Urinary incontinence in pregnant women and its impact on health-related quality of life

Experiences of digital physiotherapy during pregnancy and after childbirth: A qualitative study

Background

Pelvic girdle pain, low back pain, and pelvic floor dysfunction can affect women's mobility, quality of life, and well-being during pregnancy and the postpartum period. Digital interventions for treating perinatal depression and lifestyle changes have been studied. Research on digital physiotherapy for musculoskeletal issues related to pregnancy and the postpartum period is sparse.

Methods

This qualitative study involved in-depth, semi-structured interviews with 19 participants, of whom six were pregnant and 13 had given birth. Participants were recruited from a private clinic in Sweden through convenience sampling and had received digital physiotherapy prior to the interviews. An interview guide with questions exploring participants' experiences of digital physiotherapy, including its impact on musculoskeletal issues and daily life, and their motivation for seeking digital healthcare was used. Data were analyzed using a qualitative content analysis with an inductive approach.

Results

The analysis resulted in two main categories: Finding a new way into physiotherapy treatment and Personalized progress through tailored physiotherapy. These main categories encompassed four generic categories: Convenience and dissatisfaction motivators for digital physiotherapy, A dual experience - appreciated but not always comprehensive, Being involved in the rehabilitation process, and Perceived physical and mental improvements after digital physiotherapy.

Conclusion

Digital physiotherapy was well-accepted and perceived as beneficial for managing musculoskeletal symptoms during pregnancy and after childbirth. High accessibility and flexibility were considered advantages. However, inability to undergo a physical assessment was a challenge. Digital physiotherapy may be recommended as a complement to usual care, particularly for women with limited access to a physiotherapist specialized in women's health. Future studies exploring digital physiotherapy's efficacy for musculoskeletal issues during pregnancy and after childbirth are highly recommended.

Prevalence of urinary incontinence and associated factors, its impact on quality of life among pregnant women attending antenatal care at Asella teaching and referral hospital

BACKGROUND

Urinary incontinence (UI) is defined as any involuntary leakage of urine. UI during pregnancy is a common health problem worldwide with prevalence ranging from 11.4 to 84.5%. In Ethiopia there has been limited research conducted on UI among pregnant women. The purpose of this study was to investigate the prevalence of UI, factors associated with UI and the impact on quality of life in pregnant women.

METHOD

Cross-sectional study was conducted from December 1, 2022 to April 30, 2023. A total of 279 pregnant women attending Antenatal care were included. Data was entered into Epi-data version 3.1 and then exported to SPSS version 26 for cleaning and analysis. Chi-square test and logistic regression were done to look for factors associated with UI. We used 95% confidence interval of crude and adjusted odds ratios for analysis. Those variables with P-value < 0.05 were declared to be statistically significant.

RESULT

Overall prevalence of UI was 18.6% (n = 52). Prevalence of each type of UI during pregnancy was 9.3% for Stress UI, 5% for Urge UI and 4.3% for mixed UI. Of all participants having UI, 2(3.8%) were having UI prior to pregnancy, while 3(5.8%), 16(30.7%) and 31(59.6) have encountered during first, second and third trimester respectively. Three fourth of the participants 38(73.1%) doesn't seek treatment for their UI. Presence of history of UI [AOR = 38.1, 95%CI: (7.95, 182.75)], previous history of instrumental delivery [AOR = 7.4, 95%CI: (3.05, 18.04)] and history of alcohol intake [AOR = 17.0, 95%CI: (1.49, 194.41)] were found to be significantly associated with UI while moderate severity UI [AOR = 12.9, 95%CI (1.46, 113.28)] and severe UI [AOR = 27, 95%CI (1.98, 138.38)] were significantly associated with Poor quality of life at p-value of < 0.05. Based on severity score UI was moderate in 34 (65.4%) and severe in 8 (15.4%) of the participants.

CONCLUSION

UI affects one fifth of pregnant women (18.6%) and Stress UI is the most common type of UI during pregnancy. Previous history of UI, instrumental delivery and alcohol intake were found to be risk factors for UI. Pregnant women have to be advised to avoid or reduce alcohol consumption and to seek treatment for their problem. Follow up throughout pregnancy and postpartum period is very important to plan for further management of UI.

