Characterizing the Functional Decline of Older Women With Incident Urinary Incontinence

Weight-adjusted-waist index is positively associated with urinary incontinence: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018

BACKGROUND

Urinary incontinence (UI) is closely related to obesity. The aim of this study is to evaluate the association of a novel anthropometric indicator weight-adjusted-waist index (WWI) with UI.

METHODS

This cross-sectional study used the data from National Health and Nutrition Examination Survey (NHANES) 2001-2018. Weighted multivariable logistic regression was used to evaluate the relationship between WWI and three types of UI [stress UI (SUI), urgency UI (UUI), and mixed UI (MUI)]. The receiver operating characteristic (ROC) curve and Delong et al.'s test were utilized for comparison of the predictive capability for UI between WWI and body mass index (BMI), waist circumference (WC).

RESULTS

A total of 41,614 participants were included in this study, of whom 23.57% had SUI, 19.24% had UUI, and 9.43% had MUI. In the fully adjusted model, WWI was positively associated with three types of UI [SUI: odds ratio (OR) = 1.19, 95%Confidence interval (CI) 1.13-1.25; UUI: OR = 1.18, 95%CI 1.13-1.24; MUI: OR = 1.19, 95%CI 1.11-1.27, all p < 0.001]. Compared to the lowest WWI interval, the positive correlation between WWI and UI still existed in the highest WWI group after converting WWI to a categorical variable by quartiles (SUI: OR = 1.52, 95%CI 1.35-1.71, p < 0.001; UUI: OR = 1.50, 95%CI 1.33-1.69, p < 0.001; MUI: OR = 1.55, 95%CI 1.32-1.83, p < 0.001). WWI had a stronger prediction for three types of UI than BMI and WC (all p < 0.001).

CONCLUSION

A higher WWI was linked with an increased likelihood of three types of UI (SUI, UUI, and MUI) in the United State population. Compared to BMI and WC, WWI had a stronger predictive power for UI. WWI may be a better adiposity parameter for evaluating UI.

Urinary incontinence in middle-aged and older women with hip and knee osteoarthritis: An outpatient study of frequency and risk factors

AIMS

To investigate the frequency and the factors associated with urinary incontinence (UI) in a sample of middle-aged and older women with lower limb osteoarthritis (OA).

METHODS

Women aged 50 years or older with clinical hip/knee OA diagnoses were recruited for this cross-sectional study. Self-reported UI and type, sociodemographic characteristics, medical conditions, physical activity level, anthropometric and body composition measurements, muscle strength, and physical function were assessed. Uni and multivariable logistic regression were used to investigate the factors associated with UI.

RESULTS

Among 100 middle-aged and older women (mean 67.27 ± 8.77 SD years), 67% reported UI. In the UI group, 33% reported stress UI, 36% reported urgency UI, and 31% reported mixed UI. In the univariate analysis, age, level of physical activity, pulmonary disease, number of medications, body mass index (BMI), number of deliveries, and activity limitation were significantly associated with UI. In the multivariable analysis, older age (60-69 years OR: 4.91, 95% CI: 1.25-19.36; ≥70 years OR: 8.06, 95% CI: 1.96-33.22), compared to 50-59 years, morbid obesity (OR: 14.10, 95% CI: 1.36-146.48), compared to BMI < 30 kg/m2 , and activity limitation (OR: 5.31, 95% CI: 1.61-17.54), assessed as short physical performance battery ≤8, remained significantly associated with UI.

CONCLUSIONS

UI was highly frequent among middle-aged and older women with hip/knee OA. Older age, activity limitation, and morbid obesity were independently associated with UI. Interventions targeting physical function and weight management must be considered to prevent and treat UI in this population.

Prevalence of urinary incontinence and associated factors in nursing homes: a multicentre cross-sectional study

BACKGROUND

Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents.

OBJECTIVES

To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI.

DESIGN AND SETTING

Cross-sectional study in 5 NHs conducted from January to March 2020.

METHODS

We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed.

RESULTS

We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a p-value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44, p =.003), anticholinergic activity (OR = 3.50, p =.004) and risk of sarcopenia using SARC-F (OR = 2.75, p =.041) were associated with UI.

CONCLUSIONS

The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia.

Reducing Falls in Older Women with Urinary Incontinence

Urinary incontinence is common in older women and doubles the risk of falls in this population. The association between urinary incontinence, especially urgency urinary incontinence, and falls is multifactorial and likely the result of a complex interaction between physical, mental, social, and environmental factors. As a result of this multifactorial etiology and based on existing evidence, the integration of different fall prevention strategies including strength and resistance exercises, bladder training, and home hazard reduction have the potential to decrease the risk of falls in older women with urinary incontinence. Given the prevalence of urinary incontinence and the significant morbidity associated with falls, effective interventions to reduce fall risk in older women with urinary incontinence is of high public health significance.

Association between calf circumference and incontinence in Chinese elderly

BACKGROUND

The objective of this study was to analyze the association between calf circumference and incontinence in Chinese elderly, and to find out the maximal cut-off point by gender for the use of calf circumference in screening for incontinence.

METHODS

In this study, participants were from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The maximal calf circumference cut-off point and other incontinence-related risk factors were explored using receiver operating characteristic (ROC) curves and logistic regression analysis.

