Urogenital symptoms: prevalence, bother, associations and impact in 22 year-old women of the Raine Study

Lower Urinary Tract Symptoms, Toileting Behaviors, and Pelvic Floor Health Knowledge in Younger and Older Women

INTRODUCTION AND HYPOTHESIS

The primary aim was to examine the relationship between lower urinary tract symptoms (LUTS), toileting behaviors, and pelvic floor health knowledge in younger and older women. The secondary aim was to compare LUTS, toileting behaviors, and pelvic floor health knowledge in younger and older women.

METHODS

The study included 85 younger women and 81 older women. LUTS were evaluated using the International Consultation on Incontinence Questionnaire-Female LUTS (ICIQ-FLUTS), toileting behaviors using Toileting Behavior-Women's Elimination Behaviors (TB-WEB), and pelvic floor health knowledge using the Pelvic Floor Health Knowledge Quiz (PFHKQ).

RESULTS

In terms of LUTS, the most common symptoms in younger women are urgency (31.8%), bladder pain (28.2%), and frequency of incontinence episodes (35.3%), whereas in older women, the most common symptoms observed are urgency (64.2%), frequency of incontinence episodes (61.7%), intermittency (46.9%), urgency urinary incontinence (58%), and frequency of incontinence episodes (49.4%). Most unhealthy toileting behaviors correlated with LUTS in both groups (p < 0.05). Although a weak negative correlation was detected between ICIQ-FLUTS total score and PFHKQ function in younger women (p < 0.05), no correlation was found in older women (p < 0.05). Whereas premature voiding, straining during voiding, TB-WEB total score were higher in older women than in younger women (p < 0.05), delayed voiding, position preference for voiding, and PFHKQ function/dysfunction scores were higher in younger women than in older women (p < 0.05).

CONCLUSIONS

Within the scope of preventive health services, it may be important to provide informative programs on healthy toileting behaviors and pelvic floor health to women of all ages in order to prevent LUTS.

The Effect of Pregnancy on Urinary Symptoms

Background Urinary incontinence is a condition that causes social, medical, or hygienic problems. The increase in the incidence of stress incontinence, particularly with increasing parity, emphasizes the role of pregnancy on the etiology of incontinence and other urinary symptoms. This study aimed to estimate the effect of pregnancy on urinary incontinence and other urinary symptoms with history and urodynamic data. Methodology This study was conducted at Mustafa Kemal University, Medical Faculty, Obstetrics and Gynecology Department. A total of 72 pregnant primigravid women without any urinary problems were included in the study. Patients with severe chronic disease, neurological disorders, antepartum hemorrhage, multiple pregnancies, younger than 18, and those with physical and mental disabilities were excluded. All patients were initially evaluated in the first trimester and finally in the sixth week of the postpartum period. Demographic and obstetric data, including urological complaints and urodynamic findings, were recorded. Results There were significant increases in nocturia, frequency, dysuria, urgency, and stress urinary incontinence complaints in pregnant women. Urge incontinence was not significantly different after pregnancy. In the postpartum urodynamic studies, nine (12.5%) patients with stress urinary incontinence and six (8.3%) patients with detrusor instability were detected. There was no significant difference between cesarean section and vaginal delivery regarding incontinence. Conclusions According to the study findings, pregnant women who were continent before pregnancy could become incontinent after birth according to urodynamic data. However, long-term studies are needed to determine whether this incontinence is temporary. Additionally, according to our results, cesarean section should not be recommended over vaginal delivery only to prevent incontinence.

Association between pelvic pain bothersomeness and pain sensitivity: A community-based cross-sectional study of young adult females in the Raine Study

OBJECTIVE

Pelvic pain has been associated with augmented nociceptive processing, but large studies controlling for multiple potential confounding factors are lacking. This study investigated the association between pelvic pain bothersomeness and pain sensitivity in young adult women, accounting for potential confounding factors.

DESIGN

Cross-sectional study.

SETTING

Community-dwelling sample.

POPULATION

The Raine Study Gen2-22 year follow-up (n = 475).

MAIN OUTCOME MEASURES

The experience of bothersomeness related to pelvic pain was determined from a question in the Urogenital Distress Inventory short form. Pain sensitivity was measured using pressure pain and cold pain thresholds. Potential confounding factors included ethnicity, marital status, highest level of education, income, waist-hip ratio, level of activity, sleep quality, smoking, comorbidity history, C-reactive protein level, musculoskeletal pain experience and psychological distress.

