. J Clin Diagn Res 2017; 11:QC01-QC03. [PMID: 28969209 DOI: 10.7860/jcdr/2017/25572.10333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/11/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Urinary Incontinence (UI) in pregnancy is more than a disease; it is a social problem that necessitates special care and management. The exact rationales and biological facts behind urinary incontinence during pregnancy are unclear and multivariate. AIM This pilot study was designed to examine the direct effect of gestational factors (e.g., physical and metabolic/hormonal) on the presence of Gestational Urinary Incontinence (GUI), in nulliparous pregnant women. MATERIALS AND METHODS This was a questionnaire-based study comprising of 61 nulliparous pregnant woman who had not experienced any Urinary Incontinence (UI) before their pregnancies. Patients were examined during their pregnancies within the framework of the antenatal care program continued at the Division of Perinatology, Hacettepe University, Ankara, Turkey, between January 2015 and December 2016. A 'urinary incontinence questionnaire' was used three times during different periods of gestation (11-14, ~24 and ~37 gestational weeks) for each patient. Statistical analysis was performed using the SPSS software version 20.0. The Chi-Square test or Fisher's-exact test was used to compare proportions in groups. RESULTS The prevalence of total urinary incontinence (stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence) in nulliparous pregnant women was 4.9% (n=3), 9.8% (n=6) and 26.2% (n=16) at 11-14, ~24 and ~37 gestational weeks, respectively. Stress urinary incontinence was found to be 3.3% (n=2), 6.6% (n=4) and 16.4% (n=10) at 11-14, ~24 and ~37 gestational weeks, respectively. Urge urinary incontinence frequency was found to be 1.6% (n=1), 3.3% (n=2), 6.6% (n=4), and mixed urinary incontinence frequency was 0% (n=0), 0% (n=0), 3.3% (n=2) at 11-14, ~24 and ~37 gestational weeks, respectively. Maternal age, birth weight of the neonate and gestational age at birth had no statistically significant effect on GUI. CONCLUSION Urinary incontinence is an important issue during pregnancy and related symptoms are more common in third trimester.
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Affiliation(s)
- Alp Tuna Beksac
- Research Fellow, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Emine Aydin
- Department of Obstetrics and Gynaecology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Ceren Orhan
- Physiotherapist, Department of Physiotherapy, Hacettepe University, Ankara, Turkey
| | - Ergun Karaagaoglu
- Professor, Department of Bioistatistics, Hacettepe University, Ankara, Turkey
| | - Turkan Akbayrak
- Professor, Department of Physiotherapy Hacettepe University, Ankara, Turkey
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Frayman KB, Kazmerski TM, Sawyer SM. A systematic review of the prevalence and impact of urinary incontinence in cystic fibrosis. Respirology 2017; 23:46-54. [DOI: 10.1111/resp.13125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/04/2017] [Accepted: 06/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine B. Frayman
- Department of Respiratory and Sleep Medicine; Royal Children's Hospital; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - Traci M. Kazmerski
- Division of Pulmonary and Respiratory Diseases, Department of Medicine; Boston Children's Hospital; Boston MA USA
- Institute for Healthcare Improvement; Cambridge MA USA
| | - Susan M. Sawyer
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Royal Children's Hospital Centre for Adolescent Health; Parkville VIC Australia
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Machiyama K, Hirose A, Cresswell JA, Barreix M, Chou D, Kostanjsek N, Say L, Filippi V. Consequences of maternal morbidity on health-related functioning: a systematic scoping review. BMJ Open 2017; 7:e013903. [PMID: 28667198 PMCID: PMC5719332 DOI: 10.1136/bmjopen-2016-013903] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To assess the scope of the published literature on the consequences of maternal morbidity on health-related functioning at the global level and identify key substantive findings as well as research and methodological gaps. METHODS We searched for articles published between 2005 and 2014 using Medline, Embase, Popline, CINAHL Plus and three regional bibliographic databases in January 2015. DESIGN Systematic scoping review PRIMARY OUTCOME: Health-related functioning RESULTS: After screening 17 706 studies, 136 articles were identified for inclusion. While a substantial number of papers have documented mostly negative effects of morbidity on health-related functioning and well-being, the body of evidence is not spread evenly across conditions, domains or geographical regions. Over 60% of the studies focus on indirect conditions such as depression, diabetes and incontinence. Health-related functioning is often assessed by instruments designed for the general population including the 36-item Short Form or disease-specific tools. The functioning domains most frequently documented are physical and mental; studies that examined physical, mental, social, economic and specifically focused on marital, maternal and sexual functioning are rare. Only 16 studies were conducted in Africa. CONCLUSIONS Many assessments have not been comprehensive and have paid little attention to important functioning domains for pregnant and postpartum women. The development of a comprehensive instrument specific to maternal health would greatly advance our understanding of burden of ill health associated with maternal morbidity and help set priorities. The lack of attention to consequences on functioning associated with the main direct obstetric complications is of particular concern. REVIEW REGISTRATION CRD42015017774.
