Impact of urinary incontinence and overactive bladder on quality of life

OBJECTIVE: To assess the quality of life (QOL) of women with urinary incontinence (UI) or overactive bladder (OB) compared with women without UI. METHODS: A case-control study conducted in Italy on risk factors for UI and OB. Information on QOL were collected using the SF-12 questionnaire, validated for Italian women. RESULTS: A total of 1062 cases (258 had stress, 195 urge, 486 mixed UI and 123 OB without incontinence) and 1143 controls were interviewed. QOL, as assessed by the SF-12, was significantly impaired in cases compared with controls (p=0.0001); the mean SF-12 physical health score was 48.3 for controls, but 45.6, 42.0, 44.5 and 40.0 for cases with OB, urge, stress and mixed incontinence, respectively. Women with OB had significantly higher physical health scores than women with urge and mixed UI (p<0.005) (44.6 versus 41.7 and 41.3). Physical and mental health dimensions of cases significantly decreased with increasing severity of symptoms. CONCLUSIONS: QOL was significantly impaired in women with UI or OB compared to controls. Physical and mental functioning tended to be more impaired in patients than in controls.     

Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder

Background:   We evaluated the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on health-related quality of life (HRQOL) and sexual function.
Methods:   A total of 245 women (SUI; n  = 123 and OAB; n  = 122) from 21 to 79 years old (mean 50.4) were included in the primary analyses. To obtain HRQOL and sexual function assessments, patients were asked to fill in the 'Bristol Female Lower Urinary Tract Symptoms (BFLUTS)' and the 'Medical Outcomes Study Short Form (SF-36)' questionnaires.
Results:   Of the eight domains in the SF-36 questionnaire, only 'general health' was significantly different between the groups. Patients with SUI had a better general health than those with OAB ( P  = 0.016). When comparing the BFLUTS scores in the two groups, the score for 'BFLUTS-filling symptoms' was higher in the OAB group ( P  = 0.002) but that for 'BFLUTS-incontinence symptoms' was higher in the SUI group ( P  < 0.001). The score for 'BFLUTS-sex' was higher in the SUI group than in the OAB group but this was not statistically significant ( P  = 0.096). Of the 169 patients who had a sex life, the SUI group had experienced pain ( P  = 0.033) and leakage ( P  = 0.056) more frequently during intercourse than the OAB group.
Conclusion:   Both SUI and OAB have a detrimental impact on patient HRQOL in Korean women. In addition, our findings suggest that women with SUI had more frequently experienced pain during intercourse and coital incontinence than those with OAB.     

Outcome of coexistent overactive bladder symptoms in women with urodynamic urinary incontinence following anti-incontinence surgery

Introduction and hypothesis

The objective was to investigate the outcome of stress urinary incontinence (SUI) and overactive bladder (OAB) symptoms in women with urodynamic stress incontinence (USI) after transobturator sling procedures (TOTs).

Methods

We evaluated 109 consecutive patients with USI, who had undergone TOT in a tertiary hospital between 2012 and 2014. All patients received evaluations, including structured urogynecological questionnaires and pelvic organ prolapse quantification examination before, and 3 and 12 months after surgery. One-hour pad test and urodynamic testing were performed before and 3–6 months postoperatively. Patient demographics, lower urinary tract symptoms, and urodynamic results were analyzed between pure USI and USI with OAB symptoms.

Results

Persistent SUI occurred in 8 patients at 3 months (7.3 %) and 7 patients at 12 months (6.4 %) postoperatively. The most common OAB symptom was frequency (54.1 %), followed by urgency urinary incontinence (52.3 %), urinary urgency (42.2 %), and nocturia (33 %). Most of these OAB symptoms were resolved at the 3-month and 12-month follow-ups both in patients treated with TOT only and in those treated with TOT combined with other pelvic surgeries. There was no significant difference in the preoperative urodynamic changes between patients with pure USI and USI without OAB groups. However, postoperative urodynamic results showed a significant decrease in the maximal urethral closure pressure in the group of patients with USI and OAB symptoms, but no significant urodynamic changes in the group with pure USI.

Conclusions

Coexistent OAB symptoms are common in women who were diagnosed with USI and most of these symptoms may resolve 3 and 12 months after TOT.

