Stress urinary incontinence and visceral adipose index: a new risk parameter

Association of plasma high-density lipoprotein cholesterol level with risk of stress urinary incontinence in women: a retrospective study

BACKGROUND

Studies have found that high density lipoprotein cholesterol (HDL-C) levels are linked to a variety of diseases. However, evidence for the relationship between stress urinary incontinence (SUI) and HDL-C remain limited.

METHODS

590 eligible women were enrolled. Basic characteristic, gynecological examinations and blood sampling were collected. The examination of the possible link between HDL-C and SUI was done using univariate and multivariate logistic regression. Feature importance ranking and Receiver operating characteristic (ROC) curves were performed to further evaluate the association between HDL-C and SUI in women.

RESULTS

A significant association was found between HDL-C and SUI in women, revealing higher HDL-C levels were related to a lower risk of SUI (OR 0.238; 95%CI: 0.091-0.623; P < 0.01) after adjustment for potential key confounders. The AUC for the SUI predicted by the combined HDL-C was 0.845 (95%CI: 0.798-0.891, P < 0.001). The feature importance ranking revealed that vaginal delivery, HDL-C were the top two important factors.

CONCLUSIONS

HDL-C levels were correlated with the development of SUI. In addition to physical and surgical treatments, HDL-C may offer the possibility of potential targeted treatment and prevention of SUI afterwards.

Prevalence of overactive bladder among overweight and obese women: A prospective cross-sectional cohort study

OBJECTIVE

To evaluate the effect of body mass index (BMI) on the prevalence of overactive bladder syndrome (OAB), severity of symptoms, and quality of life in affected patients.

METHODS

We conducted a prospective cross-sectional study of 1351 consecutive patients who were recruited between June 2021 and May 2022. Patients were divided according to BMI (normal: <25.0, overweight: 25-29.9, obese: ≥30) and menopausal status. The latter were divided according to the presence or absence of urinary incontinence in the normal, wet-OAB and dry-OAB groups. A validated questionnaire, the International Consultation on Incontinence Questionnaire in Overactive Bladder (ICIQ-OAB), in the English and Arabic languages was used.

RESULTS

A total of 1351 patients were included. For women who were overweight, there was a greater prevalence of dry-OAB (p = 0.02), However, the prevalence of both dry and wet-OAB were higher in obese women (p < 0.00001). Compared to women with a normal BMI, women who were overweight or obese had a greater likelihood of developing abnormal daytime urine frequency and nocturia, with p values ≤ 0.01. The ORs of overweight and obese women were 3.1 and 5.3, respectively, for experiencing wet OAB in comparison to women with a normal BMI. Additionally, the odds of developing severe OAB in overweight and obese women were 5.8 and 18.6, respectively, which negatively affects their quality of life (QoL).

CONCLUSION

The risk of developing OAB symptomatology is significantly greater in overweight and obese patients. As BMI increases, the symptomatology, perceived discomfort and QoL of patients with OAB worsen.

Associations between visceral adipose index and stress urinary incontinence among US adult women: a cross-sectional study

OBJECTIVE

Visceral adipose index (VAI) is a novel parameter for the evaluation of visceral obesity. The present study aimed to investigate the association between VAI levels and stress urinary incontinence (SUI) in a nationally representative population.

MATERIALS AND METHODS

The National Health and Nutrition Examination Survey (NHANES) women population aged > 20 years were analyzed from 2001 to 2018. SUI was determined by self-reported questions. VAI was calculated using physical examination data and laboratory tests. Survey-weighted logistic regression models were used to analyze the correlation between SUI and VAI.

RESULTS

The final analysis included 9709 women. Among them, 4032 (41.53%) were any SUI, 1130 (11.64%) were at least weekly SUI, and 506 (5.21%) were at least daily SUI. In multivariate analysis, the odds ratio (OR) for overall SUI increased slightly after full adjustment (OR 1.06, 95% CI 1.03-1.10, P = 0.001). Similar results were observed in weekly (OR 1.04, 95% CI 1.00-1.08, P = 0.0327) and daily (OR 1.04, 95% CI 1.00-1.09, P = 0.0702) SUI. The analysis of VAI categorized showed an increased OR of any, weekly, and daily SUI in the highest compared to the lowest tertile (OR 1.44, 95% CI 1.26-1.65, P < 0.0001 for trend, OR 1.38, 95% CI 1.07-1.78, P = 0.0153 for trend, OR 1.33, 95% CI 0.94-1.87, P = 0.094 for trend).