Continence App® Impact on Puerperal Women's Knowledge, Attitude and Practice: Randomized Clinical Trial

INTRODUCTION AND HYPOTHESIS

Enhancing women's knowledge, attitude, and practice (KAP) concerning urinary incontinence (UI) through diverse educational strategies has been a focal point for professionals in recent years. This study was aimed at assessing the impact of the educational application Continence App® on the KAP of postpartum women experiencing UI. We hypothesized that access to the app would lead to improved KAP among these women.

METHODS

Postpartum women who had undergone vaginal birth, aged 18 years or above, literate, admitted in a maternity ward, delivered a full-term or large-for-gestational-age infant, and possessed a smartphone or compatible device for app usage were included. Changes in KAP were evaluated using a survey specifically designed for this purpose. The Mann-Whitney U test was employed to compare KAP scores between control and intervention groups, as well as between baseline and post-intervention assessments.

RESULTS

Among the 542 women screened for eligibility, 349 were enrolled in the study, with 138 completing post-intervention assessments. The mean (standard deviation [SD]) age of participants was 25.9 (5.8) years. Post-intervention scores for knowledge and practice demonstrated a decline among non-app users, whereas a significant increase was observed among those in the intervention group. Attitudinal changes remained insignificant.

CONCLUSIONS

The findings highlight the effectiveness of an app-based educational intervention in enhancing the knowledge and practice related to UI among postpartum women.

Effect of Yoga in Pregnancy on Maternal Pelvic Floor Distress Symptoms-A Randomised Control Study

INTRODUCTION AND HYPOTHESIS

Pregnancy is associated with an increase in pelvic floor dysfunction. Yoga, an ancient Indian practice involving asanas (physical postures), pranayam (breathing patterns) and meditation, can help women to control their pelvic floor muscles. However, the literature to support yoga as a remedy for pelvic floor dysfunction is lacking. We hypothesized that yoga could be an important method in improving pelvic floor dysfunction in pregnancy.

METHODS

In a randomised control study, 200 pregnant women matched for age, weight, parity and physical activity were randomised at the 13- to 20-week period of gestation into two groups: group I (n = 100, undergoing yoga therapy) and group II (n = 100, given usual antenatal care). A trained instructor provided two physical sessions, each lasting for 60 min and further online sessions for 5 days a week for 3 months. The Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to assess the primary outcome at recruitment, 32 weeks (antenatal), 1 week and 6 weeks post-partum in both groups.

RESULTS

In the 200 women randomised and matched for age and parity, there were no complications seen throughout the pregnancy and none of the patients was lost to follow-up in either group. The proportion of women exhibiting a decline in PFDI-20 scores was greater in group 1 (24%) than in group 2 (8%). The mean difference of scores between recruitment and 6 weeks post-partum was statistically significant (p value = 0.0026).

CONCLUSIONS

Yoga in pregnancy significantly improves pelvic floor dysfunction in an easy manner with no proven adverse effects.

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.

Epidemiological trends and risk factors related to lower urinary tract symptoms around childbirth: a one-year prospective study

BACKGROUND

Lower urinary tract symptoms (LUTS) are prevalent and distressing concerns for women worldwide. The prevalence of LUTS reaches the first peak during pregnancy and postnatal period. However, less attention has been paid to LUTS around childbirth and little progress has been made in the prevention of LUTS. Understanding the epidemiological characteristics of LUTS around childbirth would inform decision making for health care providers and perinatal women in the prevention of LUTS. The study aims to investigate the epidemiological trends and associated risk factors related to LUTS around childbirth.

METHODS

Pregnant women were consecutively enrolled during pregnancy in the obstetrical wards of a tertiary hospital and followed up at 6-8 weeks and one year postpartum through a prospective design. Urinary incontinence was assessed with the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form. Other symptoms were measured with questions based on definitions of the International Incontinence Society. Multiple logistic regression was used to examine the risk factors for LUTS including urinary incontinence, increased daytime frequency, nocturia and urgency. The report followed the STROBE statement.

RESULTS

A total of 1243 pregnant women participated in this study. The prevalence of at least one type of storage symptoms was 94%, 55% and 35% in late pregnancy, at 6-8 weeks and one year postpartum, respectively. The prevalence of urinary incontinence remained at 21% within one year postpartum. The majority of the participants suffered from mild to moderate urinary incontinence. Age, job, BMI before pregnancy, gestational diabetes mellitus, urinary tract infection history, previous history of LUTS, age at first birth and birth mode were predictors of LUTS one year postpartum.