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Affiliation(s)
- Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Atsumi Hirose
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jenny A Cresswell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Barreix
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Nenad Kostanjsek
- Department of Health Statistics and Informatics, World Health Organization, Classification, Terminology and Standards, Geneva, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Véronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Fan Y, Huang Z, Zhang D, Chang J, Jia Y, He S, Wei B. Psychometric validation of the Chinese version of the Illness Perception Questionnaire–Revised for women with stress urinary incontinence. J Obstet Gynaecol Res 2017; 43:1305-1316. [PMID: 28586129 DOI: 10.1111/jog.13351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/19/2017] [Accepted: 03/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Yijun Fan
- Department of Gynaecology and Obstetrics Second Hospital of Anhui Medical University Hefei Anhui China
| | - Zhaohui Huang
- Anhui Provincial Family Planning Institute of Science and Technology Hefei Anhui China
| | - Dazhao Zhang
- Urological Surgical Department Second Hospital of Anhui Medical University Hefei Anhui China
| | - Jun Chang
- Department of Gynaecology and Obstetrics Second Hospital of Mengcheng County Bozhou Anhui China
| | - Yun Jia
- Department of Gynaecology and Obstetrics Taihe County People's Hospital Fuyang Anhui China
| | - Shuihong He
- Lianhua Community Health Service Centers of Hefei City Hefei Anhui China
| | - Bing Wei
- Department of Gynaecology and Obstetrics Second Hospital of Anhui Medical University Hefei Anhui China
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Wang H, Ghoniem G. Postpartum stress urinary incontinence, is it related to vaginal delivery? J Matern Fetal Neonatal Med 2017; 30:1552-1555. [DOI: 10.1080/14767058.2016.1209648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hong Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing, China
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Gamal Ghoniem
- Department of Urology, University of California, Irvine, Orange, CA, USA
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Pregnant women’s awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey. Int Urogynecol J 2017; 28:1557-1565. [DOI: 10.1007/s00192-017-3309-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/26/2017] [Indexed: 12/22/2022]
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Leroy LDS, Lúcio A, Lopes MHBDM. Risk factors for postpartum urinary incontinence. Rev Esc Enferm USP 2017; 50:200-7. [PMID: 27384198 DOI: 10.1590/s0080-623420160000200004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 12/29/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the risk factors for postpartum urinary incontinence (UI) and its characteristics. METHOD This was a case-control study with 344 puerperal women (77 cases and 267 controls) with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. RESULTS Stress UI was present in 45.5% of the women, incidents of urine leakage several times a day in 44.2%, of which 71.4% were in small amounts and 57.1% when coughing or sneezing. In 70.1% of cases, UI began during pregnancy and remained through the postpartum period. After running a binary logistic regression model, the following factors remained in the final model: UI during pregnancy (OR 12.82, CI 95% 6.94 - 23.81, p<0.0001), multiparity (OR 2.26, CI 95% 1.22 - 4.19, p=0.009), gestational age at birth greater or equal to 37 weeks (OR 2.52, CI 95% 1.16 - 5.46, p=0.02) and constipation (OR 1.94, CI 95% 1.05 - 5.46, p=0.035). CONCLUSION Most often, UI first appeared during pregnancy and remained through the postpartum period. Urinary incontinence during pregnancy, multiparity, gestational age at birth greater or equal to 37 weeks, and constipation were presented as risk factors. In the studied group, stress UI was more frequent. OBJETIVO Investigar os fatores de risco para a incontinência urinária (IU) no puerpério e as suas características. MÉTODO Trata-se de estudo caso-controle com 344 puérperas (77 casos e 267 controles), com até 90 dias pós-parto. Foi aplicado, em um único momento, um questionário para os dados sociodemográficos e clínicos, e dois outros para avaliar a perda urinária, situações de perda e o tipo de IU. RESULTADOS Apresentaram IU de esforço 45,5%, perda urinária diversas vezes ao dia 44,2%, sendo 71,4% em pequena