CONCLUSION

This study revealed a significant association between SUI and VAI among US adult women. VAI is an easily applicable index for the evaluation of visceral fat dysfunction, which might be useful for the calculation of SUI risk.

Relationship of Body Composition and Urinary Incontinence in Women: A Cross-Sectional Case-Control Study

OBJECTIVE

To describe the profile of segmental body composition through the bioelectrical impedance analysis (BIA) method in continent and incontinent women and analyze the association between overweight/obesity and urinary incontinence (UI).

METHODS

This was a cross-sectional case-control study that included women aged between 20 and 65 years, who were not pregnant, were outside of their menstrual period, without neurological, psychiatric, orthopedic, or cardiac comorbidities. The presence of UI was verified using the International Consultation on Incontinence Questionnaire-Short Form. Segmental body composition was assessed with BIA. The independent Student t test was used to compare body composition means between groups, and multivariate logistic regression was used to test the association between body composition and UI.

RESULTS

The study included 62 women with a mean age of 34.4 ± 11.6 years, of whom 27 (43.5%) had UI. Of these, 15 (55.6%) were nulliparous and had a body mass index of 25.1 ± 4.2 kg/m, similar to that of continent women, who had a body mass index of 23.6 ± 3.9 kg/m (P=0.16). The sociodemographic and obstetric data were similar among continent and incontinent women. With respect to the parameters of segmental body fat, visceral fat, and waist circumference, incontinent women presented higher values than the continent group. In the final multivariate analysis model, women with high levels of visceral fat had a 1.13-times higher likelihood of presenting UI.

CONCLUSIONS

In adult women, there is an association between the level of visceral fat assessed by BIA and complaints of urinary loss, being more evident in overweight and obese women.

Chemoradiation for cervical cancer treatment portends high risk of pelvic floor dysfunction

Goal

To assess the impact of chemoradiation on pelvic floor (PF) muscle function after the treatment of cervical cancer (CC).

Methods

We performed a prospective cohort study of women between the ages of 20 and 70 years old who had a diagnosis of CC. Patients were treated with chemoradiation at the Barretos Cancer Hospital (BCH), between August 2016 and July 2017. We performed three evaluations at different time points after chemoradiation treatment to compare changes in muscle function. Pelvic floor muscle function was assessed through perineometry (PNM) and surface electromyography (EMG) at the following time points: Pretreatment Moment 1 (M1): evaluated before chemoradiation; Moment 2 (M2): at the first follow-up medical visit (usually 3 to 4 months after treatment); and Moment 3 (M3): at the second follow-up medical visit (usually after 6 to 9 months after treatment). Mean vaginal squeeze pressure levels were determined by PNM and muscle electromyographic activity by EMG and the results were evaluated by Generalized Linear Model comparisons.

Results

Forty-nine patients were evaluated at M1; 35 at M2; and 32 at M3, so that 32 patients had all three muscle evaluations performed. There was a statistically significant increase in the frequency of women with urgency urinary incontinence at the M2 evaluation time (41.9%), compared to pretreatment M1 (18.6%), p<0.001. The means of the vaginal squeeze pressures reduced through M1 to M3 in the phasic (M1: 17.7 mmHg; M3: 11.27mmHg) and tonic contractions (M1: 10.56 mmHg; M3: 7.52mmHg), p = 0.01 and p = 0.03 respectively. There was no difference in pelvic floor function in the three evaluations M1-M3, measured by EMG. The pelvic floor strength assessed by PMN and their interactions with anthropometric, parity and hormonal status variables, showed that a high body mass index (BMI) significantly influenced decreases in pelvic floor muscle function before and after treatment.

Conclusion

These results show that chemoradiation causes reduction of muscle function of the pelvic floor, especially in the late phase after the end of treatment. Both the high BMI and urgent urinary incontinence symptoms were related to decreased muscle strength.

