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Physical Activity, Diet, and Incident Urinary Incontinence in Postmenopausal Women: Women's Health Initiative Observational Study.
Bauer, SR, Kenfield, SA, Sorensen, M, Subak, LL, Phelan, S, Gupta, LR, Chen, B, Suskind, AM, Park, AJ, Iglesia, C, et al
The journals of gerontology. Series A, Biological sciences and medical sciences. 2021;(9):1600-1607
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Abstract
BACKGROUND Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI). METHODS We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food frequency questionnaire, with incident UI subtypes after 3 years among 19 741 postmenopausal women in the Women's Health Initiative Observational Study. Odds ratios (ORs) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression. RESULTS Women who reported total physical activity (metabolic equivalent task [MET]-hours/week) ≥30 versus <0.1 were 16% less likely to develop urgency UI (OR = 0.84; 95% CI 0.70, 1.00) and 34% less likely for mixed UI (OR = 0.66; 95% CI 0.46, 0.95), although linear trends were no longer statistically significant after adjusting for baseline weight and weight change (p trend = .15 and .16, respectively). The association between physical activity and incident stress UI was less consistent. Higher uncalibrated protein intake was associated with increased odds of incident urgency UI (≥19.4% vs <14.1% of energy intake OR = 1.14; 95% CI 0.99, 1.30; p trend = .02), while CIs were wide and included 1.0 for calibrated protein intake. Other macronutrients were not associated with urgency UI and macronutrient intake was not associated with incident stress or mixed UI (p trend > .05 for all). CONCLUSIONS Among postmenopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increased risk of urgency UI, but no associations were observed between other macronutrient and UI subtypes.
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Urinary incontinence, body mass index, and physical activity in young women.
Lamerton, TJ, Mielke, GI, Brown, WJ
American journal of obstetrics and gynecology. 2021;(2):164.e1-164.e13
Abstract
BACKGROUND Current evidence suggests that excess weight and obesity are important risk factors for urinary incontinence in women. However, limited data exist regarding the relationships among body mass index, physical activity, and urinary incontinence in women in their 20s. OBJECTIVE This study aimed to (1) compare prevalence rates of urinary incontinence and high body mass index in 2 cohorts of young women, (2) explore associations between changes in body mass index and urinary incontinence using analysis of combined data from the 2 cohorts, and (3) explore the associations between physical activity and urinary incontinence, with adjustment for body mass index. STUDY DESIGN Data were collected from 2 cohorts of young women in the Australian Longitudinal Study of Women's Health (n=16,065), born 17 years apart: 1973-1978 (cohort 1) and 1989-1995 (cohort 2). The women in both cohorts completed the surveys at age 18 to 23 years (T1), with follow-up 4 years later (age, 22-27 years; T2). Self-reported urinary incontinence and body mass index were assessed in both surveys. As physical activity was measured using different questions in cohort 1 at T1, self-reported physical activity data were from T2 only. A total of 9 body mass index transition categories (based on body mass index status at baseline and follow-up) and 4 physical activity categories were created to assess multivariate-adjusted prevalence ratios for urinary incontinence at T2, using Poisson regression. RESULTS Rates of obesity increased in both cohorts over 4 years, from 6.6%% (95% confidence interval, 6.1-7.2) to 10.4% (95% confidence interval, 9.7-11.0) in cohort 1 and from 11.7% (95% confidence interval, 11.0-12.4) to 19.6% (95% confidence interval, 18.7-20.5) in cohort 2. Compared with women who maintained normal body mass index at T1 and T2, the prevalence ratio for urinary incontinence among those with body mass index >30 at age 22 to 27 years was higher, regardless of body mass index category at age 18 to 23 years (prevalence ratio at T1: 1.39 for normal body mass index [95% confidence interval, 1.1-1.76]; 1.44 for overweight [95% confidence interval, 1.27-1.63]; and 1.51 for obese [95% confidence interval, 1.36-1.67]). In cohort 1, there was no relationship between physical activity and urinary incontinence. However, in cohort 2 there was an inverse dose-response relationship between physical activity and urinary incontinence. CONCLUSION The strong association between obesity and urinary incontinence in young women is a public health concern, given that obesity rates are likely to increase further with age and parity. The potential mitigating effects of physical activity on the obesity-incontinence relationship merit further investigation.
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Management of urinary incontinence.
Nightingale, G
Post reproductive health. 2020;(2):63-70
Abstract
Urinary incontinence is a common problem affecting 25-45% women. Effective management can have a huge impact on a patient's quality of life and many treatments are available. Management should be dictated by the degree of bother the symptoms are having, and vary depending on the type on incontinence. Conservative measures should always be initiated, including optimisation of body mass index and smoking cessation. Overactive bladder and urge urinary incontinence can be improved with bladder retraining and avoidance of bladder stimulants. Medical treatment then includes anticholinergic medications or Mirabegron. More invasive options include Botulinum Toxin A (Botox®) injections, sacral nerve stimulation or urological surgery. Stress urinary incontinence should be managed initially with pelvic floor exercises, and input from a specialist nurse or physiotherapist is beneficial. The surgical options for managing stress incontinence have changed considerably over the years, but include bladder neck injections, mid-urethral slings, colposuspension or autologous fascial slings. Mixed urinary incontinence is more challenging to manage, but all conservative measures should be started. Further treatment is directed towards the predominant symptom, but overactivity should be controlled before surgical measures for stress urinary incontinence are performed.
