Association between Stress Urinary Incontinence and Depressive Symptoms after Birth: the Czech ELSPAC Study

Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis

OBJECTIVE

Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth.

DATA SOURCES

MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023.

STUDY ELIGIBILITY CRITERIA

Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included.

METHODS

Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies.

RESULTS

Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months.

CONCLUSION

This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.

Effect of stress urinary incontinence on vaginal microbial communities

BACKGROUND

Postpartum women often experience stress urinary incontinence (SUI) and vaginal microbial dysbiosis, which seriously affect women's physical and mental health. Understanding the relationship between SUI and vaginal microbiota composition may help to prevent vaginal diseases, but research on the potential association between these conditions is limited.

RESULTS

This study employed 16S rRNA gene sequencing to explore the association between SUI and vaginal dysbiosis. In terms of the vaginal microbiota, both species richness and evenness were significantly higher in the SUI group. Additionally, the results of NMDS and species composition indicated that there were differences in the composition of the vaginal microbiota between the two groups. Specifically, compared to postpartum women without SUI (Non-SUI), the relative abundance of bacteria associated with bacterial dysbiosis, such as Streptococcus, Prevotella, Dialister, and Veillonella, showed an increase, while the relative abundance of Lactobacillus decreased in SUI patients. Furthermore, the vaginal microbial co-occurrence network of SUI patients displayed higher connectivity, complexity, and clustering.

CONCLUSION

The study highlights the role of Lactobacillus in maintaining vaginal microbial homeostasis. It found a correlation between SUI and vaginal microbiota, indicating an increased risk of vaginal dysbiosis. The findings could enhance our understanding of the relationship between SUI and vaginal dysbiosis in postpartum women, providing valuable insights for preventing bacterial vaginal diseases and improving women's health.

Associations of pelvic floor dysfunction and postnatal mental health: a systematic review

BACKGROUND

Postpartum mental health conditions are common and can have devastating effects for both mother and infant. Adverse birth outcomes increase the risk of postnatal mental health conditions. Pelvic floor dysfunction (PFD) is a common adverse pregnancy outcome that may be a risk factor for postnatal mental health conditions. There are many studies reporting associations between PFD and postnatal mental health conditions, but no reports have synthesised the current literature as it relates to pregnancy and the postpartum period.

METHODS

A research librarian conducted systematic literature searches using terms concerning PFD, postnatal mental health conditions, and pregnancy. Searches were conducted within PubMed, Embase, CINAHL, Cochrane, and Scopus. Two reviewers independently rated each study for inclusion and study quality. No studies were excluded based on quality.

RESULTS

A total of 47 studies were included for review. Articles addressed sexual dysfunction (n = 11), incontinence (n = 21), perineal laceration (n = 13), pelvic organ prolapse (n = 2), and general pelvic floor symptoms (n = 2) and associations with postnatal mental health conditions. Two articles addressed more than one type of PFD. The majority (44 studies) reported associations between PFD and adverse postnatal mental health conditions.

DISCUSSION

Most studies included for review found consistent associations between PFD and adverse mental health conditions. Healthcare providers should screen for PFD and postnatal mental health conditions early in the postpartum period. Future research should investigate whether the treatment of PFD can modify the associations between PFD and postnatal mental health conditions.

Influence of Stress Urinary Incontinence and Pelvic Organ Prolapse on Depression, Anxiety, and Insomnia-A Comparative Observational Study

BACKGROUND

Among pelvic floor disorders (PFDs), overactive bladder is a well-recognized condition affecting mental health. The aim of this study was to assess whether there is a correlation between stress urinary incontinence (SUI), pelvic organ prolapse (POP), and mental health in comparison to control subjects and whether objective or subjective aspects of diseases are responsible for the aforementioned symptoms.

METHODS

192 patients with SUI, 271 with symptomatic prolapse (>2 in the POPQ scale), and 199 controls without pelvic floor disorders were included in this study. Patients completed questionnaires assessing levels of depression, anxiety, and insomnia. The 1-h pad test and IIQ-7 questionnaires were collected in SUI. The pelvic organ prolapse quantification scale and the POPDI6, UDI6, and CRADI-8 questionnaires were used in POP patients.

RESULTS

Higher scores in psychiatric scales were observed in SUI (p < 0.05) and POP (p < 0.05) compared to control. There were no correlations between the objective severity of PFDs and psychological symptoms, while subjective complaints correlated with psychological health. In conclusion, we showed that subjective perceptions of SUI and POP are factors that augment psychiatric symptoms, while objective severity is not correlated with mental status.

CONCLUSIONS

Our findings suggest that patients with PFDs necessitate multidisciplinary attention, including psychiatric care.