RESULTS

The study included 14,989 elderly people (6,516 males and 8,473 females) over 60. The prevalence of incontinence in elderly males was 5.23% (341/6,516), significantly lower than females, which was 8.31% (704/8,473) (p < 0.001). There was no correlation between calf circumference < 34 cm in males and < 33 cm in females and incontinence after adjusting the confounders. We further stratified by gender to predict incontinence in elderly based on the Youden index of ROC curves. We found the association between calf circumference and incontinence was the strongest when the cut-off points were < 28.5 cm for males and < 26.5 cm for females, with an odds rate (OR) value of 1.620 (male, 95%CI: 1.197-2.288) and 1.292 (female, 95%CI: 1.044-1.600) after adjusting the covariates, respectively.

CONCLUSIONS

Our study suggests that calf circumference < 28.5 cm in males and < 26.5 cm in females is a risk factor for incontinence in the Chinese elderly population. Calf circumference should be measured in routine physical examination, and timely interventions should be made to reduce the risk of incontinence in subjects with calf circumference less than the threshold.

Mediating role of functional limitations in the association of urinary incontinence with depressive symptoms among middle-aged and older adults: The English Longitudinal Study of Aging

OBJECTIVE

To investigate the association of urinary incontinence with depressive symptoms, and to explore the mediating effect of functional limitations on this association.

METHODS

This cross-sectional study included 7039 adults aged 50 and over from the English Longitudinal Study of Aging (Wave 8). Urinary incontinence was defined as whether the participants experienced urinary incontinence in the past 12 months. Depressive symptoms were assessed based on the Center for Epidemiologic Studies-Depression Scale. Functional limitations included disability of activities of daily living, instrumental activities of daily living, mobility and large muscle groups limitation of the participants. Logistic regression based on Karlson/Holm/Breen (KHB) method was applied to estimate the association of urinary incontinence with depressive symptoms and explore the mediating effect of functional limitations.

RESULTS

Urinary incontinence was significantly associated with increased risk of depressive symptoms after controlling covariates (odds ratio = 1.75, 95 % confidence interval: 1.45-2.11). Functional limitations explained 36.96 % of this association.

CONCLUSION

Urinary incontinence might be associated with an increased risk of depressive symptoms among middle-aged and older adults and functional limitations partially mediate this association. Improving physically functional capacity might play an important role in preventing and managing depressive symptoms in elderly people with urinary incontinence.

Examining the Role of Nonsurgical Therapy in the Treatment of Geriatric Urinary Incontinence

OBJECTIVE

To examine the role of physical function impairments on the change in urinary incontinence (UI) symptoms after pelvic floor muscle training in older women.

METHODS

This is a prospective cohort study of 70 community-dwelling participants, older than age 70 years, with at least moderate incontinence symptoms. A comprehensive pelvic floor and physical function assessment was done at baseline. Individualized pelvic floor muscle training prescriptions with behavioral management strategies to reduce incontinence episodes were provided for 12 weeks. Baseline physical function was determined using the SPPB (Short Physical Performance Battery). A total score of 9 or lower out of 12 indicated impaired physical function, and scores higher than 9 indicated normal physical function. A 3-day bladder diary established daily incontinence episodes. The between-group difference in the change in number of UI episodes, from baseline to 6 weeks, was our primary outcome. Descriptive analyses compared important demographic and clinical characteristics. Longitudinal mixed model linear regression analyses determined the change in incontinence episodes and estimates of improvement based on the presence of impaired physical function and adjusted for age, race, and body mass index (BMI).

RESULTS

Participants' mean±SD age was 76.9±5.4 years, and 15.7% identified as African American, with no significant differences in age or race between groups. Participants with impaired physical function had higher mean±SD BMI (33.6±14.5 vs 27.4±5.8; P=.03) and more baseline incontinence episodes (4.5±2.9 vs 2.7±2.1 episodes per day; P=.005) than in women without functional impairment. After 6 weeks of pelvic floor exercises, the change in number of incontinence episodes per day was not different between participants with physical functional impairment compared with women with normal physical function (mean [95% CI] -1.2 [-2.0 to -0.5] vs -0.4 [-1.1 to 0.3], P=.31). Overall, after 12 weeks of pelvic floor muscle training, complete satisfaction with incontinence symptom improvement was low for both groups (41.8% with physical function impairments vs 44.8% with normal physical function; P=.90).

CONCLUSION

Behavioral therapy including pelvic floor muscle training may not significantly decrease UI symptoms to a degree that is satisfactory in women who are older than 70 years and are seeking treatment for UI, regardless of the presence of physical function impairments.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT03057834.

Effect of vitamin D supplementation on urinary incontinence in older women: ancillary findings from a randomized trial

BACKGROUND

Observational studies among older women have associated vitamin D insufficiency with a greater prevalence and incidence of urinary incontinence. However, little is known about the effect of vitamin D supplementation in reducing urinary incontinence.

OBJECTIVE

This study aimed to evaluate the effects of vitamin D supplementation in reducing the frequency of urinary incontinence in older women.

