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Boileau A, Brierre T, Castel-Lacanal É, Soulié M, Gamé X. Lower urinary tract involvement in Ehlers-Danlos and Joint Hypermobility syndromes: Review of the literature. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102698. [PMID: 39033997 DOI: 10.1016/j.fjurol.2024.102698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Ehlers-Danlos syndrome (EDS) and Joint Hypermobility syndrome (JHS) are still poorly understood, with a prevalence of 1/5000 for EDS and 1/500 for JHS. They are characterized by multisystem involvement. Urological involvement has been little studied. The aim was to carry out a review of the literature on the urological involvement of EDS and JHS. METHOD A review of the literature was carried out using the following databases: Pubmed, Canadian Hospitals and EMBASE. Search terms were "Ehlers-Danlos" or "Joint Hypermobility" associated with "Urology", "Bladder", "Pelvic Organ Prolapse", "Urinary Retention", "Leak", "Leakage", "Urinary Incontinence", "Urinary Tract Infection" and "Urdodynamic", no filters were added. RESULTS Seventy-three articles were included for a total of 259 found. The prevalence of urinary incontinence in EDS is estimated at 50-60%, and that of pelvic organ prolapse (POP) at 29-75%. Bladder diverticula are also frequently reported. For JHS, the prevalence of urinary incontinence is estimated between 40 and 73%, that of POP increased with 73% of stage greater than 2, g-JHS patients are almost 3 times more affected by prolapses (OR=2.37) which seem more severe. Patients with vesicoureteral reflux, most often severe, are more affected by joint hypermobility (OR=2.79). Few studies have been carried out on urological assessment and treatment modalities. CONCLUSION EDS patients often have urinary incontinence, pelvic organ prolapse or bladder diverticula. JHS patients frequently have urinary incontinence, pelvic organ prolapse and vesicoureteral reflux.
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Affiliation(s)
- Adrien Boileau
- Department of Urology, Renal Transplantation and Andrology, CHU de Rangueil, université Paul-Sabatier, Toulouse, France.
| | - Thibaut Brierre
- Department of Urology, Renal Transplantation and Andrology, CHU de Rangueil, université Paul-Sabatier, Toulouse, France
| | - Évelyne Castel-Lacanal
- Inserm, UPS, Physical Medicine and Rehabilitation Department and ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Toulouse University Hospital, Toulouse, France
| | - Michel Soulié
- Department of Urology, Renal Transplantation and Andrology, CHU de Rangueil, université Paul-Sabatier, Toulouse, France
| | - Xavier Gamé
- Department of Urology, Renal Transplantation and Andrology, CHU de Rangueil, université Paul-Sabatier, Toulouse, France
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Clark NL, Johnson M, Rangan A, Kottam L, Swainston K. The biopsychosocial impact of hypermobility spectrum disorders in adults: a scoping review. Rheumatol Int 2023; 43:985-1014. [PMID: 36894757 PMCID: PMC10126066 DOI: 10.1007/s00296-023-05298-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Abstract
Joint hypermobility affects approximately 30% of the United Kingdom (UK) population, characterised by the ability to move joints beyond the physiological limits. Associated conditions include Ehlers-Danlos syndrome and hypermobility spectrum disorders, affecting individuals across physical, psychological and social levels detrimentally impacting their health and wellbeing. The scoping review aims to describe the known biopsychosocial impact of joint hypermobility conditions in adults over the last decade. Additional objectives include to (1) identify the types of studies that address these factors, (2) to understand how the impact of the condition is measured and managed and (3) what healthcare professionals (HCPs) are involved. The scoping review was conducted using the five-stage framework by Arksey and O'Malley. The search strategy related to two main keywords, "hypermobility" and, "biopsychosocial" across a number of electronic databases. A pilot search was conducted to determine the suitability of the databases and terms. Following the search, the data was extracted and charted, summarised and narratively reported. 32 studies met the inclusion criteria. The majority were conducted in either the UK or United States of America and case-control in design. The biopsychosocial impact was wide-ranging including, but not limited to, musculoskeletal system and dermatology, gastroenterology, mood and anxiety disorders, education and employments. This review is the first of its kind to summarise all reported symptoms and impact of joint hypermobility conditions in adults, highlighting a clear need to promote a multidisciplinary and holistic approach in raising awareness of these conditions and improving their management.