RESULTS

Three hundred and sixty-two women (76.2%) reported no pelvic pain bothersomeness, 74 (15.6%) reported mild pelvic pain bothersomeness and 39 (8.2%) reported moderate-severe pelvic pain bothersomeness. After adjusting for marital status (and test site), moderate-severe pelvic pain bothersomeness was associated with a lower pressure pain threshold (i.e. greater pressure pain sensitivity) (coefficient -51.46, 95% CI -98.06 to -4.86, p = 0.030). After adjusting for smoking, moderate-severe pelvic pain bothersomeness was also associated with a higher cold pain threshold (i.e. greater cold pain sensitivity) (coefficient 4.35, 95% CI 0.90-7.79, p = 0.014).

CONCLUSIONS

This study suggests augmented nociceptive processing as a contributing factor in pelvic pain bothersomeness for some women. Thorough assessment of women who present clinically with pelvic pain should consider pain sensitivity as a potential contributing factor to their presentation.

Pelvic Floor Support and Symptoms 1 Year Postpartum in Relation to Excess Body Habitus Before, During and After First Vaginal Birth

IMPORTANCE

Obesity may be a modifiable risk factor for pelvic floor disorders.

OBJECTIVES

The objective of this study is to determine associations between weight, weight changes, and cumulative exposure to excess body mass index (BMI) from prepregnancy to 1 year postpartum on pelvic floor support and symptoms 1 year after first vaginal birth.

STUDY DESIGN

In 645 primiparous women who gave birth vaginally, we assessed anatomic pelvic floor support, pelvic floor symptoms and BMI at the third trimester, 5 - 10 weeks, and 1 year postpartum; we also assessed BMI prepregnancy and predelivery. Using multivariable models, we determined associations between pelvic floor outcomes 1 year postpartum and BMI quartiles at different timepoints, gestational weight gain, and postpartum weight retention. We evaluated associations between stress urinary incontinence (SUI) and moderate/severe urinary incontinence (UI) 1 year postpartum and cumulative excess BMI from prepregnancy to 1-year postpartum (BMI1year).

RESULTS

Body mass index was not associated with anatomic support, composite symptom burden, overactive bladder, anal incontinence, or constipation at any timepoint. Gestational weight gain and postpartum weight retention were not associated with any 1-year outcome. Body mass index at every timepoint was positively associated with SUI and moderate/severe UI; BMI1year was most predictive. Cumulative excess BMI was positively associated with SUI and moderate/severe UI but only slightly more predictive of these outcomes than BMI1year alone.

CONCLUSIONS

Body mass index over the pregnancy trajectory was not associated with outcomes other than UI. The small advantage of cumulative exposure to excess BMI over BMI1year in predicting SUI and moderate/severe UI suggests that BMI1year adequately captures risk of these 1-year outcomes.

Habitus and Pelvic Floor Symptoms and Support 1 Year Postpartum

OBJECTIVE

To estimate the association between habitus measures and pelvic floor support and symptoms in primiparous women 1 year after term vaginal delivery.

METHODS

In this cross-sectional study including women enrolled at seven academic and community sites, we assessed pelvic floor support, weight, height, waist circumference, and percent fat using air displacement plethysmography and participants completed questionnaires, all at one year postpartum. We tested the association of quintiles of habitus measure, including body mass index (BMI), waist circumference, percent body fat, and waist/height ratio, with the primary outcomes: anatomic support, dichotomized as maximal vaginal descent less than 0 cm (better support) compared with 0 cm or more (worse support) per the pelvic organ prolapse quantification examination and symptom burden (positive with bothersome symptoms in two or more of six symptom domains), and on five secondary outcomes. The sample size provides 90% power to detect odds ratios (ORs) of 1.78 or greater between women at mean compared with mean+1 SD of habitus measure.

RESULTS

Of 592 participants, 55 (9.3%) demonstrated worse support and 321 (54.2%) symptom burden. In multivariable analyses, habitus measures were not significantly associated with anatomic support or, except for the highest waist/height ratio quintile, with symptom burden. Compared with women in the first quintile of each habitus measure, those in most higher quintiles demonstrated elevated odds of moderate to severe urinary incontinence (UI); increased odds for stress urinary incontinence (SUI) were mainly limited to the highest quintile. After adjusting for percent body fat, the increased odds for BMI on SUI (OR 2.47, 95% CI 1.43-4.28) were no longer significant (OR 1.38, 95% CI 0.54, 3.51).