STUDY DESIGN

We conducted an ancillary study of women aged ≥55 years in the Vitamin D and Omega-3 Trial, a randomized trial with a 2×2 factorial design. Recruitment of participants started from 2011 to 2014 across 50 US states, and the follow-up of participants ended in January 2018. Randomized treatments in the parent study included (1) vitamin D₃ (cholecalciferol) at a dosage of 2000 IU/d, (2) marine omega-3 fatty acids at a dosage of 1 g/d, and (3) matching placebo. Here, we analyzed women according to their randomization to vitamin D supplementation or placebo, regardless of treatment with omega-3 fatty acid supplementation. Validated frequency of urinary incontinence questions were added in year 2 of the study and were used again in year 5 at the end of trial. Prespecified ancillary outcomes included the prevalence of urinary incontinence at years 2 and 5, along with incident incontinence and progression of incontinence (from lower to higher frequency) from year 2 to year 5. Preplanned subgroup analyses examined the following outcomes: prerandomization of low serum levels of vitamin D (serum 25-hydroxyvitamin D<20 ng/mL), incontinence types, weight categories, and African American race.

RESULTS

Among the randomized women who provided urinary incontinence data, 11,646 women at year 2 and 10,527 women at year 5, the mean age was 70 years at year 2, with 29% racial and ethnic minorities. The prevalence of urinary incontinence that occurred at least weekly was 29% at year 2 and increased to 37% at year 5. Vitamin D supplementation compared to with placebo was not associated with lower odds of urinary incontinence occurring at least weekly at year 2 (odds ratio, 1.08; 95% confidence interval, 0.99-1.19) or year 5 (odds ratio, 1.04; 95% confidence interval, 0.94-1.15). Vitamin D supplementation compared to placebo was not associated with lower incidence or progression of urinary incontinence from year 2 to year 5: incidence (odds ratio, 1.06; 95% confidence interval, 0.83-1.35) or progression (odds ratio, 0.94; 95% confidence interval, 0.82-1.08). Women with prerandomization of low serum levels of vitamin D (n=836) did not have lower odds of the prevalence, incidence, or progression of urinary incontinence. The findings were null in subgroups according to incontinence type, women with obesity, and African American women. Only women with healthy weight randomized to vitamin D had lower odds of progression of urinary incontinence (odds ratio, 0.78; 95% confidence interval, 0.63-0.95; P=.01).

CONCLUSION

Vitamin D supplementation compared to placebo for 2 to 5 years was not associated with differences in the prevalence, incidence, or progression of urinary incontinence in older women with and without adequate serum vitamin D levels, with inconsistent differences among subgroups. The findings showed that the broad use of moderate doses of vitamin D supplementation did not reduce urinary incontinence in older women.

Sarcopenia Is Associated with Fecal Incontinence in Patients with Dysphagia: Implication for Anal Sarcopenia

OBJECTIVES

To examine the relationship between sarcopenia and fecal incontinence in patients with dysphagia.

DESIGN

Cross-sectional study using the Japanese sarcopenic dysphagia database.

SETTING

19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation center.

PARTICIPANTS

460 dysphagic patients, aged 20 years and older.

MEASUREMENTS

Sarcopenia was diagnosed by the 2019 criteria of the Asian Working Group for Sarcopenia. Fecal incontinence was assessed by health care professionals at baseline according to the definition of the Japanese Practice Guidelines for Fecal Incontinence. We examined whether there was a significant difference between the rate of fecal incontinence in patients with/without sarcopenia. Age, sex, type of dwelling, Barthel index, Charlson comorbidity index (CCI), calf circumference, handgrip strength, body mass index, malnourishment, C-reactive protein level, serum albumin level, and delivery of enteral nutrition by nasogastric and/or gastrostomy tube were measured. To examine the relationship between sarcopenia and fecal incontinence, logistic regression analysis was performed with adjustments for age, sex, sarcopenia, CCI, enteral nutrition, and dwelling.

RESULTS

The mean age of patients was 81 ± 10 years. Of the 460 study patients, 404 (88%) patients had sarcopenia and 104 had fecal incontinence (23%). The rate of fecal incontinence was higher in the sarcopenia group than the non-sarcopenia group (25% vs. 7%, P = 0.003). Logistic regression analysis showed that sarcopenia was independently associated with fecal incontinence (odds ratio: 3.114, 95% confidence interval: 1.045, 9.282).

CONCLUSION

The prevalence of fecal incontinence was 23% in patients with dysphagia. Sarcopenia was independently associated with fecal incontinence, which suggests the presence of anal sarcopenia. Defecation control should be assessed in patients with sarcopenia.

Urinary Incontinence in Older Women: A Syndrome-Based Approach to Addressing Late Life Heterogeneity

Urinary incontinence is a prevalent pelvic floor disorder among women of all ages. However, in many older women, especially those who have multiple chronic conditions it may be a geriatric syndrome because of its shared characteristics of physical function impairments, cognitive decline, and mobility disability. The geriatric incontinence syndrome may represent a poorly characterized phenotype of UI among older women which in many ways reflects unhealthy aging. In this article, we explore the evidence behind these concepts together with potentiel impact on the diagnosis and management of UI in this group.

The Inflection Point Model: a Model to Explore the Hidden Burdens of Non-Cancerous Genitourinary Conditions

OBJECTIVE

To propose a conceptual model to identify points along the condition course where actions or inaction affect downstream burdens of non-cancerous genitourinary conditions (NCGUC).