CONCLUSION

LUTS were highly prevalent during pregnancy and postnatal period. The prevalence of urinary incontinence was more stable than that of other LUTS within one year postpartum. Women aged more than 35 years, engaging in manual work, with gestational diabetes mellitus, with a history of urinary tract infection and LUTS, with advanced age at first birth and vaginal delivery were more likely to suffer from LUTS postpartum. The findings provided a novel and deep insight into the epidemiological trends and related risk factors of LUTS around childbirth.

Group-based PFMT programme for preventing and/or treating UI in pregnant women: protocol of a randomized controlled feasibility study

BACKGROUND

Urinary incontinence (UI) is a prevalent health problem in women worldwide. Many women experience UI during pregnancy. The National Institute for Health and Care Excellence (NICE) recommended pelvic floor muscle training (PFMT) as the first-line conservative treatment for UI. However, it is not widely implemented due to the limited number of healthcare trainers. Group-based PFMT has been used with older women and a limited number of maternity studies. But the effectiveness of the group-based PFMT needs to be investigated because the overall quality of the studies is low. Therefore, this study aims to assess the feasibility of delivering a group-based PFMT programme for pregnant women in Nanjing city.

METHODS

This feasibility study will be conducted in Nanjing Maternity and Child Health Care Hospital in China, using a mixed methods design to investigate the feasibility and acceptability of delivering group-based PFMT to pregnant women. Pregnant women with or without the symptoms of UI will be included. This study aims to recruit 48 pregnant women with 24 in each arm. Participants will receive either the group-based PFMT delivered by a midwife or usual antenatal care which includes only verbal instruction on PFMT. The study will assess the completion rates, acceptability of outcome measures, recruitment and retention rate and calculate an appropriate sample size for a future study.

DISCUSSION

The results of this study will inform the design and implementation of a definitive randomized clinical trial to explore the effectiveness of the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05242809.

Sitting on the fence: A qualitative study of perceptions regarding pelvic floor muscle training among pregnant women with urinary incontinence

Objectives

To explore the perceptions of pregnant women with urinary incontinence toward pelvic floor muscle training (PFMT).

Methods

Semi-structured personal interviews were used to collect data. Pregnant women with urinary incontinence and no contraindications to PFMT were recruited for semi-structured interviews in the Outpatient Department of Obstetrics in a Class A tertiary hospital in Shenzhen from October to November 2021. Purposive sampling was performed, and Braun & Clarke thematic analysis was used for the data analysis.

Results

Sixteen pregnant women with urinary incontinence and a mean age of (30.81 ± 3.66) years participated in the interview. "Sitting on the fence" was the predominant theme acquired after analysis. Pregnant women had contradictory attitudes toward PFMT. A total of four themes and nine sub-themes have been extracted: "It is normal and does not really matter" (normalized urinary incontinence, insufficient attention to PFMT); "There is nothing I can do" (insufficient subjective motivations, limitation of objective conditions, lack of social support); "We have to take care of ourselves" (the increasing self-care awareness, emerging autonomous motivation to practice PFMT); "Training should be guaranteed" (requiring the guidance, suggestions, and surveillance of healthcare professionals; requiring the perceptive benefits).

Conclusions

This study reveals varying attitudes towards PFMT among pregnant women with urinary incontinence. To better promote pregnant women's engagement in PFMT, it is necessary to provide professional guidance, increase self-care awareness, improve social support, and emphasize the benefits of PFMT.

Translation and validation of Incontinence Impact Questionnaire Short Form in the Urdu language

INTRODUCTION AND HYPOTHESIS

The Incontinence Impact Questionnaire Short Form (IIQ-7 SF) is a self-administered questionnaire that is used to assess the impact of urinary incontinence on the quality of life in women. It is translated into different languages; however, there is currently no official Urdu version of this tool. The main purpose of this study was to translate the IIQ-7 SF into the Urdu language and to find out its validity and reliability in women with urinary incontinence.

METHODS

The IIQ-7 was translated into the Urdu language by following the standardized steps. The original version was translated into Urdu by two translators and the back translation into English was done by an independent translator. A panel of experts reviewed the translations and a final version was drafted. Fifteen women with urinary incontinence were involved in the pilot study. The validity and reliability were then assessed on 70 women with urinary incontinence.

RESULTS

The content validity index (CVI) of each question ranged from 0.91 to 0.94. The convergent validity with UDI-6 was determined by using Spearman's correlation coefficient (r=0.90). Cronbach's α showed the internal consistency, which is 0.87. The test-retest reliability was calculated by the intra-class correlation coefficient, ICC=0.95. The scree plot showed the two components have eigen values greater than 1.