CONCLUSION

Habitus in primiparous patients at 1 year postpartum was not associated with anatomic support or symptom burden. Habitus was more associated with moderate to severe UI than mild UI. The association of higher BMI with SUI was attenuated by fitness, reflected by fat percentage.

Trajectories of Pelvic Floor Symptoms and Support After Vaginal Delivery in Primiparous Women Between Third Trimester and 1 Year Postpartum

OBJECTIVES

The objectives of this study were to describe trajectories of pelvic floor symptoms and support from the third trimester to 1 year postpartum in primiparous women after vaginal delivery and to explore factors associated with their resolution between 8 weeks postpartum and 1 year postpartum.

METHODS

Five hundred ninety-seven nulliparous women 18 years or older who gave birth vaginally at term completed the Epidemiology of Prolapse and Incontinence Questionnaire and the Pelvic Organ Prolapse Quantification examination at the third trimester, 8 weeks postpartum, and 1 year postpartum.

RESULTS

At 1 year postpartum, 41%, 32%, and 23% of participants reported stress urinary incontinence, nocturia, and flatus incontinence, respectively, and 9% demonstrated maximal vaginal descent (MVD) ≥ 0 cm. For more common symptoms, incidence rates between the third trimester and 8 weeks postpartum ranged from 6% for urinary frequency to 22% for difficult bowel movements, and resolution rates between 8 weeks postpartum and 1 year postpartum ranged from 23% for stress urinary incontinence to 73% for pain. Between the third trimester and 8 weeks postpartum, 13% demonstrated de novo MVD ≥ 0 cm. For most symptoms, the presence of the same symptom before delivery decreased the probability of resolution between 8 weeks postpartum and 1 year. However, the sensitivities of predelivery vaginal bulge and MVD of 0 cm or greater for those outcomes at 1 year postpartum was overall low (10-12%).

CONCLUSIONS

One year postpartum, urinary and bowel symptoms are common in primiparous women who gave birth vaginally. A substantial portion of this burden is represented by symptoms present before delivery, while most of the prevalence of worse anatomic support is accounted for by de novo changes after delivery.

Relationship between urinary incontinence and back or pelvic girdle pain: a systematic review with meta-analysis

INTRODUCTION AND HYPOTHESIS

Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population.

METHODS

This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the "Critical Review Form for quantitative studies" (McMaster University).

RESULTS

From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain.

CONCLUSIONS

Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice.

Association Between Measures of Trunk Recovery 5 to 10 Weeks Postpartum and Pelvic Floor Support and Symptoms 1 Year Postpartum in Primiparas Delivered Vaginally

OBJECTIVE

To determine whether 2 aspects of trunk recovery after childbirth, intraabdominal pressure (IAP) generation and trunk flexor endurance (TFE), predict measures of pelvic floor health 1 year postpartum.

METHODS

In this prospective cohort study, we enrolled nulliparas in their third trimester and followed up those delivered vaginally for 1 year. We measured IAP while lifting a weighted car seat (IAPLIFT), IAP during TFE testing (IAPTFE), and TFE duration 5 to 10 weeks postpartum and assessed pelvic floor support and symptoms 1 year postpartum.

RESULTS

Mean age of the 624 participants was 28.7 years. At 5 to 10 weeks postpartum, mean (SD) maximal IAPLIFT and IAPTFE were 47.67 (11.13) and 51.57 (12.34) cm H2O, respectively. Median TFE duration was 126 seconds (Interquartile range, 74-211). At 1 year postpartum, 9.3% demonstrated worse support (maximal vaginal descent at or below hymen) and 54% met criteria for symptom burden (bothersome symptoms in ≥2 domains of Epidemiology of Prolapse and Incontinence Questionnaire). In multivariable models, neither IAPLIFT nor IAPTFE were associated with worse support or symptom burden (P = 0.54-1.00). Trunk flexor endurance duration increased prevalence of worse support (prevalence ratio, 1.05; 95% confidence interval, 1.01-1.08) per 60-second increase, P = 0.005) but not symptom burden (prevalence ratio, 1.00; 95% confidence interval, 0.98-1.03; P = 0.92).

CONCLUSIONS

These results provide some reassurance to early postpartum women, who are unlikely to perform routine activities that generate IAP far outside the range tested. Further research is needed to understand why women with long TFE durations have increased prevalence of worse support.