quantidade e 57,1% ao tossir ou espirrar. Em 70,1% dos casos a IU iniciou-se na gestação e permaneceu no puerpério. Ao ajustar-se um modelo de regressão logística binária, apenas IU na gestação (OR 12,82, IC 95% 6,94 - 23,81, p<0,0001), multiparidade (OR 2,26, IC 95% 1,22 - 4,19, p=0,009), idade gestacional no parto maior ou igual a 37 semanas (OR 2,52, IC 95% 1,16 - 5,46, p=0,02) e constipação (OR 1,94, IC 95% 1,05 - 5,46, p=0,035) permaneceram no modelo final. CONCLUSÃO A IU iniciou-se frequentemente na gestação e permaneceu no puerpério. A presença de IU na gestação, multiparidade, idade gestacional no parto maior ou igual a 37 semanas e constipação foram fatores de risco. No grupo estudado a IU de esforço foi a mais frequente.
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Affiliation(s)
- Lígia da Silva Leroy
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem, Campinas, SP, Brazil
| | - Adélia Lúcio
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Pós-Doutorado, Campinas, SP, Brazil
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Gordon B, Shorter B, Isoldi KK, Moldwin RM. Obesity with Comorbid Stress Urinary Incontinence in Women: A Narrative Review to Inform Dietetics Practice. J Acad Nutr Diet 2016; 117:889-907. [PMID: 27881287 DOI: 10.1016/j.jand.2016.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Stress urinary incontinence (SUI) is a common problem among women; clinical treatment guidelines include weight reduction as a strategy for controlling urinary leakage. The purpose of this review was to gather evidence on the association between obesity and SUI and to ascertain whether there are any special considerations for implementing medical nutrition therapy with community-dwelling, obese, adult females with comorbid SUI. Five key findings emerged: epidemiologic studies consistently report statistically significant associations between obesity and SUI, randomized control trials found that weight loss appears to ameliorate SUI symptoms, the SUI-activity link may affect weight management, there is a potential interplay between SUI and the obesity-sleep connection, and dietary components are associated with the exacerbation of urinary symptoms. The pathogenesis of SUI and obesity-related contributions to urinary leakage is included in the introductory discussion. Lastly, insights on special considerations for implementing nutrition interventions with this population are offered.
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Nyangoh Timoh K, Bessede T, Lebacle C, Zaitouna M, Martinovic J, Diallo D, Creze M, Chevallier JM, Darai E, Benoît G, Moszkowicz D. Levator ani muscle innervation: Anatomical study in human fetus. Neurourol Urodyn 2016; 36:1464-1471. [PMID: 27813139 DOI: 10.1002/nau.23145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/05/2016] [Indexed: 12/25/2022]
Abstract
AIMS To characterize the nature and function of the levator ani muscle innervation pathways and to perform a comprehensive three-dimensional reconstruction of female pelvic innervation. METHODS A computer-assisted anatomical dissection protocol was applied to seven female human fetuses, after approval from the national biomedicine agency. Specimens were serially sectioned and immunostained for overall (antibody against protein S100), somatic (antibody against peripheral myelin protein 22), adrenergic (antibody against tyrosine hydroxylase), cholinergic (antibody against vesicular acetylcholine transferase), and nitrergic (antibody against the neural isoform of nitric oxide synthase) nerve fibers. Slides were digitized for three-dimensional reconstructions using WinSurf®. RESULTS Three main nerve pathways to the levator ani muscle were observed: the levator ani nerve, the pudendal nerve, and the inferior hypogastric plexus. The pudendal nerve was both somatic and autonomic, located below the levator ani muscle (infralevator pathway), supplying innervation to the inferior aspect of the levator ani muscle. The levator ani nerve was solely somatic, located above the levator ani muscle (supralevator pathway), supplying innervation to the superior aspect of the levator ani muscle. The inferior hypogastric plexus nerve fibers were solely autonomic, located in between the levator ani muscle and pelvic organs (endolevator pathway), supplying innervation to the medial portion of the levator ani muscle. CONCLUSIONS Our study provides a new representation of levator ani muscle innervation with three nerve pathways, and the levator ani muscle itself as an anatomical landmark.