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Affiliation(s)
- Natalie L Clark
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Melissa Johnson
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.,The Mary Kinross Trust and RCS Chair, Department of Health Sciences and Hull York Medical School, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Katherine Swainston
- School of Psychology, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
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Veriki M, Coomer A, V Simmonds J. Parental perceptions of bladder dysfunction in children with symptomatic joint hypermobility. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2021; 187:586-592. [PMID: 34845822 DOI: 10.1002/ajmg.c.31952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/16/2021] [Indexed: 06/13/2023]
Abstract
Children with symptomatic joint hypermobility (SJH) report chronic pain, fatigue, and joint instability as their main symptoms. Symptoms can extend beyond musculoskeletal and include lower urinary tract dysfunction (LUTD). There are no studies exploring parent-perceived quality of life (QoL) in children with LUTD, or strategies used to manage symptoms in this population. Our online cross-sectional survey assessed parents of 6-18-year-olds via two UK charitable organizations. It included the Pediatric Incontinence Questionnaire (PinQ), the Dysfunctional Voiding Symptom Score, and questions exploring treatments and efficacy. Sixty-seven parental questionnaires were analyzed. The majority of children were white females (95%, n = 64). Urgency (97%, n = 65) and enuresis (41.7%, n = 28) were the most frequently reported symptoms. The PinQ questionnaire showed that children were emotionally distressed by LUTD. Twenty-nine parents (43%, n = 29) reported pharmacotherapy as the most effective treatment. Few had accessed other treatments such as physiotherapy (16%, n = 18). Most parents reported that overall treatment did not meet their expectations. This study highlights that parents perceive LUTD as having a great impact on their child's QoL. There is need for education among clinicians about LUTD and hypermobility-related disorders, and for development and evaluation of treatments.
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Affiliation(s)
- Marianna Veriki
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Children's Physiotherapy, Homerton University Hospital, London, UK
| | - Annette Coomer
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Children's Physiotherapy, Imperial College Healthcare, NHS Trust, London, UK
| | - Jane V Simmonds
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- London Hypermobility Unit, Central Health Physiotherapy, Wellington Hospital, London, UK
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Simmonds JV. Advances in assessment of hypermobility-related disorders. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:453-457. [PMID: 34741798 DOI: 10.1002/ajmg.c.31943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022]
Abstract
There has been increasing recognition in recent years of the prevalence and impact of symptoms which extend beyond the musculoskeletal system on the lives of people with hypermobility-related disorders. This has led researchers to develop more comprehensive assessment tools to help direct and monitor treatment. This article presents some of the latest assessment and diagnostic developments and their implications for practice from a physical therapy perspective.
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Affiliation(s)
- Jane V Simmonds
- Great Ormond Street Institute of Child Health, University College London, London, UK.,London Hypermobility Unit, Wellington Hospital and Central Health Physiotherapy, London, UK
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Whitney KE, Holtzman B, Cook D, Bauer S, Maffazioli GDN, Parziale AL, Ackerman KE. Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes. J Pediatr Urol 2021; 17:290.e1-290.e7. [PMID: 33622629 DOI: 10.1016/j.jpurol.2021.01.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/24/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Relative Energy Deficiency in Sport (RED-S) is a clinical syndrome that includes the many complex health and performance consequences of low energy availability (EA) in athletes, when there is insufficient caloric intake to meet exercise-related energy expenditure and to support basic physiologic functions. There is a high prevalence of urinary incontinence (UI) in female athletes and it is more common in female athletes than non-athletes. The objective of this study was to determine if low EA is associated with UI in a population of adolescent and young adult female athletes and to evaluate for an association between sport categories and UI. MATERIAL AND METHODS 1000 nulliparous female patients, ages 15-30 years, presenting to a sports medicine subspecialty clinic, provided informed consent/assent to participate in a cross-sectional study involving a comprehensive survey, anthropomorphic measurements, and medical record review. Low EA was defined as meeting ≥1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), and/or a high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or a high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed using questions adapted from the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), questions regarding timing of UI onset/duration, and a binary question regarding UI during sport activities. A total of 36 sport types were included in the survey and sub-divided into categories. RESULTS AND DISCUSSION Of the 1000 female athletes surveyed, 165 (16.5%) reported a history of experiencing UI during athletic activities. ICIQ- UI-SF responses indicated that 14% (137/1000) of the cohort experienced slight incontinence, 4% (35/1000) moderate incontinence, and 2 athletes experienced severe incontinence. There was a significant difference between UI categories in age (p = 0.01), low EA (p < 0.001), and sport category (p < 0.001). Females who had low EA had twice the likelihood (OR = 1.97; 95% CI = 1.39 to 2.81; p < 0.001) of UI compared to those with adequate EA, controlling for sports category and menstrual dysfunction. Females who participated in high impact sports were 4.5 times more likely (OR = 4.47; 95% CI = 2.29 to 8.74; p < 0.001) to have had UI compared to females who participated in ball sports, controlling for EA and menstrual dysfunction. CONCLUSIONS UI during athletic activities is a common problem among nulliparous adolescent and young adult female athletes, occurring in 16.5% of female athletes surveyed. UI was significantly associated with low EA across all sport categories. Sport type was significantly associated with UI, with the highest impact sport group demonstrating a higher prevalence and symptom severity compared to other sport categories.
