Estrogen and urinary incontinence in women

Objective: The purpose of this study was to review the efficacy of estrogen therapy for urinary incontinence by examining published trials and to review the epidemiologic and physiologic evidence for its action. Data Sources: Controlled and uncontrolled trials of estrogen therapy in the English literature were collected. Eight controlled and 14 uncontrolled trials were identified. Methods of Study Selection: Trials were selected if they were prospective. All types of estrogen treatment were included. All types of outcome measurements were included. Data Extraction and Synthesis: Trials were categorized by type of estrogen used; outcome variables (subjective improvement vs. objective urodynamic data); and cure/improvement rates. Conclusions: Published trials do not support estrogen replacement as efficacious therapy for stress urinary incontinence. It may be useful for incontinence associated with urgency and frequency. Adequately large controlled trials that evaluate estrogen replacement regimens used in the USA remain to be done.     

Association between urinary incontinence and urinary tract infections, and fractures in postmenopausal women

Objective: The association between urinary disorders, such as ongoing urinary incontinence (UI), history of urinary incontinence (HIST-UI) and urinary tract infactions (UTI), and fractures in peri- and postmenopausal women was assessed in an epidemiological study. Subjects and methods: The sample consisted of 10 000 women from seven birth cohorts, born between 1900 and 1940, who were investigated regarding urinary disorders, fractures and reproductive history by means of a postal questionnaire. Results: The overall response rate was 74.6%. The respondents (n = 7459) represented 53% of the total population from the respective birth cohorts. There was a significant independent correlation between UI, HIST-UI and UTI, respectively, and fractures after the age of 30. In subjects with HIST-UI, tobacco smokers compared to non-smokers had significant more fractures in both the 1930 and 1940 birth cohorts (P < 0.01). Logistic multiple regression in the 1930 and 1940 cohorts demonstrated that age (P < 0.001), HIST-UI (P < 0.001) and tobacco smoking (P < 0.05), respectively, had an independent explanatory value for fractures. Conclusion: The prevalence of fractures increased with increasing age, in smokers compared to non-smokers and in women with a history of UI.     

Quality of life and urinary incontinence in women

Urinary incontinence greatly diminishes quality of life. It is important to diagnose the three main types of urinary incontinence correctly - stress, urge or mixed incontinence - and to evaluate the impact of incontinence on quality of life. After a detailed history, a bladder diary and questionnaires are the most useful tools with which to determine what aspects of quality of life are most impaired - daily, work-related, recreational or sexual activities. In general, urgency and urge incontinence have a worse effect on quality of life than stress urinary incontinence. Measures of quality of life have become essential in developing management plans and in follow-up.     

General practitioners and women with urinary incontinence.

BACKGROUND: Urinary incontinence is a common problem for adult women. It results in a large financial and psychosocial cost. Much urinary incontinence goes unreported. Women with urinary incontinence can be successfully assessed and treated in general practice but studies have shown that many GPs manage the condition inadequately. AIM: This study aims to examine GPs' awareness of urinary incontinence in women and their management of, and attitudes to, female urinary incontinence. METHOD: A qualitative study was conducted with 21 GPs responding to semi-structured interviews. Thematic analysis was carried out on these interviews, with recurrent views and experiences being identified and grouped. RESULTS: The interviews of 11 male and nine female GPs were suitable for analysis. GPs were aware of the prevalence and under-reporting of urinary incontinence in women. Many were unhappy with their own management of the condition and with the management options available to them. Male GPs in particular were reluctant to carry out gynaecological examinations, and few GPs expressed enthusiasm for teaching pelvic floor exercises or bladder drills. Medications were frequently used but generally considered ineffective or intolerable. The services of both public health nurses and practice nurses were under-used, largely because of lack of training in this area. Although incontinence nurses were employed in the area, many GPs did not know of their availability and, of those who did, few referred to them more than infrequently. CONCLUSION: This study demonstrates that many GPs avoid dealing with the problem of urinary incontinence in women and that they find it to be a difficult, chronic problem to treat. Specialist options seem not to be useful in general practice. The findings need to be explored in other GP settings.     

Management of urinary incontinence in women.

Control of micturition is a complex physiological and anatomical process which often fails in women. The sequelae of urinary incontinence in women range from inconvenience to social and psychological stigmatization. Surprisingly, many women are tolerant of often quite severe sequelae, despite a range of management techniques that exist to alleviate or cure incontinence. Some of the more successful techniques are well suited to general practice management and can be carried out by the patient under the supervision of her doctor, district nurse, practice nurse or midwife. This paper reviews the physiology of micturition, stress urinary incontinence and incontinence caused by detrusor instability, and the management techniques available to alleviate or cure the problem.     