     

The effect of overactive bladder syndrome on the sexual quality of life in Korean young and middle aged women

Some reports showed that urinary incontinence (UI) or female lower urinary tract symptoms (LUTS) affect life quality and sexual activity. In clinical practice, it is commonly found that not only the symptoms of UI but also overactive bladder (OAB) syndrome affect daily lifestyle and sexual activity, especially in women in the most active era in their social and personal life. However, there is lack of data proving the effect of OAB syndrome on sexual activity or sexual life quality in sexually active age group. This study aimed at evaluating the effect of OAB syndrome and UI on the sexual activity and on the sexual quality of life (QoL) of Korean women age from 20s to 40s. We investigated 3372 women aged between 20 and 49 y, enrolled via a multicenter internet survey. A structured questionnaire was used to collect data about their LUTS and sexual activities. The prevalence of OAB syndrome and UI in 3372 women was 12.7 and 21.0%, respectively. Mean subject age was 26.4+/-4.8 y and 79.5% of subjects were 20-29 y old. Having OAB syndrome or UI were found to be significant predictors of sexual life problems (OAB syndrome: OR=5.08, 95% CI=3.68-7.01; UI: OR=4.16, 95% CI=3.06-5.67). Sexual activity was significantly reduced in OAB syndrome and UI versus the asymptomatic group (OAB syndrome: OR=4.8, 95% CI=3.14-6.83; UI: OR=3.9, 95% CI=2.81-5.27). This study is the first internet-based study concerning the sexual QoL in UI and OAB syndrome. In this study, OAB syndrome was found to cause a greater deterioration in the sexual QoL than UI. These results suggest that these symptoms have a significant impact upon women's personal and social lives and markedly affect the QoL.     

Impact of stress urinary incontinence and overactive bladder on micturition patterns and health-related quality of life

We examined the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on micturition habits and health-related quality of life (QOL). A total of 250 Korean women were included in the study. The Medical Outcomes Study Short Form (SF-36) and the King’s Health Questionnaire (KHQ) were used to assess QOL in the patient (SUI, n=158 and OAB, n=92) and control (n=70) groups. A control group was recruited at the Health Promotion Center of our hospital. Each of the dimension scores in the SF-36 represents better health, while that of the KHQ does worse health perception. On the frequency-volume charts, patients with OAB had more nighttime voids than those with SUI (P=0.001). Of the eight domains in the SF-36 questionnaire, four domains were significantly different between the control and OAB groups. Patients with SUI had a significantly lower score on one domain than the controls. Between the SUI and OAB groups, only one domain showed a significant difference. Regarding the KHQ, all domain scores in control subjects were significantly lower than those in the SUI and OAB groups. Between the SUI and OAB groups, the OAB group had higher scores on ‘general health perception’ and ‘sleep/energy disturbances’, while the scores of ‘physical limitations’ and ‘severity measures’ were higher in the SUI group. Women with OAB have a higher number of nocturic episodes than those with SUI, but the QOL is not less affected by SUI than by OAB. Furthermore, simultaneous disease-specific QOL instruments should be used in the evaluation of urinary incontinence because the generic QOL instrument is not a sensitive tool for measuring QOL in this population.     

Structured behavioral treatment research protocol for women with mixed urinary incontinence and overactive bladder symptoms

Aims

The primary aim is to provide detailed rationale and methodology for the development and implementation of a perioperative behavioral/pelvic floor exercise research protocol for women who self‐chose surgical intervention and who may or may not have been offered behavioral treatments initially. This protocol is part of the ESTEEM trial (Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence Trial) which was designed to determine the effect of a combined surgical and perioperative behavioral/pelvic floor exercise intervention versus surgery alone on improving mixed urinary incontinence (MUI) and overactive bladder (OAB) symptoms.

Methods

As part of a multi‐site, prospective, randomized trial of women with MUI electing midurethral sling (MUS) surgical treatment, participants were randomized to a standardized perioperative behavioral/pelvic floor exercise intervention + MUS versus MUS alone. The specific behavioral intervention included: education on voiding habits, pelvic floor muscle training (PFMT), bladder training (BT), strategies to control urgency and reduce/prevent urinary symptoms, and monitoring/promoting adherence to behavioral recommendations. To ensure consistency across all eight research sites in the pelvic floor disorders network (PFDN), selective behavioral treatments sessions were audiotaped and audited for protocol adherence.

Results

The behavioral intervention protocol includes individualization of interventions using an algorithm based on pelvic floor muscle (PFM) assessment, participant symptoms, and findings from the study visits. We present, here, the specific perioperative behavioral/pelvic floor exercise interventions administered by study interventionists.

Conclusions

This paper details a perioperative behavioral/pelvic floor exercise intervention research study protocol developed for women undergoing surgery for MUI.     