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Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series.
Kilpatrick, KA, Paton, P, Subbarayan, S, Stewart, C, Abraha, I, Cruz-Jentoft, AJ, O'Mahony, D, Cherubini, A, Soiza, RL
Maturitas. 2020;:42-48
Abstract
BACKGROUND Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. OBJECTIVE To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. METHODS A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane up to June 2018. Primary trials with a population mean age ≥65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. RESULTS Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality. CONCLUSIONS There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.
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Prevention of Urinary Incontinence in Women.
Swanton, AR, Gormley, EA
Current urology reports. 2020;(10):43
Abstract
PURPOSE OF REVIEW Despite available treatments for urinary incontinence, the data regarding prevention is less established. This review sought to identify prevention measures and discuss their underlying evidence base with an attempt to include the most recent updates in the field. RECENT FINDINGS Urinary incontinence is a prevalent issue among women, particularly surrounding pregnancy and menopause. Interventions regarding pregnancy include not only general health promotion but also potentially interventions such as pelvic floor muscle training and decisions regarding method of delivery. With regard to menopause, the literature suggests avoiding treatments that have adverse effects on continence. Lastly, promoting healthy life style and reducing effects of co-morbid conditions can impact a woman's continence. The literature indicates that preventative strategies exist for urinary incontinence, though the data is limited in this area. Further work is needed to determine the impact of prevention measures and how best to implement them.
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Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: a systematic review and dose-response meta-analysis of prospective studies.
Aune, D, Mahamat-Saleh, Y, Norat, T, Riboli, E
BJOG : an international journal of obstetrics and gynaecology. 2019;(12):1424-1433
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Abstract
BACKGROUND Adiposity has been associated with elevated risk of urinary incontinence in epidemiological studies; however, the strength of the association has differed between studies. OBJECTIVES To conduct a systematic literature review and dose-response meta-analysis of prospective studies on adiposity and risk of urinary incontinence. SEARCH STRATEGY We searched PubMed and Embase databases up to 19 July 2017. SELECTION CRITERIA Prospective cohort studies were included. DATA COLLECTION AND ANALYSIS Data were extracted by one reviewer and checked for accuracy by a second reviewer. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. MAIN RESULTS Twenty-four prospective studies were included. The summary RR per 5 kg/m2 increment in body mass index (BMI) was 1.20 (95% CI 1.16-1.25, I2 = 62%, n = 11) for population-based studies and 1.19 (95% CI 1.08-1.30, I2 = 87.1%, n = 8) for pregnancy-based studies, 1.18 (95% CI 1.14-1.22, I2 = 0%, n = 2) per 10 cm increase in waist circumference and 1.34 (95% CI 1.11-1.62, I2 = 90%, n = 2) per 10 kg of weight gain. Although the test for nonlinearity was significant for BMI, P = 0.04, the association was approximately linear. For subtypes of urinary incontinence the summary RR per 5 BMI units was 1.45 (95% CI 1.25-1.68, I2 = 85%, n = 3) for frequent incontinence, 1.52 (95% CI 1.37-1.68, I2 = 34%, n = 4) for severe incontinence, 1.33 (95% CI 1.26-1.41, I2 = 0%, n = 8) for stress incontinence, 1.26 (95% CI 1.14-1.40, I2 = 70%, n = 7) for urge incontinence, and 1.52 (95% CI 1.36-1.69, I2 = 0%, n = 3) for mixed incontinence. CONCLUSION These results suggest excess weight may increase risk of urinary incontinence. TWEETABLE ABSTRACT Overweight and obesity increase the risk of urinary incontinence.
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[Urinary incontinence and lower urinary tract dysfunction prevalence in schoolchildren: risk factors].
Somoza Argibay, I, Méndez Gallart, R, Casal Beloy, I, García González, M
Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica. 2019;(3):145-149
Abstract
Recently, many papers report an increase of pediatric lower urinary tract dysfunction (LUTD), which affects 10-15% of schoolchildren. Recent life style and dietary changes have been postulated as the cause of that high prevalence. There is a lack in epidemiological investigations about bowel and bladder dysfunctions and the risk factors. We aim to know the LUTD prevalence and the main risk factors. We carry out an observational and transversal investigation with a representative sample of our pediatric schoolchildren (N=1,069). We used a questionnaire about toilet training habits, social, familiar, and dietary data. We also used the PLUTSS (Pediatric Lower Urinary Tract Symptoms Score) questionnaire after validation of the Spanish version. The logistic regression analysis determined the main risk factors of DTUI. Results showed that boys get toilet trained later than girls (2.41 vs. 2.25) and the rate of incontinence is greater than girls when they start on the school. 31.9% of children remove their diapers to get into school. The prevalence was 15% for diurnal urinary incontinence and 12.2% nocturnal, DTUI 8.3%, constipation 20%, faecal incontinence 2.8%, ITUs 12.4%, retention habits 39.8%. 28.7% of children with DTUI refer psychological affectation. The main independent predictors were: male sex (OR 1.87), younger children (OR 0.78), forced toilet training (OR 2.14), constipation (OR 1.61) and holding habits (OR=3.87). This study showed a high prevalence of bladder in our pediatric population. Male gender, voiding postposition, early schooling or constipation were the main risk factors. The knowledge of the bladder and bowel dysfunction prevalence and the toilet training habits in our Community lets us to conclude school, family and primary care recommendations. This will let to prevent this so much prevalent disease.