The Relationship between Overweight and Overactive Bladder Symptoms

BACKGROUND

Several authors have investigated the relationship between obesity - assessed only by body mass index (BMI) - and overactive bladder (OAB) symptoms.

OBJECTIVES

The objective of this study was to determine the relationship between body fat percentage (BFP) and the severity of OAB symptoms with an impact on quality of life.

DESIGN

Cross-sectional study. The sample consisted of 206 overweight women; they were university students (BMI = 25.8 ± 3.0) with an average age of 30.6 ± 2.4 years. Body composition analysis was used, including assessment of BFP, visceral fat area (cm2/level), and other parameters. OAB symptoms were evaluated with an OAB questionnaire (OAB-q), voiding diary, and quality of life scale (I-QoL).

RESULTS

Ninety women had a BFP >32% and 116 had a BFP <32%. The voiding diary and OAB-q confirmed significant differences in 24-h daytime and nighttime frequency of voiding and average urine volume during the day. The OAB-q symptom score was lower in the group with BFP <32%. I-QoL recorded significantly worse parameters in the group with BFP >32% (p < 0.01). The Patient Perception of Intensity of Urgency Scale significantly correlated with BFP (r = 0.466, p < 0.001). Women with a BFP above 32% had a 1.95 times greater chance of developing OAB (odds ratio = 1.95, 95% CI = 1.09-3.52, p < 0.02).

CONCLUSION

Young women with a BFP >32% were 95% more likely to have OAB than other young women with a BPF <32%.

Effect of an exercise programme for reducing abdominal fat on overactive bladder symptoms in young overweight women

INTRODUCTION AND HYPOTHESIS

The effect of exercise in relation to overweight and overactive bladder (OAB) in young women has not been sufficiently supported by studies. The objective of our study was to reduce symptoms of OAB through a 3-month exercise programme in young overweight women with OAB. The sample consisted of 70 women (mean age 26.7 ± 4.8 years), 36 being treated and 34 in the control group.

METHODS

We used a body composition analyser with the assessment of skeletal muscle mass (SMM) (kg), body fat mass (BFM) (kg), body fat percentage (BFP) (%), visceral fat area (VFA) (cm²/level) and the waist/hip circumference index (WHR). OAB symptoms were evaluated using a voiding diary, the overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a programme for the reduction of abdominal fat (PRAF), with elements of aerobic training, strengthening of the abdominal muscles and stretching.

RESULTS

In the OAB symptoms assessed through the voiding diary (number of voidings per 24 h, nocturia, mean voided volume) as well as in the OAB-q and PPIUS scales after training, significant differences were reported in favour of the treatment group [number of voidings per 24 h: treatment vs. control group, baseline 9.1 ± 0.3 vs. 8.6 ± 0.3, final 6.9 ± 0.2 vs. 8.1 ± 0.2, p < 0.0001; mean voided volume per 24 h (ml): treatment vs. control group, baseline 154.2 ± 9.1 vs. 162.2 ± 9.3, final 201.3 ± 9.3 vs. 164.1 ± 9.6, p < 0.0001] with a large effect size (ES). In the body composition analysis after training, significant differences were also reported in favour of the treatment group in the reduction of body mass index (BMI), BFP and VFA (p < 0.0001), with a large ES.

CONCLUSIONS

Body composition analysis confirmed a reduction of BMI, body weight, body fat percentage, visceral abdominal fat, the WHR index and waist circumference in favour of the treatment group after the 12-week PRAF exercise programme. A reduction in OAB symptoms was also objectively confirmed following the PRAF exercise programme.

The impact of different intensities of exercise on body weight reduction and overactive bladder symptoms- randomised trial

OBJECTIVES

to investigate the effect of a 3-month exercise programme with two different intensities on the reduction of body weight and body fat percentage in overweight women with overactive bladder symptoms (OAB).

STUDY DESIGN

randomised controlled study. The sample consisted of 77 overweight women with OAB symptoms, with an average age of 26.2 years. Body mass index (BMI) measurements confirmed if women were overweight. Participants were split into two groups, as follows: Group 1 (programme with high intensity) (n = 39) and group 2 (programme with low intensity) (n = 38). For evaluation of body composition, we used Bioelectric impedance analysis with assessment of body fat percentage (BFP) and visceral fat area (VFA). OAB symptoms were evaluated using a voiding diary, an overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a Programme for Reduction of Abdominal Fat, aimed at reducing abdominal fat with elements of aerobic training, strengthening of the surface and deep abdominal muscles and stretching.