MATERIALS AND METHODS

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened an interdisciplinary meeting to comprehensively consider the burdens of NCGUCs. Subsequently, the authors met monthly to conceptualize the model.

RESULTS

Inflection points (IP) describe time points during a condition course that are sensitive to change. Our proposed Inflection Point Model (IPM) helps conceptualize burden/benefit trade-offs in any related decision and provides a platform to identify the downstream aggregate burden of a NCGUC across multiple socio-ecological levels at a single time point, which may be summed across the condition course to measure cumulative burden. Two personae demonstrate the utility of this model to better understand impacts of two common NCGUCs.

CONCLUSIONS

The IPM may be applied in multiple contexts: narrowly to explore burden of a single NCGUC at a single IP; or more broadly, to address multiple conditions, multiple IPs, or multiple domains/levels of social ecology. Applying the IPM may entail combining population data describing prevalence of NCGUCs, associated behaviors, and resulting outcome patterns that can be combined with suitable mathematical models to quantify aggregate and cumulative burden. The IPM challenges stakeholders to expand from the individual to include broader levels of social ecology. Application of the IPM will undoubtedly identify data gaps and research needs that must be fulfilled to delineate and address the burden of NCGUCs.

Prevalence of sarcopenia in older women with pelvic floor dysfunction

BACKGROUND

Sarcopenia is a determinant of age-related skeletal muscle weakness. In this sense, it is believed that there may be a pathophysiological association between pelvic floor dysfunction (PFD) and sarcopenia; however, few articles investigating an association between these two pathologies have been published.

OBJECTIVES

To identify the prevalence of sarcopenia in older women with PFD and verify the association between the severity of PFD and the severity of sarcopenia.

METHODS

This cross-sectional study was undertaken in urogynaecology outpatient clinics in Fortaleza, Ceará, Brazil. Women with PFD aged ≥ 60 years were included. Women with cognitive impairments, amputations and/or limb fractures were excluded. Sociodemographic, anthropometric and PFD data were evaluated, and tests for measuring muscle strength, muscle mass and physical performance were performed.

RESULTS

In total, 217 women were included in this study; of these, 121 (55.8%) presented without sarcopenia, 71 (32.7%) presented with probable sarcopenia, 23 (10.6%) presented with confirmed sarcopenia, and two (0.9%) presented with severe sarcopenia. Regarding sarcopenia related to PFD, a higher prevalence of probable sarcopenia was observed in women with urinary incontinence (UI) (n = 55, 77.5%). Confirmed sarcopenia was more prevalent in women with pelvic organ prolapse (POP) (n = 19, 82.6%); among these cases, most women had POP of the anterior, posterior and apical compartments (n = 8, 42.1%). All the women with severe sarcopenia had UI and POP and, considering the specific types of these dysfunctions, the prevalence of severe sarcopenia was 50.0% in the women with UI and POP of the anterior and apical wall. The most severe stages of POP were associated with sarcopenia (p = 0.002).

CONCLUSION

The prevalence of sarcopenia in women with PFD was high. Healthcare providers who assist women with PFD should consider the possibility of assessing sarcopenia, especially when faced with more extensive POP in older women. The evaluation of sarcopenia may play a role in the management of women with PFD.

Serum vitamin D levels in females with urinary incontinence: a meta-analysis of observational trials

INTRODUCTION AND HYPOTHESIS

The association of vitamin D deficiency with female urinary incontinence is unclear.

METHODS

A systematic review of English and non-English articles was conducted. All observational studies in databases including PubMed, EMBASE, the Cochrane Library Trials Register, and Google Scholar were searched until 5 October 2020. Additional studies were identified by contacting clinical experts and searching the bibliographies and abstracts of the compiled articles. Search terms included urinary incontinence and vitamin D. Article data, including study quality indicators, were independently extracted by two authors using predefined data fields.

RESULTS

Two cohort studies, four case-control studies and five cross-sectional studies were included in the qualitative synthesis. Two cohort studies and one cross-sectional study, with a total of 2501 females, were included in the meta-analysis. Heterogeneity among the three studies was not observed (I2 = 0.0%, P = 0.69). All pooled analyses were based on fixed-effects models. No difference in vitamin D level was observed between the urinary incontinence group and the control group (mean difference 0.07 ng/ml; 95% confidence interval [CI] -0.57-0.72, P = 0.81, I2 = 0%).

CONCLUSIONS

Our meta-analysis revealed that adult females with urinary incontinence did not have lower serum vitamin D levels than control females.

Vitamin D Intake and Progression of Urinary Incontinence in Women

OBJECTIVE

To determine if vitamin D intake is associated with reduced progression of urgency urinary incontinence (UI) in women.

METHODS

We used the Nurses' Health Study (NHS) I and NHSII cohorts to evaluate the association of vitamin D intake with progression of urgency UI and mixed UI, from mild-moderate to severe symptoms, from 2004 to 2012 (NHS) and 2005-2013 (NHSII). Intake of vitamin D at study baseline was categorized and updated at the start of each 2-4 year follow-up period. Multivariable-adjusted relative risks (RRs) and 95% confidence intervals (95% CI) of progression to severe UI were estimated using Cox proportional hazard models.