Psychosocial Factors Associated with Lower Urinary Tract Symptoms One Year Postpartum

Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04-1.11) and perceived stress (AOR 1.12, 95% CI 1.04-1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88-0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98-0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95-0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.

Effect of pilates performed during pregnancy on postpartum stress urinary incontinence in primipara women

INTRODUCTION

Stress urinary incontinence (SUI) constitutes the majority of urinary incontinence (UI) cases that occur due to anatomical and physiological changes during pregnancy and postpartum period. The objcetive of this study was to evaluate the effect of pilates in preventing the occurrence of SUI in the postpartum period.

METHODS

A retrospective case-control study was conducted in a private hospital. Participants consisted of patients who gave birth vaginally at the hospital and were admitted to the hospital for routine control at the postpartum 12th week. The women did pilates for two days a week from the 12th week of pregnancy until the birth were included in the case group. The women did not do pilates in the control group. Data was collected using the "Michigan Incontinence Symptom Index". To detect the presence of SUI, researchers asked women "Do you have urinary incontinence problems in your daily life?". STROBE research check-list was used for reporting the study.

RESULTS

The study was completed with a total of 142 women consisting of 71 women in each group. Of the women, postpartum SUI occurred in 39.4%. The severity score of women who did pilates were found to be statistically significantly lower than those who did not do pilates.

CONCLUSION

During pregnancy, women should be encouraged to do pilates about the prenatal period by health professionals.

Impact of Urinary Incontinence on Postpartum Sexual Function

OBJECTIVE

The aim of the study is to evaluate the incidence of urinary incontinence (UI) and its impact on sexual function among women within 3 years of delivery.

METHODS

This was a cross-sectional study of 531 participants who gave birth by any method in the past 3 years. Participants were administered the Edinburgh Depression Screening Questionnaire, Generalized Anxiety Disorder-7 questionnaire, the Overactive Bladder Symptom Score questionnaire, Incontinence Impact Questionnaire, Sexual Function Questionnaire's Medical Impact Scale, and Decreased Sexual Desire Screener. The primary outcome of interest was the report of any sexual dysfunction and urinary symptoms.

RESULTS

There were 531 total participants of 600 who completed the survey in its entirety. The mean age of the cohort was 29.6 ± 7.1 years, the majority were non-Hispanic White (76.6%). It was found that 55% of the women (n = 292) reported postpartum UI (73% [n = 213] stress incontinence, 26.7% [n = 78] urgency incontinence, and 0.003% [n = 1] mixed incontinence). Sexual dysfunction was more likely to be reported in participants with UI compared with those without UI (34.2% vs 17.8%, P < 0.001). Urinary incontinence was found to be associated with any form of sexual dysfunction after adjustment for confounders (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.07-2.14). Additional variables that were correlated with sexual dysfunction were perceived difficulty healing after any delivery injury (aOR, 4.79; 95% CI, 1.11-20.72), current breastfeeding (aOR, 3.29; 95% CI, 1.26-8.59), and an increasing Generalized Anxiety Disorder-7 score (aOR, 1.10 per 1-point increase; 95% CI, 1.05-1.15).

CONCLUSION

Urinary incontinence is independently associated with sexual dysfunction and should be systematically evaluated during postpartum care.

The effect of acupuncture on postpartum stress urinary incontinence: A protocol for systemic review and meta-analysis

BACKGROUND

Postpartum stress urinary incontinence (PSUI) is a widespread complaint in postpartum women, which significantly affects their quality of life. Acupuncture has been widely used as an alternative complementary therapy for the treatment of PSUI. This protocol is carried out to comprehensively explore the effectiveness and safety of acupuncture for treating PSUI.

METHODS

Randomized clinical trials related to acupuncture treatment of PSUI will be searched in Chinese and English literature databases: PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, and the Technology Periodical Database. Changes in pelvic floor muscle strength compared with baseline will be accepted as the primary outcomes, and secondary outcomes will be the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score, the urodynamic indexes, the incontinence quality of life questionnaire, and adverse effects of acupuncture. All publications will be screened and extracted by 2 reviewers independently. Quality of the eligible publications will be assessed according to the Cochrane Risk of Bias tool and statistical analyses will be conducted by using the Review Manager V.5.3.

RESULTS

This study will provide a high-quality comprehensive evaluation for the clinical efficacy and safety of acupuncture for PSUI.

CONCLUSION

This systematic review will provide comprehensive evidence of acupuncture treatment on specific outcomes for PSUI.

ETHICS AND DISSEMINATION

Because of the study will not collect personal information, ethical approval will not be required. The results will be published in a peer-reviewed journal.

