A Preliminary Study on Balance Performance and Fall Status in Older Women With Urinary Incontinence

Hip dysfunction-related urinary incontinence and total hip arthroplasty with the direct lateral approach

OBJECTIVES

There is a functional relationship between the hip joint and the pelvic floor muscles. In patients with secondary osteoarthritis of the hip, urinary incontinence is also seen. Research has shown that total hip arthroplasty (THA) surgery improves the symptoms of urinary incontinence. This prospective cross-sectional study without a control group was performed on THA candidates with urinary incontinence and secondary osteoarthritis with the aim of investigating the effect of THA with a direct lateral approach and subsequent routine physiotherapy on the symptoms of urinary incontinence.

METHODS

Sampling was performed using a simple method among those referred to orthopedic clinics in the private sector. Data were collected in all patients before and 3 months after THA using demographic, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and hip range of motion record tables. The results are presented as mean with standard deviation.

RESULTS

In this study, 16 men with a mean age of 76.75 years (±4.65) and 8 women with a mean age of 72.75 years (±7.32) participated. Before THA, stress urinary incontinence (54.16%) and urgency urinary incontinence (20.83%) had the highest frequency. However, after THA, the frequency of stress and urgency urinary incontinence decreased (16.66% and 8.33%, respectively). According to the results of the ICIQ, complete improvement of urinary incontinence symptoms was observed in up to 62.5% of the subjects. After THA, there was a significant difference between the mean total score obtained from the WOMAC questionnaire compared to before surgery. There was a significant improvement in the range of motion of the hip joint in all directions.

CONCLUSIONS

THA and routine hip physiotherapy in patients with urinary incontinence and secondary hip osteoarthritis have a significant positive effect on improving symptoms of urinary incontinence and hip function. In addition, it significantly improves the ICIQ and WOMAC questionnaire scores.

Controle postural estático e risco de quedas em mulheres idosas com e sem incontinência urinária

RESUMO A incontinência urinária (IU) está associada à ocorrência de quedas em idosos e pode ter relação com déficits no controle postural. O objetivo deste trabalho é comparar o controle postural estático, na condição de olhos abertos e fechados, e o risco de quedas entre idosas com IU e idosas sem IU. A amostra foi dividida em dois grupos: idosas com IU (n=21, idade=65,33±4,57 anos) e idosas sem IU (n=19, idade=66,37±5,26 anos). As características da perda urinária do grupo com IU foram avaliadas por meio do International Consultation on Incontinence Questionnaire: Short Form (ICIQ-SF). O controle postural estático dos grupos foi mensurado pelo deslocamento do centro de pressão (COP) por meio de uma plataforma de força; e o risco de quedas foi avaliado pelo teste timed up and go. Para a análise estatística, foi utilizado o teste U de Mann-Whitney e o teste qui-quadrado. A maioria das participantes com IU perdiam urina em pequena quantidade e todas perdiam em baixa frequência. Não foi observada diferença entre os grupos em relação às variáveis do COP (p>0,05) e o risco de quedas (p=0,082). Entretanto, na análise intragrupos, houve diferença na velocidade do COP de ambos os grupos na comparação olhos abertos versus olhos fechados (p<0,05). Não houve diferença no controle postural estático e no risco de quedas entre idosas com e sem IU.

The association between lower urinary tract symptoms and falls: Forming a theoretical model for a research agenda

BACKGROUND

There is a well-recognised association between falls and lower urinary tract symptoms (LUTS) in older adults, with estimates of odd ratios for falls in the presence of LUTS ranging between 1.5 and 2.3. Falls and LUTS are both highly prevalent among older people and both are markers of frailty, with significant associated morbidity, mortality, and healthcare resource cost. This association is not well examined or explained in the literature.

AIMS

We aimed to outline current knowledge of the association between falls and lower urinary tract symptoms and suggest a research program to further investigate this.

MATERIALS AND METHODS

A consensus conference of experts in the field was convened to review the current literature and brainstorm potential future investigative avenues.

RESULTS AND DISCUSSION

Despite the recognition of this association, there has been little research to examine its potential causes, and no intervention trial has established if reducing LUTS or urinary incontinence can reduce the risk of falls. The commonly held assumption that urgency causes falls through rushing to the toilet is likely incorrect. Falls and LUTS are both symptoms of frailty and have many common causes. Gait, balance, and continence are all processes requiring cognitive input, and the concept of dual tasking may be a further link.

CONCLUSION

The significant association between lower urinary tract symptoms and falls is currently unexplained, and further research into the potential causes of this association is needed.