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Affiliation(s)
- Krystel Nyangoh Timoh
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France.,EA4465 URDIA, University Paris Descartes, Paris, France
| | - Thomas Bessede
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France.,Department of Urology, Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Cedric Lebacle
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Mazen Zaitouna
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Jelena Martinovic
- Department of Fetal Pathology, Hopitaux Universitaires Paris-Sud, Clamart, France
| | - Djibril Diallo
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Maud Creze
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | | | - Emile Darai
- Department of Obstetrics and Gynecology, Tenon University Hospital, France Research Unit S938, Pierre and Marie Curie University, Paris, France
| | - Gérard Benoît
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - David Moszkowicz
- UMR 1195, Université Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France.,EA4465 URDIA, University Paris Descartes, Paris, France
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Roberts L, Rantell A, Cardozo L. Antepartum voiding symptoms following prior tension-free vaginal tape (TVT) operation: A case report. J OBSTET GYNAECOL 2016; 36:1002-1003. [PMID: 27626362 DOI: 10.1080/01443615.2016.1217512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lewis Roberts
- a King's College London GKT, School of Medical Education , London , UK
| | - Angie Rantell
- b Department of Urogynaecology , King's College Hospital , London , UK
| | - Linda Cardozo
- b Department of Urogynaecology , King's College Hospital , London , UK
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Demircan N, Özmen Ü, Köktürk F, Küçük H, Ata Ş, Harma M, Arıkan İİ. What are the probable predictors of urinary incontinence during pregnancy? PeerJ 2016; 4:e2283. [PMID: 27547579 PMCID: PMC4974920 DOI: 10.7717/peerj.2283] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/03/2016] [Indexed: 12/13/2022] Open
Abstract
Objectives. The frequency, predisposing factors and impact of urinary incontinence (UI) on quality of life (QoL) during pregnancy were investigated. Materials and Method. A preliminary cross-sectional survey was studied among pregnant women between January and July of 2014. A total of 132 pregnant women were recruited using a questionnaire form for sociodemographic features, the Turkish version of the International Consultation on Incontinence-Short Form (ICIQ-SF), for the characteristics of UI and Wagner’s Quality of Life scale to assess impact on QoL. p < 0.05 was set significant. Results.Urinary incontinence was present in 56 out of 132 pregnant women (42.4%, UI-present group): mean age, 26.7 ± 5.4y(p = 0.780); median height, 160 cm (min–max: 153–176, p = 0.037); median BMI, 28.7 kg/m2(min–max: 22.4–50.0, p = 0.881); urine leakage occurred per week once (n = 18, 32.1%), twice or thrice (n = 8, 14.3%); per day few times (n = 14, 25%), once (n = 5, 8.9%) and always (n = 8, 14.3%) with mainly a small amount of urine leakage (n = 33, 58.9%) or a moderate (n = 4, 7.1%). There were statistically significant relationships between QoL scores and frequency of UI (p = 0.002) or amount of leakage (p = 0.002). Impact on QoL scores ranged from mild (n = 33, 58.9%), moderate (n = 4, 7.1%) to severe (n = 4, 7.1%) levels in daily life. UI impacted the daily life activities of women by making them less likely to undertake activities outside their homes (23.2%), by affecting their working performance and friendships (8.9%), their daily home activities (7.1%), their general health status (12.5%), their sexual relations (12.5%), by making them more nervous or anxious (10.7%) and by the need to wear pads or protectors (25%). ANOVA, Tukey, and Tamhane tests as the minimal important difference model yielded significant relevance between statistical analyses and clinical outcomes by using standard deviations (p = 0.001, 0.001 and 0.005 respectively). The following features favored the occurence of UI: Age (OR = 0.845, 95% CI [0.268–2.669]), being a housewife (OR = 1.800, 95% CI [0.850–3.810]), anemia (OR = 0.939, 95% CI [0.464–1.901]), parity (OR = 0.519, 95% CI [0.325–0.829]), miscarriage (OR = 1.219, 95% CI [0.588–2.825]) and living in rural areas (OR = 1.800, 95% CI [0.887–3.653]). Height (p = 0, 037), educational status (0.016), miscarriage (0.002), parity (0.006) and place of living (0.020) were significant factors. Conclusions.Many pregnant women are suffering from UI, which warrants a significant public health consideration in the region. Age, height, being a housewife or graduation level higher than primary school, living in rural, parity, miscarriage, and anemia were the factors in favor of the onset of UI. The authors plan a health promotion program in the region according to the results in order to provide information to health caregivers, especially family physicians, and to educate women about the predictors of UI and pelvic floor exercises for primary prevention and secondary relief of UI during and after pregnancy and provide some hygienic supplies to the poor in this aspect.