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Affiliation(s)
- Kristin E Whitney
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, 319 Longwood Avenue, Ste 6, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Bryan Holtzman
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, 319 Longwood Avenue, Ste 6, Boston, MA, 02115, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Danielle Cook
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, 319 Longwood Avenue, Ste 6, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Stuart Bauer
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Department of Urology, Boston Children's Hospital 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Giovana D N Maffazioli
- Departamento de Obstetricia e Ginecologia, Hospital Das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Allyson L Parziale
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, 319 Longwood Avenue, Ste 6, Boston, MA, 02115, USA; Johns Hopkins University School of Nursing 525 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Kathryn E Ackerman
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, 319 Longwood Avenue, Ste 6, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, 457B, Boston, MA, 02114, USA.
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Gilliam E, Hoffman JD, Yeh G. Urogenital and pelvic complications in the Ehlers-Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clin Genet 2020; 97:168-178. [PMID: 31420870 PMCID: PMC6917879 DOI: 10.1111/cge.13624] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 12/19/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a heterogenous group of connective tissue disorders associated with significant morbidity. The urogenital aspects of these disorders are understudied and there is little guidance on the prevalence, types, or outcomes of urogenital complications in EDS/HSD. Our objective was to perform a scoping review to characterize and synthesize the literature reporting urogenital and pelvic complications in EDS/HSD patients. We performed a systematic search of three databases (Medline, CINAHL, Embase) to January 2019. English language, full-text articles reporting on urogenital or pelvic complications in EDS/HSD were included. A total of 105 studies were included (62 case reports/series, 43 observational) involving patients with hypermobile (23%), vascular (20%), classical (12%) EDS, and HSD (24%). Some studies looked at multiple subtypes (11%) or did not report subtype (33%). Reported complications included urinary (41%), gynecological (36%), obstetrical (25%), renal (9%), and men's health problems (7%), with some studies reporting on multiple areas. Urinary and gynecological complications were most prevalent in patients with HSD, while a broad range of complications were reported in EDS. While further research is required, results suggest a higher index of suspicion for urogenital problems is probably warranted in this population.
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Affiliation(s)
- Elizabeth Gilliam
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jodi D. Hoffman
- Division of Genetics, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Gloria Yeh
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Gomes T, Baqueiro P, Oliveira C, Alves R, Lordelo P. Microneedling on the external female genitalia's flaccidity in patients with Ehlers-Danlos: Case report. J Cosmet Dermatol 2019; 18:1336-1341. [PMID: 30729679 DOI: 10.1111/jocd.12867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/29/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The Ehlers-Danlos Syndrome (EDS) can presentis a reduction in fibroblast proliferation and collagen production. Microneedling a minimally invasive technique that through mechanical stimulus there is incentive to the production of collagen and elastin. OBJECTIVE Present a case study in a patient with EDS complaining of flaccidity on large genital labia, using microneedling as a therapeutic proposal. METHODOLOGY A 36-year-old female with EDS type III. The external genitalia showed tissue flaccidity associated with hyperchromia. Microneedling was performed with 0.5 mm needles and the cosmetology was used soon after the application. The level of pain was questioned to the patient through a Likert scale. The clinical response to treatment was evaluated through self-report, visual analogue scale and analysis of photographic images. Five other people evaluated the results through before and after images. RESULTS Microneedle was shown to be bearable in relation to pain and associated with cosmetology for tissue flaccidity due to EDS in the genital region proved to be very satisfactory for the patient, as well individuals who evaluated the comparative image. CONCLUSION Microneedle associated with cosmetology may be a new option for studies on skin flaccidity treatments on individuals with EDS and for treatments of genital hyperchromias.