TRIAL REGISTRATION

INPLASY 202220045.

A nomogram model predicting the risk of postpartum stress urinary incontinence in primiparas: A multicenter study

Stress urinary incontinence (SUI) is a common gynecological urinary system disease, and globally, 200 million or more people suffer from it. However, the existing literature mostly focuses on postpartum urinary incontinence (UI) or UI in middle-aged and elderly people, with little focus on primiparas. To analyse urinary incontinence prevalence and its risk factors in primiparas and establish a nomogram prediction model, 360 parturients were recruited from three hospitals between April and September 2021. A homemade electronic questionnaire was used to investigate the general demographic and perinatal characteristics of primiparas. The SUI was diagnosed by the physicians. Logistic regression analysis of independent risk factors for SUI and a nomogram prediction model were established. Ninety people were diagnosed as SUI. The number of pregnancies (OR = 3.322, 95% CI = 1.473-7.492), residence (OR = 5.451, 95% CI = 2.725-10.903), occupation (OR = 3.393, 95% CI = 1.144-10.064), education level (OR = 3.551, 95% CI = 1.223-10.308), delivery method (OR = 10.270, 95% CI = 4.090-25.789), and oxytocin use (OR = 2.166, 95% CI = 1.142-4.109) were independent risk factors for SUI. The C-index of the nomogram prediction model was 0.798 (95% CI = 0.749-0.846). The POPDI score, CRADI score, UDI score, and PFDI scores of women with SUI were significantly higher than those of non-SUI women, while I-QOL scores were significantly lower than those of non-SUI women. In conclusion, the prevalence of SUI among primiparas in Fuyang, China, was 25.00%, which exhibited a large impact on the quality of life of puerperae. The present study successfully established an individualized nomogram prediction model of SUI for primiparas with good discrimination and diagnostic efficiency, which was helpful for the early clinical identification of high-risk primiparas with SUI.

Is there an association between parity and urinary incontinence in women during pregnancy and the first year postpartum?: A systematic review and meta-analysis

AIMS

To systematically review the literature on possible associations between parity and urinary incontinence (UI) during pregnancy and in the first year postpartum.

METHODS

We searched the databases Pubmed, CINAHL, Embase, the Cochrane Library, PsycINFO, MIDIRS, ClinicalTrials.gov (inception-18 April 2020). One reviewer screened all titles. Two reviewers independently selected studies by abstract and full text. Risk of bias was assessed using the Quality In Prognosis Studies tool. Findings were synthesised in meta-analysis or narratively. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group approach adopted for prognostic studies.

RESULTS

We identified 16 643 records and 39 were included. Thirty studies examined UI during pregnancy and 12 examined UI postpartum. Multiparity was associated with UI at any point in the last pregnancy (odds ratio [OR]: 1.59 [1.26-2.00], 5 studies, 1565 participants) and in the third trimester when measured by ICIQ-SF (OR: 2.67 [1.53-4.67], 4 studies, 1150 participants), but not when studies measured the UI point prevalence (OR: 2.48 [0.91-6.79], 4 studies, 52 976 participants), or if they measured the prevalence at one point in any trimester (OR: 1.09 (0.60-1.95), 3 studies, 872 participants). At 3 months postpartum, UI was associated with multiparity (OR: 2.03 [1.35-3.06], 4 studies, 6781 participants).

CONCLUSIONS

Increased parity was associated with UI in the first year postpartum, but studies on UI during pregnancy had conflicting results. The evidence was (very) uncertain. Future studies should use comparable definitions and further explore UI sub-types.

Urinary incontinence and the association with depression, stress, and self-esteem in older Korean Women

The objectives were to investigate the prevalence of urinary incontinence (UI) and its relationships with depression, stress, and self-esteem in older Korean women from the Korean Study of Women's Health Related Issues (K-Stori), a nationally representative cross-sectional survey. A total of 3000 women between 65 and 79 years were the final study subjects. We applied multiple linear regression models to analyze associations with depression, stress, and self-esteem levels in relation to UI types. Types of urinary incontinence included stress, urge, and mixed UI. UI affects at least one in two older Korean women (52.2%). The prevalences of SUI, UUI, and MUI were 45.7%, 39.6%, and 33.1%, respectively. UI was found to be adversely associated with depression, stress, and self-esteem: women with UI reported significantly higher levels of depression and stress and lower levels of self-esteem than those without UI. Women with MUI reported significantly greater impairment than the women with SUI or UUI. Our results provide an evidence base for the evaluation of mental health in older women with incontinence. The prioritization of UI detection and the identification of psychological factors may help improve the diagnosis and management of UI and potentially yield significant economic and psychosocial benefits.