CONCLUSIONS

The Urdu version of the IIQ-7 has shown good validity and reliability in incontinence patients, according to the findings.

Investigation on prevalence and risk factors associated with genitourinary syndrome of menopause in middle-aged and older women in Beijing community: a cross sectional study

BACKGROUND

Genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections) associated with menopause. To avoid invasive testing and painful physical examinations, validated questionaries, which can assess the prevalence and risk factors associated with symptoms of GSM. We aimed to investigate the prevalence and risk factors associated with GSM in middle-aged and older women in the communities of Beijing, China.

METHODS

A cross-sectional, questionnaire study was performed among 35-70 years old Chinese woman. Vaginal health index score and urinary distress inventory (UDI-6) was used to evaluate vulvovaginal atrophy (VVA) and urinary incontinence (UI). Stages of pelvic organ prolapse (POP) was measured during gynecological examination with POP-Q system. Mean ± standard deviation (SD) and proportion/percentages were used to summarize continuous and categorial variables respectively. The Bonferroni method was used to adjust for multiple comparisons.

RESULTS

A total of 2702/3000 participants completed the questionnaire survey. The mean ± SD age of participants was 53.7 ± 7.0 years and prevalence of VVA among participants was 34.8% (941/2702). In UDI-6 questionnaires total 47.5% (1284/2702) participants reported experiencing urinary incontinence (UI). Further, POP was highly prevalent in anterior vaginal wall 38.9% (1050/2702) followed by posterior vaginal wall 25.3% (683/2702) and uterine 22.2% (599/2702). Besides, multiple logistic regression analysis inferred older age (45-54 years [OR (95% CI): 3.38 (2.03, 5.64)]; 55-64 years [OR (95% CI): 8.63 (5.09, 14.64)]), menopause [OR (95% CI): 2.20 (1.71, 2.85)] and Faecal Inconsistence (FI) [OR (95% CI): 1.31(1.00, 1.72)] as independent risk factors for VVA.

CONCLUSIONS

Our study evidenced that GSM is prevalent in old age Chinese women. GSM is related with UI, POP and VVA. Further older age, menopause and FI were risk factors associated with VVA. Our findings could help health care personnel to get a comprehensive overview of factors associated with VVA and urinal distress, which may facilitate early detection and prevention of GSM.

Two year follow-up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study

INTRODUCTION

Few prospective studies have revealed the long-term neuromuscular alterations of pelvic floor after vaginal delivery. The aim of this study was to evaluate the impact of episiotomy on the electrical activity of pelvic floor muscle 2 years following vaginal delivery, and explore the relation between surface electromyography (sEMG) amplitudes and urinary incontinence.

MATERIAL AND METHODS

A total of 427 primiparous women with full-term singleton vaginal delivery were included in the cohort and 362 with no further births within the 2 year follow-up completed observations. Of these, 200 underwent episiotomy and 162 underwent nonepisiotomy. Clinical demographic characteristics, vaginal EMG variables and urinary incontinence-specific questionnaire scores were collected at 6 weeks, 6, 12 and 24 months after childbirth, respectively. Primary outcomes were the comparison of sEMG values between the episiotomy and nonepisiotomy groups throughout 2 years. Secondary outcomes were the correlation between sEMG of both groups and the incidence and severity of urinary incontinence. Spearman's correlation analysis, Kruskal-Wallis test and ANOVA with Bonferroni correction were used to analyze the variables.

RESULTS

Amplitude of maximal fast and endurance contractions on sEMG in the episiotomy group was significantly lower than the nonepisiotomy counterpart. Such difference of sEMG persisted for a long period after birth: endurance contraction, 33.12 ± 8.92 vs 35.085 ± 9.98, p < 0.01 at 24 months, and fast contraction, 36.53 ± 8.87 vs 39.05 ± 9.98, p = 0.01 at 12-month. Although there was no significant difference in incidence and severity of urinary incontinence between both groups, a negative correlation existed between EMG values of muscle contraction and urinary incontinence symptoms throughout.

CONCLUSIONS

Primiparous women delivered with episiotomy demonstrated lower contractile sEMG activity of pelvic floor muscle in the long term. The lower sEMG values of fast contraction were associated with urinary incontinence symptoms.