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Affiliation(s)
- Tâmara Gomes
- Bahiana School of Medicine and Public Health, Salvador, Brazil
- Pelvic Floor Care Center, Salvador, Brazil
| | - Priscilla Baqueiro
- Bahiana School of Medicine and Public Health, Salvador, Brazil
- Pelvic Floor Care Center, Salvador, Brazil
| | - Caroline Oliveira
- Bahiana School of Medicine and Public Health, Salvador, Brazil
- Pelvic Floor Care Center, Salvador, Brazil
| | - Rafael Alves
- Bahiana School of Medicine and Public Health, Salvador, Brazil
- Pelvic Floor Care Center, Salvador, Brazil
| | - Patrícia Lordelo
- Bahiana School of Medicine and Public Health, Salvador, Brazil
- Pelvic Floor Care Center, Salvador, Brazil
- Federal University of São Paulo, São Paulo, Brazil
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Engelbert RHH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JV. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:158-167. [PMID: 28306230 DOI: 10.1002/ajmg.c.31545] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.
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Psychological and Physical Environmental Factors in the Development of Incontinence in Adults and Children: A Comprehensive Review. J Wound Ostomy Continence Nurs 2017; 44:181-187. [PMID: 28267126 DOI: 10.1097/won.0000000000000308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this review was to identify etiological environmental factors related to incontinence in children and adults. A variety of etiological environmental factors for the development of incontinence were identified. In children, these encompass stressful life events and trauma, family dysfunction, parental psychopathology, school-related stressors, toilet or "potty" training, fluid consumption habits, housing conditions, and the availability of toilets. In adults, physical exercise, obesity, working conditions, fluid intake, and the availability of toilets play a role. Intervening variables such as hormonal variations due to work shifts have also been identified as influencing the likelihood of incontinence. Current research suggests that environmental factors influence the development of incontinence in children and adults. The interactions between biological factors, the immediate environment, and intervening variables need to be explored in greater detail. Practical solutions to reduce barriers to adequate fluid intake and healthy toileting habits should be implemented in school and work settings.
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Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:48-69. [PMID: 28145611 DOI: 10.1002/ajmg.c.31538] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The hypermobile type of Ehlers-Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue. It has been described largely in those with musculoskeletal complaints including joint hypermobility, joint subluxations/dislocations, as well as skin and soft tissue manifestations. Many patients report activity-related pain and some go on to have daily pain. Two undifferentiated syndromes have been used to describe these manifestations-joint hypermobility syndrome and hEDS. Both are clinical diagnoses in the absence of other causation. Current medical literature further complicates differentiation and describes multiple associated symptoms and disorders. The current EDS nosology combines these two entities into the hypermobile type of EDS. Herein, we review and summarize the literature as a better clinical description of this type of connective tissue disorder. © 2017 Wiley Periodicals, Inc.
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Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy? Int Urogynecol J 2017; 28:1223-1231. [PMID: 28083713 DOI: 10.1007/s00192-016-3252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. METHODS This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. RESULTS MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. CONCLUSION LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.
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12
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Lower urinary tract dysfunction in patients with functional movement disorders. J Neurol Sci 2015; 361:192-4. [PMID: 26810540 DOI: 10.1016/j.jns.2015.12.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/10/2015] [Accepted: 12/28/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Functional movement disorders (FMD) are not associated with the kind of structural or biochemical alterations seen in other movement disorders and therefore would be unlikely to be associated with lower urinary tract (LUT) dysfunction. However, LUT symptoms have been observed in patients with FMD. OBJECTIVE To evaluate the frequency and pattern of LUT symptoms, their possible nature and the impact they have on the quality of life of patients with FMD. METHODS The clinical records of patients with FMD were reviewed retrospectively and patients reporting LUT symptoms were invited to complete standardised validated questionnaires-Urinary Symptom Profile (USP) and Short Form-Qualiveen (SFQ). Management of LUT dysfunction was also reviewed. RESULTS Out of the 150 patients with clinically established (n=97) or probable (n=53) FMDs, thirty (20%) self-reported LUT symptoms. Twenty two of these completed the USP and SFQ questionnaires. Overactive bladder symptoms were most commonly reported (n=14; 63.6%). Patients with fixed dystonia reported more severe LUT symptoms and had higher SFQ scores as compared to patients with other FMDs (p=0.01). Five patients with significant LUT symptoms had been referred to uroneurology. Of them, three had urinary retention managed with sacral neuromodulation, two had overactive bladder and were managed conservatively. CONCLUSION LUT dysfunction can be seen in 20% patients with FMD. Patients with fixed dystonia are more likely to report LUT dysfunction which can be severe. It may be advisable to ask for LUT symptoms in all patients with FMD and be more proactive in referring them for specialist investigation and treatment.