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Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review.
Benjamin, DR, Frawley, HC, Shields, N, van de Water, ATM, Taylor, NF
Physiotherapy. 2019;(1):24-34
Abstract
BACKGROUND Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy. OBJECTIVES To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes. DATA SOURCES Six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro). STUDY SELECTION Included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life. STUDY APPRAISAL & SYNTHESIS METHODS Methodological quality was assessed using the Effective Public Health Practice Project tool. A narrative summary was completed for DRAM presence and presence of the various musculoskeletal dysfunctions, and DRAM width and the severity of these dysfunctions. RESULTS Twelve studies involving 2242 participants were included. There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence. There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain. LIMITATIONS Quality of studies was weak. There was variability in the methods used to assess DRAM. CONCLUSION There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity. Systematic Review Registration Number: PROSPERO CRD42017058089.
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Multifaceted self-management interventions for older women with urinary incontinence: a systematic review and narrative synthesis.
Fu, Y, Nelson, EA, McGowan, L
BMJ open. 2019;(8):e028626
Abstract
OBJECTIVE To synthesise the evidence for the multifaceted self-management interventions for older women with urinary incontinence (UI) and to understand the outcomes associated with these interventions. DESIGN A systematic review and narrative synthesis to identify randomised controlled trials that investigated the effect of multifaceted self-management interventions for older women with UI. METHODS MEDLINE, PsycINFO, EMBASE, The Cochrane Library, CINAHL and Applied Social Sciences Index and Abstracts databases were searched (January 1990 to May 2019) using a systematic search strategy, complemented by manually screening the reference lists and citation indexes. Study selection, data extraction and risk of bias assessment were undertaken independently. A narrative synthesis was undertaken in which studies, interventions and outcomes were examined based on the intervention components. The effect size and 95% CI were estimated from each study. RESULTS A total of 13 147 citations were identified and 16 studies were included. There was no study rated as of high quality. Three types of multifaceted interventions were found: those that had an element of pelvic floor muscle exercises (PFME), those with bladder retraining and some with combination behavioural interventions. Outcome measures varied across studies. A statistically significant improvement in incontinence symptoms was reported in the intervention group compared with the control in 15 studies. CONCLUSION Multifaceted interventions that included PFME, bladder retraining or combination behavioural techniques appear to be useful in some settings for UI management in older women, but the quality of the evidence was poor and unclear. There was insufficient evidence to determine whether any of the combination of components is superior to others in improving UI symptoms. There is a need for high-quality studies to confirm the effectiveness of these interventions and to identify comparative effectiveness. PROSPERO REGISTRATION NUMBER CRD42018104010.
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The Urinary Tract Microbiome in Health and Disease.
Aragón, IM, Herrera-Imbroda, B, Queipo-Ortuño, MI, Castillo, E, Del Moral, JS, Gómez-Millán, J, Yucel, G, Lara, MF
European urology focus. 2018;(1):128-138
Abstract
CONTEXT The urinary tract, previously considered a sterile body niche, has emerged as the host of an array of bacteria in healthy individuals, revolutionizing the urology research field. OBJECTIVE To review the literature on microbiome implications in the urinary tract and the usefulness of probiotics/prebiotics and diet as treatment for urologic disorders. EVIDENCE ACQUISITION A systematic review was conducted using PubMed and Medline from inception until July 2016. The initial search identified 1419 studies and 89 were included in this systematic review. EVIDENCE SYNTHESIS Specific bacterial communities have been found in the healthy urinary tract. Changes in this microbiome have been observed in certain urologic disorders such as urinary incontinence, urologic cancers, interstitial cystitis, neurogenic bladder dysfunction, sexually transmitted infections, and chronic prostatitis/chronic pelvic pain syndrome. The role of probiotics, prebiotics, and diet as treatment or preventive agents for urologic disorders requires further investigation. CONCLUSIONS There is a microbiome associated with the healthy urinary tract that can change in urologic disorders. This represents a propitious context to identify new diagnostic, prognostic, and predictive microbiome-based biomarkers that could be used in clinical urology practice. In addition, probiotics, prebiotics, and diet modifications appear to represent an opportunity to regulate the urinary microbiome. PATIENT SUMMARY We review the urinary microbiome of healthy individuals and its changes in relation to urinary disorders. The question to resolve is how we can modulate the microbiome to improve urinary tract health.