RESULTS

At baseline, of the 20,560 older women (age range 58-73 years) in NHS I with mild/moderate urgency or mixed UI, 21% reported oral vitamin D intake of at least 800 IU per day. Among 12,573 middle-aged women (age range 42-59) in NHS II with mild/moderate urgency or mixed UI, 17% reported oral vitamin D intake of at least 800 IU daily. From 2004 to 2012, 4853 incident cases of urgency/mixed UI progression were identified among older women. From 2005 to 2013, 1378 incident cases of urgency/mixed UI progression were identified among middle-aged women. After multivariable adjustment, no significant associations between vitamin D intake and incidence of urgency/mixed UI progression were observed in either cohort (RR = 1.10, 95% CI 0.99-1.23 in older women, RR = 0.88, 95% CI 0.71, 1.10 in middle-aged women).

CONCLUSION

Despite interest in vitamin D as a low-cost strategy to prevent or reduce UI, our findings indicate oral vitamin D may not reduce urgency/mixed UI progression.

Physical performance measures in older women with urinary incontinence: pelvic floor disorder or geriatric syndrome?

Objective:

To evaluate physical performance measures of mobility and functional impairments and assess their association with urinary incontinence (UI) severity and impact on quality of life among older women with UI.

Methods:

In a cross-sectional pilot study, 20 women aged ≥ 70 years with UI completed UI questionnaires (Global Impression of Severity, Incontinence Impact Questionnaire (IIQ-7)) and functional status evaluation. Functional status evaluation included the Modified Physical Performance Test (MPPT; range 0–36), Short Physical Performance Battery (SPPB; range 0–12), and other physical performance measures (e.g., Timed Up and Go [TUG]). MPPT and SPPB scores <32 and <10, respectively, indicated impaired mobility and function. Descriptive statistics and spearman correlation coefficients evaluated study variables and associations between UI and physical performance measures.

Results:

Women were 76.6±4.7 years old with mean body mass index 33.5±9.0 kg/m². Mixed UI was the most prevalent (n=17; 85%), and 14 (70%) participants rated their UI as moderate or severe. Low MPPT (<32) and SPPB (<10) scores were present in 65% (n=13) and 35% (n=7) of participants, respectively. Lower MPPT score (r=−0.46; P=0.04) and worse TUG performance (r=0.50; P=0.03) were associated with greater UI impact on quality of life based on IIQ-7. SPPB did not correlate (P>0.05) with UI measures.

Conclusions:

Mobility and functional impairments are common among older women with UI. Associations between MPPT score, TUG performance with UI impact on quality of life suggest these physical performance measures could be markers of mobility and functional impairments in future research on UI in older women.

Further research in utility of physical performance measures as markers of mobility and functional impairments in older women with urinary incontinence is warranted.

Beneficial relevance of vitamin D concentration and urine flow rate

BACKGROUND & AIMS

Micturition dysfunction is a problem in the general population that progresses with aging in both males and females. In the past few decades, the relationship between voiding symptoms and body biochemical status has been a subject of research in several disciplines. Micronutrition is considered to affect different aspects of urinary flow, including neuroregulation, detrusor muscle function, and the structures around the bladder outlet such as the pelvic floor and prostate. Therefore, the objective of our study was to determine the correlation between urine flow rate (UFR) and 25-hydroxyvitamin D (25(OH)D) in the general healthy population.

METHODS

Our study involved 3981 adult participants over age 20 from the U.S. National Health and Nutrition Examination Survey datasets (2011-2012). The associations between UFR and serum 25(OH)D concentration were analyzed through multivariate regression models.

RESULTS

There was a significant positive association of serum 25(OH)D concentration with UFR (25(OH)D₂+25(OH)D₃: β coefficient: 0.003; 95% CI: 0.002, 0.004; p < 0.001, 25(OH)D₃; p = 0.003; epi-25(OH)D₃, p = 0.020) in an unadjusted model. The substantial associations were still observed in the gender and age subgroups. In analysis of age subgroup, the association of serum 25(OH)D concentration with urine flow rate was significant in fully adjusted model (age<60: 25(OH)D₂+25(OH)D₃: β coefficient: 0.004, p < 0.001; 25(OH)D₃: p = <0.001, epi-25(OH)D₃: p = 0.007; Age≥60: 25(OH)D₂+25(OH)D₃: β coefficient: 0.004, p = 0.002; 25(OH)D₃: p = 0.001, epi-25(OH)D₃: p = 0.001). In gender subgroup analysis, the β coefficient of 25(OH)D₂+25(OH)D₃ in male is 0.004 (p < 0.001), and in female is 0.004 (p < 0.001) in fully adjusted model. The higher quartiles of UFR tended to have higher 25(OH)D₃ levels with statistically significant in quartile-based analysis.

CONCLUSIONS

UFR was associated with increased level of total vitamin D and bioactive form vitamin D₃. Vitamin D supplements may be a simple and effective way of improving of bladder function.