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Pacey V, Tofts L, Adams RD, Munns CF, Nicholson LL. Quality of life prediction in children with joint hypermobility syndrome. J Paediatr Child Health 2015; 51:689-95. [PMID: 25622801 DOI: 10.1111/jpc.12826] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 12/17/2022]
Abstract
AIMS To assess the child- and parent-reported health-related quality of life (HRQOL) of children with joint hypermobility syndrome (JHS), to compare these with other chronic paediatric conditions and to determine whether symptoms experienced by children with JHS can predict their HRQOL. METHODS Eighty-nine children with JHS and one of their parents completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scale, the Multidimensional Fatigue Scale and the Pediatric Pain Questionnaire. Anthropometric measures and reported symptoms were recorded. Child-reported HRQOL scores were compared with parent report, and both child- and parent-reported HRQOL scores of children with JHS were compared with those of children with other chronic conditions. Stepwise multiple regression was undertaken to determine whether any combination of measures could predict HRQOL. RESULTS Parent- and child-reported HRQOL scores were strongly correlated (r = 0.6-0.84, all P < 0.001); however, parents of children with JHS perceived lower overall HRQOL (mean difference = 4.44, P = 0.001), physical (mean difference = 7.11, P < 0.0001) and emotional functioning (mean difference = 5.24, P = 0.011) than their children. When considered together with previously reported HRQOL scores for children with other chronic conditions, parent and child scores were similarly strongly correlated (r = 0.93, P = 0.001). Multiple regression revealed that 75% of the variance in child-reported HRQOL scores was accounted for by a child's level of pain and fatigue, and presence of stress incontinence symptoms (P < 0.0001). CONCLUSION Children with JHS experience poor HRQOL and disabling fatigue, with parent scores providing a good proxy. Pain, fatigue and the presence of stress incontinence symptoms have the greatest impact on their HRQOL.
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Affiliation(s)
- Verity Pacey
- Physiotherapy Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Biomedical Sciences, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Louise Tofts
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Roger D Adams
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig F Munns
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Endocrinology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Leslie L Nicholson
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Biomedical Sciences, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Derpapas A, Cartwright R, Upadhyaya P, Bhide AA, Digesu AG, Khullar V. Lack of association of joint hypermobility with urinary incontinence subtypes and pelvic organ prolapse. BJU Int 2014; 115:639-43. [DOI: 10.1111/bju.12823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Alex Derpapas
- Department of Urogynaecology; St Mary's Hospital; Imperial College Healthcare NHS Trust; London Merseyside UK
| | - Rufus Cartwright
- Institute of Reproductive and Developmental Biology; Hammersmith Hospital; London Merseyside UK
| | | | - Alka A. Bhide
- Department of Urogynaecology; St Mary's Hospital; Imperial College Healthcare NHS Trust; London Merseyside UK
| | - Alex G. Digesu
- Department of Urogynaecology; St Mary's Hospital; Imperial College Healthcare NHS Trust; London Merseyside UK
| | - Vik Khullar
- Department of Urogynaecology; St Mary's Hospital; Imperial College Healthcare NHS Trust; London Merseyside UK
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Abstract
Joint hypermobility syndrome is a common clinical entity which is much misunderstood, overlooked, misdiagnosed and mistreated. It was first described in the 1960s as a purely musculoskeletal condition due to joint laxity and hypermobility occurring in otherwise healthy individuals. Some four decades later it is now perceived to be a multi-systemic heritable disorder of connective tissue with manifestations occurring far beyond the confines of the locomotor system and with ramifications potentially affecting most, if not all, of the bodily systems in one way or another. Most authorities in the field find it clinically indistinguishable from the Ehlers-Danlos syndrome--hypermobility type (formerly, EDS type III). In >50% of patients the diagnosis is delayed for ≥10 years. Failure to diagnose and treat the condition correctly results in needless pain and suffering and in many patients to a progressive decline in their quality of life and in some to a loss of independence.
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