RESULTS

Group 1 lost body weight and showed a reduction in Body Fat Percentage (BFP) of more than 5%, whereas group 2 did not. Significant differences in OAB symptoms (p < 0.01) were recorded after training in favour of group 1 (number of voiding per 24 h changed from 8.92 ± 1.7 to 6.87 ± 0.40, OAB-q SS from 11.36 ± 8.57 to 1.46 ± 3.4). In the body composition assessment, significant differences (p < 0.001) were recorded after training in favour of group 1, in terms of BMI, BFP, WFA and body weight reduction.

CONCLUSION

The high intensity exercise programme for reducing abdominal fat (PRAF) significantly reduces overweight and mild symptoms of OAB after 12 weeks.

Comparison of body composition and overactive bladder symptoms in overweight female university students

OBJECTIVES

To compare body composition in young overweight women with OAB compared to women without OAB, and to determine the severity of the symptoms of OAB, as well as to investigate the impact of OAB on quality of life.

STUDY DESIGN

Cross-sectional study. The sample consisted of 1932 enrolled women classed as overweight (BMI:25-29.9).From this sample, 276 women were recruited. Of these, 206 women with an average age of 30.6 ± 20.4 years and an average BMI of 25.8 ± 3.0 were confirmed to be overweight. We used the Voiding Diary, the Overactive Bladder Questionnaire(OAB-q),and the Incontinence Quality of Life (I-QoL) scale. Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis, with assessment of: skeletal muscle mass(kg)(SMM), body fat mass (kg)(BFM), body fat percentage (%)(BFP), visceral fat area (cm²/level)(VFA), and waist to hip ratio(WHR).

RESULTS

The voiding diary and OAB-q results confirmed OAB in 102 women. There was no significant difference in BMI between groups. The body composition analysis showed significant differences in BFP, VFA, and WHR, with higher values in the OAB group(p < 0.01). SMM, however, was higher in the group without OAB(p < 0.01). Recorded I-QoL scores showed worse parameters in the OAB group(p < 0.001). Women with a body fat percentage above 32% have a 1.95 times greater chance of developing OAB. Odds ratio [OR] = 1.95,(95%CI:1.09-3.52,p < 0.02).

CONCLUSION

Body fat percentage, visceral fat area, and waist to hip ratio were significantly higher in overweight women with OAB, compared with women without OAB and a comparable BMI.

Obesity with Comorbid Stress Urinary Incontinence in Women: A Narrative Review to Inform Dietetics Practice

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.

Obesity and Pelvic Floor Disorders: A Review of the Literature

Overweight and obesity are becoming a worldwide health problem associated with numerous co-morbidities. National costs of obesity and pelvic flor disorders have been rising since the 1950s across the world. Obesity is thought to have a very strong effect on pelvic floor disorders, and, considering the high prevalence of both problems worldwide, it is of utmost importance to evaluate the association between these pathologies as well as the impact of obesity on treatment efficacy. This review is based on a selection of reports in the literature (PubMed search), including guidelines and Cochrane reviews.

Obesity seems to be a well-documented risk factor for lower urinary tract symptoms (LUTS) and is a predictor of exacerbation of stress urinary incontinence (SUI) and overactive bladder (OAB). Weight loss is also associated with improvement or resolution of SUI and OAB. In the case of pelvic organ prolapse (POP), weight loss is associated with improvement in quality of life. Although obesity is associated with POP in general, the exact role of obesity in symptomatic POP remains uncertain. While outcomes of anti-incontinence surgery among obese women are similar to those in non-obese women, postoperative urge incontinence is more likely to occur. It seems that obesity is not a risk factor for postoperative complications or short-term efficacy of POP surgical treatment. Long-term effects are still uncertain.

Obesity is a strong risk factor for LUTS, but in most cases it does not affect efficacy of operative treatment. It may be associated with some post-operative complications. Weight loss in many cases allows avoiding surgical intervention.