Abordagem fisioterapêutica da incontinência urinária em idosos na atenção primária em saúde

RESUMO O objetivo deste estudo foi avaliar os benefícios da abordagem fisioterapêutica da IU em idosos em uma unidade básica de saúde (UBS) de Belém (PA). Trata-se de uma proposta para treinamento dos músculos do assoalho pélvico (MAP) em 10 encontros semanais com atividades progressivas. Foram incluídos idosos de ambos os sexos, e excluídos os indivíduos com prejuízo cognitivo, instabilidade hemodinâmica e mobilidade impossibilitada, além dos idosos com participação inferior a 50% dos encontros. Foi realizada avaliação por meio de dados sociodemográficos e clínicos, e da QV, por meio do King’s Health Questionaire (KHQ), que foi reaplicado ao final dos encontros. A amostra inicial contou com 10 idosos, com idade de 70,3±5,01 anos, sendo 80% do sexo feminino, 80% dos idosos relataram cirurgias pélvicas prévias, prolapsos em 3 idosos, destes, 2 eram de bexiga. Os domínios do KHQ com escores mais altos, e consequente pior QV, foram impacto da IU (54,1±24,8), percepção de saúde (43,7±11,5) e medidas de gravidade (31,2±23,8). Houve significância estatística em vários domínios da QV dos idosos submetidos a abordagem fisioterapêutica, demonstrando que, mesmo em um nível mais baixo de atenção à saúde é possível ter efeitos relevantes sobre a IU e a QV desse público.

The prevalence and risk factors for urinary incontinence among inpatients, a multicenter study from Turkey

OBJECTIVE

To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey.

METHOD

The population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. The LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI.

RESULTS

The prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients ≥65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients.

CONCLUSIONS

The factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. The factors associated with UI vary in different age groups.

Continence: Bowel and Bladder and Physical Function Decline in Women

Purpose of review

The purpose of this article is to review the various forms of incontinence, highlight their impact on older women, and to explore current literature regarding the link between physical activity, physical function, and incontinence.

Recent findings

Both urinary and fecal incontinence become more prevalent with age, and are associated with significant morbidity. In parallel, there is a well-established decline in physical function that occurs with age. Furthermore, incontinence has a bidirectional relationship with physical function decline. Given the known link between increasing physical activity and preserved physical function, there is an emerging body of literature seeking to determine whether increases in physical activity may also improve incontinence outcomes. We review some recent data on this topic.

Summary

Continence and physical function are two closely linked entities. Further research is needed to determine whether interventions that increase physical activity might result in improved continence outcomes.

Correlation between lumbar skeletal muscle size and urinary incontinence after radical prostatectomy

OBJECTIVES

Urinary incontinence is a major concern after radical prostatectomy because it can decrease quality of life. The aim of the present study was to explore the effect of preoperative skeletal muscle on urinary quality of life after robot-assisted radical prostatectomy.

METHODS

A total of 762 patients underwent robot-assisted radical prostatectomy. Longitudinal health-related quality of life was evaluated using the Expanded Prostate Cancer Index Composite instrument. The skeletal muscle area at the level of the third lumbar vertebra was assessed preoperatively by computed tomography and was standardized to height to obtain the skeletal muscle index. Reduced skeletal muscle size (RSMS) was defined as a skeletal muscle index ≤ 53 or ≤ 43 cm² /m² in patients with a body mass index (BMI) ≥25 or < 25, respectively.

RESULTS

A total of 301 patients were included in this study, of whom 91 were classified as having RSMS (30.2%). Non-RSMS patients exhibited better urinary function at 12 months (P = .012) and better urinary continence recovery at 2 weeks and 12 months (P = .033 and P = .014, respectively) after prostatectomy compared with RSMS patients. Univariate and multivariate analyses identified preoperative RSMS as a significant and independent predictor of urinary incontinence (odds ratio = 1.77, P = .028).

CONCLUSIONS

Patients with RSMS had a lower urinary quality of life compared with non-RSMS patients after robot-assisted radical prostatectomy, and RSMS, independent of age or BMI, was predictive of postoperative urinary incontinence.

Vitamin D intake and the 10-year risk of urgency urinary incontinence in women

Evidence indicates that higher serum 25-hydroxy vitamin D levels may be associated with decreased prevalence of urgency urinary incontinence (UI), but the impact of vitamin D consumption on development of urgency and mixed UI is unclear. The objective was to assess whether greater vitamin D intake was associated with decreased risk of incident urgency and mixed UI over 10 years using 2 large prospective cohorts of middle-aged and older women. We analyzed 38,101 women from the Nurses' Health Study I (NHS I) and 35,190 women from NHS II who were free of UI at baseline. We followed incident UI, defined as new UI occurring at least monthly, separately by subtype (urgency, mixed, stress UI), from 2002-2012. We categorized vitamin D intake from supplements and diet. We estimated relative risk for developing UI according to vitamin D intake using Cox-proportional hazard models with adjustment for covariates. Median vitamin D intake was 580IU in the older women in NHS I (age range 56-71 at baseline) and 487IU in middle-aged women in NHS II (age range 40-57). Among women taking ≥1000IU of vitamin D, median intake in the older women was 1252IU and 1202IU in the middle-aged women. Among the older women, we found no relation of vitamin D intake to risk of developing UI, across all UI subtypes. In multivariable-adjusted analysis for middle-aged women, the relative risk of developing mixed UI among women taking >1000IU was 0.79 (0.63, 0.99) and for urgency UI was 0.88 (0.71, 1.07), versus <200IU. Risks of developing stress UI were not related to vitamin D intake categories. Overall, we did not find a relationship between vitamin D intake and UI incidence in middle-aged and older women; however, the reported intake was moderate.