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Affiliation(s)
- Nejat Demircan
- Faculty of Medicine, Department of Family Medicine, Bülent Ecevit University , Zonguldak , Turkey
| | - Ülkü Özmen
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bülent Ecevit University , Zonguldak , Turkey
| | - Fürüzan Köktürk
- Faculty of Medicine, Department of Biostatistics, Bülent Ecevit University , Zonguldak , Turkey
| | - Hamdi Küçük
- Faculty of Medicine, Department of Family Medicine, Bülent Ecevit University , Zonguldak , Turkey
| | - Şevket Ata
- Faculty of Science and Literature, Bülent Ecevit University , Zonguldak , Turkey
| | - Müge Harma
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bülent Ecevit University , Zonguldak , Turkey
| | - İnan İlker Arıkan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bülent Ecevit University , Zonguldak , Turkey
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125
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Palacios López A, Díaz Díaz B. Fisioterapia en incontinencia urinaria de embarazo y posparto: una revisión sistemática. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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126
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Bhat C, Khan M, Ballala K, Kamath A, Pandey D. Reduced Pelvic Floor Muscle Tone Predisposes to Persistence of Lower Urinary Tract Symptoms after Puerperium. SCIENTIFICA 2016; 2016:5705186. [PMID: 27119044 PMCID: PMC4826944 DOI: 10.1155/2016/5705186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/28/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
Pregnant primiparous women at term were enrolled in the study. ICIQ-FLUTS questionnaire was used to find out prevalence of LUTS. MOS was used to assess pelvic floor muscle strength. Women were followed up after 8-10 weeks of delivery to find out remission or persistence of these symptoms. We found that increased frequency of micturition was the most common (82%) LUTS seen in primiparous women at term. More than half (51%) of these women who complained of LUTS had a poor pelvic floor muscle tone (MOS grade 3). Out of those who had symptoms during pregnancy 11% remained symptomatic even after puerperium. Interestingly 61% of those with persistence of symptoms demonstrated a very poor pelvic floor muscle tone at term (MOS grade 2), while the remaining 39% also had a tone of only MOS grade 3. Thus women with LUTS during pregnancy should be screened for their pelvic floor muscle tone with simple MOS system which will help to predict the persistence of these symptoms later on. Women with a low score (three or less) should be triaged for regular pelvic floor muscle exercises.
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Affiliation(s)
- Chandana Bhat
- KMC Manipal, Manipal University, Manipal, Karnataka 576104, India
| | - Mahjabeen Khan
- KMC Manipal, Manipal University, Manipal, Karnataka 576104, India
| | | | - Asha Kamath
- KMC Manipal, Manipal University, Manipal, Karnataka 576104, India
| | - Deeksha Pandey
- KMC Manipal, Manipal University, Manipal, Karnataka 576104, India
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127
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Abdullah B, Ayub S, Mohd Zahid A, Noorneza A, Isa MR, Ng P. Urinary incontinence in primigravida: the neglected pregnancy predicament. Eur J Obstet Gynecol Reprod Biol 2016; 198:110-115. [DOI: 10.1016/j.ejogrb.2016.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 12/07/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
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128
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Okido MM, Valeri FL, Martins WP, Ferreira CHJ, Duarte G, Cavalli RC. Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study. Int Urogynecol J 2015; 26:1475-81. [DOI: 10.1007/s00192-015-2719-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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129
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130
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Fan Y, Huang Z, Yu D. Incontinence-specific quality of life measures used in trials of sling procedures for female stress urinary incontinence: a meta-analysis. Int Urol Nephrol 2015; 47:1277-95. [DOI: 10.1007/s11255-015-1020-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/23/2015] [Indexed: 02/03/2023]
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131
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Mannion CA, Vinturache AE, McDonald SW, Tough SC. The Influence of Back Pain and Urinary Incontinence on Daily Tasks of Mothers at 12 Months Postpartum. PLoS One 2015; 10:e0129615. [PMID: 26083252 PMCID: PMC4471341 DOI: 10.1371/journal.pone.0129615] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 05/11/2015] [Indexed: 11/24/2022] Open
Abstract