Efficacy and safety of duloxetine in elderly women with stress urinary incontinence or stress-predominant mixed urinary incontinence

OBJECTIVES: To evaluate the efficacy and safety of duloxetine in community-dwelling women > or =65 years with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (S-MUI) versus placebo. METHODS: Patients were randomly assigned for 12 weeks to placebo (N=134) or duloxetine (N=131) (20mg twice daily [BID] for 2 weeks and 40 mg BID for an additional 10 weeks), followed by a double-blind 4-week dose de-escalation/discontinuation phase. The primary efficacy variable was the percent change in incontinence episode frequency (IEF) from baseline to endpoint. Other variables included absolute IEF change, responder rate, changes in mean time between voids (MTBV), weekly continence pad usage, the impact of treatment on quality of life, patient's global impression of improvement (PGI-I), and changes in depression and cognition. RESULTS: Duloxetine-treated patients had a significantly greater decrease from baseline to endpoint in mean IEF/week than placebo-treated patients (-52.47% vs. -36.70%, P<0.001). The IEF responder rate (> or =50% reduction in IEF/week) was 57.1% in the duloxetine group and 35.2% in the placebo group (P<0.001). Significant benefits of duloxetine were also demonstrated for weekly continence pad usage (P=0.011), MTBV (P<0.001), incontinence quality of life questionnaire (I-QOL) scores (P<0.001), and PGI-I ratings (P<0.001). Patients with depressive symptoms and cognitive impairments were few and changes were insignificant. The proportion of patients with > or =1 treatment-emergent adverse event (TEAE) was similar with both treatments, but dry mouth, fatigue, constipation, and hyperhidrosis were significantly more common in women taking duloxetine. CONCLUSIONS: Duloxetine is a safe and effective treatment for elderly women with symptoms of SUI or S-MUI.     

New surgical approaches for urinary incontinence in women

Urinary incontinence (UI) is highly prevalent and common complaint. A large proportion of women with UI can be correctly diagnosed by their symptoms alone. First line of treatment should follow conservative route in a form of pelvic floor muscle training for stress UI and bladder training for the urgency UI. If conservative management is ineffective, medical and surgical treatment is the next considered. For the treatment of over-active bladder and urgency UI, intra-vesical injections of botulinum toxin A, utilising a flexible or rigid cystoscope has become an established treatment. An alternative to the use of onaBoNTA is sacral nerve stimulation (SNS).     

Treatment seeking behavior for urinary incontinence among north Indian women

Background: Urinary incontinence is a common but neglected problem of women. Aims: To ascertain the treatment seeking behavior of north Indian women having urinary incontinence (UI). Setting: Two residential colonies of Chandigarh. DESIGN: Cross-sectional face-to-face interview based study. Materials and Methods: This study was conducted by a trained nurse during April 2005-July 2005 among women aged 18 years and above. Women with UI were identified in a screening survey. They were interviewed individually regarding their treatment seeking behavior and socio-demographic data. Statistical Analysis Used: Percentage, mean, standard deviation, chi-square test. Results: Of the 220 enlisted incontinent women 20% (44) women consulted some health agency. Only 8.6% (19) women had heard about pelvic floor muscle exercises. Seventy-two percent (158) cases had UI for more than one year. The most common reason quoted for not seeking treatment was, 'UI was considered as 'normal', 'did not take it seriously' and 'shyness.' Many (153;70%) women reported that UI affected their daily routine as well as social activities like shopping and visiting friends. Conclusion: Urinary incontinence seriously affected the quality of life of women. Still, consultation rate for UI was low in the north Indian women.     

Lifestyle and health factors associated with stress urinary incontinence in Japanese women

Objectives

Studies focusing on lifestyle and health factors and stress urinary incontinence (SUI) are scarce in Japan. The aim of this study is to examine the association of lifestyle and health factors in SUI.

Methods

Study subjects were retrieved from Japanese women participating in a health checkup program provided by a general hospital between October 2003 and March 2006. The presence of SUI was confirmed by responses to a self-administered questionnaire assessing lower urinary tract symptoms. The questionnaire included other questions on lifestyle and health factors. Each subject underwent weight and height measurements.

Results

A total of 823 women completed the questionnaire and were included in the analyses (the response rate was 62.6%). Of them, 70 (8.5%) women had SUI. BMI and parity were significantly positively associated with SUI (OR = 3.47 and 7.17, 95% CI 1.65–7.33 and 1.71–30.04, respectively). Multiple logistic regression analysis controlling for age, parity, and BMI showed that first delivery at age >27 (OR = 1.82, 95% CI 0.97–3.41), past estrogen use (OR = 2.50, 95% CI 1.14–5.47), and unilateral ovariectomy (OR = 3.07, 95% CI 1.16–8.13) were also significantly associated with SUI.