Risk factors and prevalence of urinary incontinence in mid-life Singaporean women: the Integrated Women's Health Program

INTRODUCTION AND HYPOTHESIS

The objective was to identify the prevalence and risk factors for urinary incontinence (UI) in healthy midlife Singaporean women.

METHODS

Healthy women, aged 45-69 years, were assessed for UI and sociodemographic characteristics, including ethnicity, menopausal status, parity, and body mass index (BMI). UI subtypes corresponding to stress (SUI) alone, urge (UUI) alone, mixed (MUI), and leakage (drops only) incontinence were classified using the Urinary Distress Inventory 6 (UDI-6). Risk factors were examined using Chi-squared tests, followed by sequential multivariate logistic regression to estimate adjusted odds ratios (aOR and 95% confidence intervals).

RESULTS

A total of 1,119 women (mean age 56.2 ± 5.2) completed the UDI-6. 52.3% reported any UI; MUI and SUI were the most common, each affecting 20% of women. Post-menopausal women had a lower risk (aOR 0.5 [0.3-0.9]) of SUI, but a higher risk (aOR 4.4 [1.0-19.9]) of UUI compared with premenopausal women. Higher education was negatively associated (aOR 0.3 [0.2-0.7]) with UUI, but positively associated with MUI (aOR 2.3 [1.3-4.0]). Parity (1-2 children) increased the risk of SUI (aOR 1.8 [1.0-3.1]), but reduced the risk of UUI (aOR 0.4 [0.2-0.9]). Obesity was associated with increased risk for MUI (aOR 2.2 [1.4-3.4]) and leakage (aOR 2.0 [1.0-4.1]). Malays and Indians had a higher risk of MUI, having (aOR 2.1 (1.2-3.7) and 1.7 (1.1-2.7) respectively compared with Chinese, a difference mediated by higher BMI.

CONCLUSION

Urinary incontinence is a major morbidity prevalent in healthy midlife Asian women. Post-menopausal status, education level, parity, BMI (and its link with ethnicity) are independent risk factors in this population, and should be incorporated into counseling and targeted interventions.

Vitamin D Status in Women with Pelvic Floor Disorders: A Meta-Analysis of Observational Studies

The current evidence regarding the association between vitamin D status and pelvic floor disorder (PFD) are inconclusive. This meta-analysis was aimed to summarize existing data demonstrating the association between Vitamin D status and PFD using published observational studies. All national and international databases including Web of Science, PubMed, Google Scholar, and Scopus were searched up until January 30, 2018, and related published studies retrieved for meta-analysis. The effect sizes of Vitamin D status were presented as standardized mean difference (SMD) with 95% confidence interval (CI), using random-effect models and inverse variance method. The Cochran Q statistic and I² tests were used to evaluate the heterogeneity across included studies. Seven studies with 3219 women were included our meta-analysis. There was heterogeneity existing among included studies (I² = 96.4%, P < 0.001), so a random-effect model was used. The findings of this meta-analysis revealed that the mean serum Vitamin D levels in women with PFD were significantly lower than healthy women (SMD −0.60; 95% CI, −1.06, −0.13; P = 0.01). This meta-analysis demonstrates lower levels of serum Vitamin D in women with PFD rather than healthy women. Additional prospective studies regarding the association between Vitamin D status and PFD are required to confirm our findings.

Comparing Vitamin D Supplementation Versus Placebo for Urgency Urinary Incontinence: A Pilot Study

OBJECTIVES

To estimate the efficacy of vitamin D supplementation to reduce urgency urinary incontinence (UUI) episodes.

DESIGN

Pilot, two-arm, randomized trial conducted from 2013 to 2017. Interventions were 12 weeks of weekly oral 50,000 IU vitamin D3 or placebo.

SETTING

Academic, university-based outpatient clinic.

PARTICIPANTS

Community-dwelling postmenopausal women, 50 years or older, with at least three UUI episodes on 7-day bladder diary and serum vitamin 25-hydroxyvitamin D (25[OH]D) of 30 ng/mL or less.

MEASUREMENTS

The primary efficacy estimate was the percentage change in UUI episodes. Secondary estimates included changes in other lower urinary tract symptoms, along with exploratory subgroup analysis by race/ethnicity and obesity.

RESULTS

We randomized 56 women (aged 50-84 years; mean = 60.5 ± 8.2 years), 28 to vitamin D and 28 to placebo; 51 completed treatments. Mean serum 25(OH)D at baseline (21.2 ± 5.2 and 18.2 ± 5.6, P = .30) improved to 57.9 ± 16.3 ng/mL with vitamin D3 and 21.9 ± 8.2 ng/mL with placebo (P < .001). UUI episodes per 24-hour day decreased by 43.0% with vitamin D3 compared to 27.6% with placebo (P = .22). Among black women (n = 33), UUI episodes decreased by 63.2% with vitamin D3 compared to 22.9% with placebo (P = .03). Among obese women, UUI episodes decreased by 54.1% with vitamin D compared to 32.7% with placebo (P = .29). For all women, changes in voiding frequency (P = .40), nocturia (P = .40), urgency (P = .90), incontinence severity (P = .81), and overactive bladder symptom severity (P = .47) were not different between arms.