Objective The present study examined back pain (BP) and/or urinary incontinence (UI) impact on the ability to perform daily tasks at 12 months after childbirth in healthy reproductive women who sought maternity care in community based family practice clinics. Methods This study is a secondary analysis from the All Our Babies Study, a prospective, community-based pregnancy cohort in Calgary, Alberta. Maternal self-reported information on demographics, lifestyle, experiences with pregnancy and childbirth, occurrence of BP, UI and consequent impairment of daily tasks were collected by questionnaires administered before 25 weeks, at 34-36 weeks gestation and at 4 and 12 months postpartum. The occurrence and severity of BP and UI at one year after childbirth was assessed using descriptive and bivariate analyses. Logistic regression models examined the association between demographic and obstetrical variables and the severity of functional impairment due to UI and BP. Results From 1574 women with singleton pregnancies included in the study, 1212 (77%) experienced BP, 773 (49%) UI, and 620 (40%) both BP and UI. From the 821 women reporting impairment of daily tasks due to BP, 199 (24 %) were moderately and 90 (11%) severely affected with the remainder, 532 (64%) being mildly affected. From 267 women with functional impairment due to UI, 52 (19%) reported moderately to severe impairment in their ability to perform daily tasks. Obesity and parity were risk factors for impairment of daily functioning due to BP, whereas obesity and vaginal delivery increased the risk of moderate to severe impairment due to UI. Conclusions BP and UI are common occurrences 1 year after childbirth. Maternal performance of daily tasks and women’s health and quality of life are more often impaired due to BP than UI. Our study brings new evidence of the risk factors that predict severity and impact of these conditions on women functioning at 12 months postpartum.
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Affiliation(s)
| | - Angela E. Vinturache
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Sheila W. McDonald
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C. Tough
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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132
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Maheu-Giroux M, Filippi V, Samadoulougou S, Castro MC, Maulet N, Meda N, Kirakoya-Samadoulougou F. Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data. LANCET GLOBAL HEALTH 2015; 3:e271-8. [DOI: 10.1016/s2214-109x(14)70348-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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133
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Herrera-Imbroda B, Lara MF, Izeta A, Sievert KD, Hart ML. Stress urinary incontinence animal models as a tool to study cell-based regenerative therapies targeting the urethral sphincter. Adv Drug Deliv Rev 2015; 82-83:106-16. [PMID: 25453264 DOI: 10.1016/j.addr.2014.10.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/10/2014] [Accepted: 10/15/2014] [Indexed: 01/19/2023]
Abstract
Urinary incontinence (UI) is a major health problem causing a significant social and economic impact affecting more than 200million people (women and men) worldwide. Over the past few years researchers have been investigating cell therapy as a promising approach for the treatment of stress urinary incontinence (SUI) since such an approach may improve the function of a weakened sphincter. Currently, a diverse collection of SUI animal models is available. We describe the features of the different models of SUI/urethral dysfunction and the pros and cons of these animal models in regard to cell therapy applications. We also discuss different cell therapy approaches and cell types tested in preclinical animal models. Finally, we propose new research approaches and perspectives to ensure the use of cellular therapy becomes a real treatment option for SUI.
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134
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Prevalence of musculoskeletal dysfunctions among Indian pregnant women. J Pregnancy 2015; 2015:437105. [PMID: 25642349 PMCID: PMC4302374 DOI: 10.1155/2015/437105] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives. Pregnancy triggers a wide range of changes in a woman's body leading to various musculoskeletal dysfunctions. Most commonly reported musculoskeletal discomforts by pregnant women are low back pain and symphysis pubis pain. The culture and the environmental factors may influence the discomforts experienced by a pregnant woman. There is a dearth of literature in India, regarding the common musculoskeletal dysfunctions experienced by a pregnant woman, and hence this study. Method. A questionnaire to identify the musculoskeletal dysfunction was developed; content was validated and was translated to local languages through parallel back translation. 261 primiparous pregnant women participated in the study and filled the questionnaire in their native language. Results. Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain (37%). Conclusion. Musculoskeletal dysfunctions and general discomforts very commonly affect the activities of daily living of pregnant women. Understanding the common discomforts during various trimesters of pregnancy will help to develop a comprehensive program for prevention and cure.