Conclusions

The data suggested that lifestyle and health factors such as parity, BMI, age at first delivery, past estrogen use, and unilateral ovariectomy were associated with SUI in Japanese women.     

Post-menopausal women and osteoporosis: available choices for maintenance of skeletal health

Objective: To briefly summarize the therapeutic choices for osteoporosis prevention which are currently available to post-menopausal women. Methods: Results of randomized clinical trials and epidemiological studies in post-menopausal women, and pre-clinical studies in ovariectomized rats were summarized. Results: Estrogen combined with progestogen in hormone replacement therapy (HRT) is effective in relieving perimenopausal symptoms and maintaining bone mineral density. However, the increased breast cancer risk associated with long-term HRT use makes it a less desirable option for many women. Selective estrogen receptor modulators (SERMs), such as raloxifene, are also effective in maintaining bone density, without stimulating the breast or uterus. However, SERMs do not relieve perimenopausal hot flashes. Conclusion: HRT is effective for acute relief of perimenopausal symptoms, but for women who are unwilling or unable to take HRT long-term, SERMs such as raloxifene are a useful therapy for the prevention of osteoporosis.     

An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women

The prevalence of urinary incontinence (UI) and related urogenital symptoms (UGS) was investigated in a random sample (n = 4206) of women from the 1900-20 birth cohorts residing in the city of G?teborg. It was reported by 16.9% of the respondents that they currently had UI and by 22.7% that they had regularly suffered from this complaint at some time in their lives. The prevalence of UI increased (P less than 0.001) with rising age, from 13.9% in the 1920 birth cohort to 24.6% in the 1900 birth cohort. Over 50% of the sufferers reported daily incontinence. An objective assessment was performed in a subsample (n = 300) of the women complaining of UI. In 14 cases (4.6%) the diagnosis could not be confirmed, while in the remainder UI was classified by type as follows: stress incontinence 24%, urge incontinence 49% and mixed incontinence 27%. The number of urinary tract infections (UTI) reported by the respondents increased (P less than 0.001) with rising age. UGS such as pruritus, burning, pain and vaginal discharge were reported by 11% of the respondents. The reported frequency of local vaginal discomfort did not increase with age, unlike that of UI and UTI. Systemic or local oestrogen treatment was being received by 9.2% of the respondents.     

Assessment of symptoms of urinary incontinence in women with polycystic ovary syndrome

OBJECTIVES:

The pelvic floor muscles are sensitive to androgens, and due to hyperandrogenism, women with polycystic ovary syndrome can have increased mass in these muscles compared to controls. The aim of this study is to compare reports of urine leakage and quality of life between women with and without polycystic ovary syndrome.

METHODS:

One hundred thirteen 18- to 40-year-old nulliparous women with polycystic ovary syndrome or without the disease (controls) were recruited at the University Hospital of School Medicine of São Paulo University at Ribeirão Preto City, Brazil. The subjects were not taking any hormonal medication, had not undergone previous pelvic surgery and did not exercise their pelvic floor muscles. The women were divided into the following four groups: I- polycystic ovary syndrome with normal body mass index (n = 18), II- polycystic ovary syndrome with body mass index ≥25 (n = 32), III- controls with normal body mass index (n = 29), and IV- controls with Body Mass Index ≥25 (n = 34). Quality of life was evaluated using the SF-36 questionnaire, and the subjects with urinary complaints also completed the International Consultation on Incontinence Questionnaire Short Form to evaluate the severity of their urinary incontinence.

RESULTS:

The replies to the International Consultation on Incontinence Questionnaire Short Form revealed a significant difference in urinary function between groups, with 24% of the subjects in group IV reporting urinary incontinence. The mean scores for the SF-36 questionnaire revealed that group II had the lowest quality of life.

CONCLUSIONS:

The control obese group (IV) reported a higher prevalence of urinary incontinence. There was no difference in the reported frequency of urine loss between the polycystic ovary syndrome and control groups with normal body mass index or between the polycystic ovary syndrome and control groups with body mass index ≥25.     

Prostate cancer and urinary incontinence

Prostate cancer is the third most common cancer worldwide and an increasing proportion of men are being diagnosed with localised disease. Urinary incontinence is uncommon in healthy men, but may develop as a result of curative treatment for prostate cancer. The optimal therapy remains undefined so the treatment associated morbidity is an important determinant in patient choice. Urinary incontinence may also develop from tumour progression during deferred treatment, sphincter involvement in advanced disease or surgery for symptomatic malignant bladder outlet obstruction. As urinary incontinence is known to have a significant impact on health related quality of life, we have reviewed the literature on incontinence related to prostate cancer and its treatment.