CONCLUSIONS

Postmenopausal women with UUI and vitamin D insufficiency demonstrated a greater than 40% decrease in UUI episodes, which did not reach statistical significance compared to placebo, except in the subset of black women. The results of this pilot study support further investigation of vitamin D3 alone or in combination with other treatments for UUI, particularly for women in higher-risk subgroups. J Am Geriatr Soc 67:570-575, 2019.

Predicting continence decline in institutionalized older people: A longitudinal analysis

AIMS

To verify the incidence of urinary continence decline and the probability of maintaining urinary continence, as well as identify the prognostic factors of urinary continence decline in institutionalized older people.

METHODS

A 2-year longitudinal study (with five 6-month waves) was conducted with subjects ≥60 years old who lived in 10 nursing homes in the city of Natal-RN (Brazil). Urinary incontinence was assessed by the Minimum Data Set version 3.0. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time-dependent variables included cognitive decline, functional decline, and incidences of falls, hospitalizations, and fractures during the period. The actuarial method, the log-rank test, and Cox's regression were applied as statistical methods.

RESULTS

Among the cohort of 196 older adults, 105 (53.6%) individuals maintained the continence status during the period, 21 (10.7%) improved it at one or more assessments, and 76 (38.8%) subjects declined. The cumulative probability of maintaining continence status was 82.6% (confidence interval [CI], 95%: 76.5%-87.3%), 74.7% (CI, 95%: 67.8%-80.4%), 66.9% (CI, 95%: 59.4%-73.2%), and 49.3% (CI, 95%: 40.1%-57.9%) at 6, 12, 18, and 24 months, respectively. Predicting factors for continence decline were: disability (hazard ratio [HR] = 4.03; P < 0.001), functional decline (HR = 3.02; P = 0.001) and potentially inappropriate medication (HR = 1.84; P = 0.008).

CONCLUSIONS

The incidence of continence decline and the cumulative probability of maintaining continence status in institutionalized older adults was approximately 39% and 49%, respectively, at the 2-year follow-up. Disability and potentially inappropriate drugs at baseline and functional decline across the period predicted continence decline in this cohort.

Urinary Incontinence Is Associated With Physical Performance Decline in Community-Dwelling Older Women: Results From the International Mobility in Aging Study

Objective: The objective of this study is to evaluate the influence of urinary incontinence (UI) on physical performance. Method: In prospective analyses from the International Mobility in Aging Study (IMIAS), 915 women (65-74 years) from Canada, Colombia, Albania, and Brazil were evaluated in relation to self-reported UI (past week) and physical performance (Short Physical Performance Battery [SPPB]), with reevaluation after 2 years. Linear mixed models examined the influence of UI on SPPB, adjusted by covariates (age, study site, education, income sufficiency, body mass index [BMI] and parity). Results: Women reporting some UI presented lower SPPB mean (β = -0.41, p = .009) and a greater reduction (β = -0.53, p = .001) over 2 years than those reporting no UI. Discussion: Compared with no reported UI, some UI was associated with worse and more pronounced declines in physical performance over 2 years. This study highlights the importance of practices to reduce UI to contribute to healthier aging.

Vitamin D Deficiency and Lower Urinary Tract Symptoms in Women

OBJECTIVE

The association of vitamin D deficiency and pelvic floor dysfunction has been examined by numerous studies. Lower urinary tract symptoms (LUTS) associated with bladder filling and voiding functions are common in both sexes. A recent study reports a higher incidence of LTUS in men over 50 years old with vitamin D deficiency. The aim of the study is to investigate whether there is a difference in the Lower Urinary Tract Symptoms frequency between women with vitamin D deficiency and the control group or not.

STUDY DESIGN

In this case control study, a total of 150 women who had a measured vitamin D level within a month were divided into two groups, one with a serum vitamin D deficiency and the other with a normal vitamin D level. Both groups were evaluated in terms of menopausal status, numbers of pregnancy and delivery, pelvic examination findings, pelvic floor muscle strength, level of pelvic organ prolapse, LUTS scores, and the findings were recorded. Both groups were compared for the presence of lower urinary system symptoms. The BFLUTS validated for Turkish-speaking populations was used to assess lower urinary system symptoms. Statistical analyses were performed via IBM SPSS Statistics 23.0. The results were considered significant at p < 0.05 and a confidence interval of 95%.

RESULTS

Vitamin D deficiency was detected in 67.3% of the participants. No significant differences were found between the groups regarding variables that could affect lower urinary system symptoms such as menopausal status, presence of pelvic organ prolapse and neonatal weight (fetal macrosomia) The Pelvic Floor Muscle Strength was significantly lower in the group with vitamin D deficiency than the control group. BFLUTS scores of premenopausal women with vitamin D deficiency were found to be similar to the control group, likewise no significant differences in the BFLUTS scores were detected in postmenopausal women.

CONCLUSION

Although vitamin D deficiency causes a significant reduction in pelvic floor muscle strength, no significant correlation was found between lower urinary tract symptoms and vitamin D deficiency. There is a necessity of prospective randomized controlled trials to investigate the relationship between vitamin D deficiency and pelvic floor functions.