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135
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Stangel-Wjcikiewicz K, Piwowar M. Genetic background of urinary incontinence – state-of-the-art and perspectives. BIO-ALGORITHMS AND MED-SYSTEMS 2015. [DOI: 10.1515/bams-2015-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe paper presents an overview of the current studies attempting to determine the genetic background of urinary incontinence (UI) problems. The overview referred to the adaptations of biomedical literature from Medline, life science journals, and online books were searched from the earliest date possible to March 2015. Genetic variability studies (mostly with the use of single nucleotide polymorphism) in the context of UI are discussed. The authors indicate the variability of polymorphic forms of proteins, whose modified function may be related to the observed phenotypic symptoms: UI. The paper includes a discussion of the varied level of gene expression and the issue of defective process of the development of the urinary system in the context of UI disorders. The literature does not present any general, unequivocal description of the relationship between the genetic background and phenotype as UI. It is suggested that the methods of integration of data from various techniques (e.g. high throughputs) in reference to social, demographic, and other data may be the way of the approach used for the effective description of the relationship between genetic background and observed UI.
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136
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Lin KL, Shen CJ, Wu MP, Long CY, Wu CH, Wang CL. Comparison of low urinary tract symptoms during pregnancy between primiparous and multiparous women. BIOMED RESEARCH INTERNATIONAL 2014; 2014:303697. [PMID: 25431763 PMCID: PMC4241740 DOI: 10.1155/2014/303697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/07/2014] [Accepted: 09/07/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Low urinary tract symptoms (LUTS) are a common problem during pregnancy. This study aimed to compare changes in the prevalence of LUTS during pregnancy between primiparous and multiparous women. METHODS A chart review of consecutive pregnant women who attended our antenatal clinic from March 2002 to January 2006 was performed. All of the women were asked to respond to a LUTS questionnaire in either of the three trimesters. RESULTS Of the 270 women included, 164 were nullipara and 106 were multipara. The most common LUTS during pregnancy were frequency (77%), followed by nocturia (75.6%), stress urinary incontinence (SUI) (51.1%), incomplete emptying (43.7%), dysuria (17.8%), and urgency incontinence (10.4%). There was a significantly higher prevalence of SUI (P<0.001) and urgency incontinence (P=0.005) in the multiparous compared to the nulliparous women. Increasing prevalence rates of frequency, nocturia, SUI, and incomplete emptying were reported with gestational age in both the nulliparous and multiparous women. CONCLUSIONS Frequency and nocturia were the two most common LUTS during pregnancy. The prevalence rates of all LUTS increased with increasing gestational age except for frequency in the nulliparous women during the second trimester. In addition, multipara was a predictor of SUI during pregnancy.
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Affiliation(s)
- Kun-Ling Lin
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Ching-Ju Shen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Ming-Ping Wu
- Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan 710, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, 100 Shih-Chuan Road, San-Min District, Kaohsiung 80708, Taiwan
| | - Chin-Hu Wu
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Chiu-Lin Wang
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, 100 Shih-Chuan Road, San-Min District, Kaohsiung 80708, Taiwan
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Martínez Franco E, Parés D, Lorente Colomé N, Méndez Paredes JR, Amat Tardiu L. Urinary incontinence during pregnancy. Is there a difference between first and third trimester? Eur J Obstet Gynecol Reprod Biol 2014; 182:86-90. [DOI: 10.1016/j.ejogrb.2014.08.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/09/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022]
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138
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Riesco MLG, Fernandes-Trevisan K, Leister N, Cruz CDS, Caroci ADS, Zanetti MRD. Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study. Rev Esc Enferm USP 2014; 48 Spec No:32-8. [DOI: 10.1590/s0080-623420140000600005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/04/2014] [Indexed: 01/04/2023] Open
Abstract
Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.
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139
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Pelvic floor awareness and the positive effect of verbal instructions in 958 women early postdelivery. Int Urogynecol J 2014; 26:223-8. [PMID: 25062656 DOI: 10.1007/s00192-014-2483-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS It is uncertain how reliable a personal belief is about the ability to do pelvic floor muscle (PFM) contractions early postdelivery and how instructional feedback affects pelvic floor muscle contraction (PFMC) performance. We hypothesize that many women do not have a reliable idea about PFMC and that instructional feedback can help improve their control. METHODS Prospective observational study in 958 women (median 30 years) early postdelivery PFMC was evaluated with visual observation: an inward movement of the perineum was accepted as sign of good contraction. The women who could not show PFMC three consecutive times got verbal instructions, and re-evaluation was afterward. RESULTS In 500 women, no inward movement of the perineum was observed: 275 women (29%) showed no movement at all, and 225 women (24%) showed some movement but no inward displacement. In 33.4%, the personal conviction to be able or not to perform PFMC proved false. After verbal instructions, 74% improved their PFMC. CONCLUSIONS The belief of doing correct PFM contraction was false in at least one of five postpartum women. Verbal instructions have a positive effect on performing PFMC in 73.6% of women.
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Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol 2014; 178:27-34. [DOI: 10.1016/j.ejogrb.2014.04.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 02/10/2014] [Accepted: 04/08/2014] [Indexed: 12/30/2022]
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141
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Park KM, Son JY, Choi JH, Kim IG, Lee Y, Lee JY, Park KD. Macro/Nano-Gel Composite as an Injectable and Bioactive Bulking Material for the Treatment of Urinary Incontinence. Biomacromolecules 2014; 15:1979-84. [DOI: 10.1021/bm401787u] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kyung Min Park
- Department
of Molecular Science and Technology, Ajou University, Suwon 443-749, Republic of Korea
| | - Joo Young Son
- Department
of Molecular Science and Technology, Ajou University, Suwon 443-749, Republic of Korea
| | - Jong Hoon Choi
- Department
of Molecular Science and Technology, Ajou University, Suwon 443-749, Republic of Korea
| | - In Gul Kim
- Department
of Urology, Catholic University, Seoul St. Mary’s Hospital, Seoul 137-701, Republic of Korea
| | - Yunki Lee
- Department
of Molecular Science and Technology, Ajou University, Suwon 443-749, Republic of Korea
| | - Ji Youl Lee
- Department
of Urology, Catholic University, Seoul St. Mary’s Hospital, Seoul 137-701, Republic of Korea
| | - Ki Dong Park
- Department
of Molecular Science and Technology, Ajou University, Suwon 443-749, Republic of Korea
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142
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Thaker H, Sharma AK. Regenerative medicine based applications to combat stress urinary incontinence. World J Stem Cells 2013; 5:112-123. [PMID: 24179600 PMCID: PMC3812516 DOI: 10.4252/wjsc.v5.i4.112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/07/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
Stress urinary incontinence (SUI), as an isolated symptom, is not a life threatening condition. However, the fear of unexpected urine leakage contributes to a significant decline in quality of life parameters for afflicted patients. Compared to other forms of incontinence, SUI cannot be easily treated with pharmacotherapy since it is inherently an anatomic problem. Treatment options include the use of bio-injectable materials to enhance closing pressures, and the placement of slings to bolster fascial support to the urethra. However, histologic findings of degeneration in the incontinent urethral sphincter invite the use of tissues engineering strategies to regenerate structures that aid in promoting continence. In this review, we will assess the role of stem cells in restoring multiple anatomic and physiological aspects of the sphincter. In particular, mesenchymal stem cells and CD34+ cells have shown great promise to differentiate into muscular and vascular components, respectively. Evidence supporting the use of cytokines and growth factors such as hypoxia-inducible factor 1-alpha, vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor and insulin-like growth factor further enhance the viability and direction of differentiation. Bridging the benefits of stem cells and growth factors involves the use of synthetic scaffolds like poly (1,8-octanediol-co-citrate) (POC) thin films. POC scaffolds are synthetic, elastomeric polymers that serve as substrates for cell growth, and upon degradation, release growth factors to the microenvironment in a controlled, predictable fashion. The combination of cellular, cytokine and scaffold elements aims to address the pathologic deficits to urinary incontinence, with a goal to improve patient symptoms and overall quality of life.
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