Prevalence and correlation of urinary incontinence and overactive bladder in Taiwanese women

AIMS: We randomly sampled a community-based, healthy population to evaluate the prevalence and correlation of urinary incontinence and overactive bladder. We also assessed the influences of these conditions on quality of life and associated risk factors. METHODS: Of the 1,581 women sampled (2.92% of registered female residents aged 20 years and older), 1,253 (79.1%) women were successfully interviewed by using the Bristol Female Urinary Tract Symptoms Questionnaire (r=0.87, P<0.05) and the Questionnaire of Impact index regarding the impact on quality of life (r=0.91, P<0.05). RESULTS: A total of 53.7% of the women sampled suffered from urinary incontinence and related symptoms. The prevalence of stress urinary incontinence, overactive bladder, and mixed incontinence, mutually exclusive of each, was 18.0%, 18.6%, and 17.1%, respectively, from the patients' perceptions. Judging by the criteria of the International Continence Society, the prevalence of the above three conditions was 4.3%, 2.4%, and 1.8%, respectively. Of the women who perceived storage symptoms, 21.1% experienced frequency, 12.6% had urgency, 25.5% had nocturia, and 9.1% had urge incontinence. The occurrence of stress urinary incontinence increased with age up to 65 years old (25% in 50-65-year-old cohort), and the number of overactive bladder conditions significantly increased in the elderly women (over 65 years old, 39.3%). Approximately two thirds of the incontinent women had restricted their social activities (due to worrying about wetting or leakage and no toilet facilities available), and approximately 19% of the incontinent women had an affected sexual life. However, only 27.1% of the women with urinary incontinence and related symptoms in this study had reported seeking medical services to solve these problems. CONCLUSIONS: The prevalence of urinary incontinence and overactive bladder in Taiwanese women is similar to that of Western women.     

Impact of self-perceived bothersomeness on health-related quality of life in women with overactive bladder symptoms

INTRODUCTION: The objective of this study was to examine the impact of self-perceived bothersomeness of overactive bladder (OAB) symptoms on the health-related quality of life (QOL). PATIENTS AND METHODS: A total of 92 women with a mean age of 53.3 (range 23-79) years suffering from OAB were included in the study. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and King's Health Questionnaire (KHQ) were used to assess the QOL. The patients were divided into two groups according to the bothersomeness degree of OAB: 'low' and 'moderate' to 'high'. RESULTS: The SF-36 and the KHQ scores of the patients were significantly different from those of the controls (p <0.05), except for three domains of the SF-36. No difference in the results of the frequency-volume charts was observed between the two patient groups. The scores of the SF-36 and the KHQ domains did not correlate with the data of the frequency-volume charts. Significant differences were found between the two patient groups for most domains of the SF-36 (p <0.05). Significant differences were also detected in most domains of the KHQ (p <0.05). CONCLUSIONS: Objective data are not a sensitive tool for measuring the QOL in women with OAB symptoms. Our findings suggest that patient-perceived bothersomeness significantly influences QOL and that strategies for assessing bothersomeness should be developed to evaluate the QOL in these patients.     

Multimodal vaginal toning for bladder symptoms and quality of life in stress urinary incontinence

Introduction and hypothesis

Treatment options for women with stress urinary incontinence (SUI) have limitations. We hypothesized that multimodal vaginal toning therapy would improve bladder symptoms and quality of life in women with postpartum SUI and sexual function complaints.

Methods

Patients self-administered 24 sessions of multimodal vaginal toning therapy lasting 10 min each over 50 days. Outcomes included 1-h pad weight test, Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire-Short Form (IIQ-7), Female Sexual Distress Scale-Revised 2005 (FSDS-R), Female Sexual Function Index (FSFI), pelvic floor muscle strength, patient satisfaction, and adverse events.

Results

Of the 55 patients enrolled (safety population), 48 completed the study per-protocol (PP population). A total of 38 (79%) patients had a positive 1-h pad weight test at baseline. In this group, urine leakage was moderate or severe in 82% of patients at baseline, but in only 18% after treatment. Treatment success was 84%, defined as >50% improvement in pad weight relative to baseline. In the PP population, mean UDI-6 score improved by 50% (p?<?0.001) and IIQ-7 score improved by 69% (p?<?0.001). Sexual function quality of life improved by 54% for FSDS-R and 15% for FSFI (both p?<?0.001). Pelvic floor muscle strength significantly improved (p?<?0.001). Patient satisfaction with therapy was reported in 83% of patients. In the safety population, 2 (3.6%) adverse events were reported—1 urinary tract infection and 1 report of discomfort due to excessive warmth.

Conclusions

Multimodal vaginal toning therapy yields clinically meaningful improvements in bladder symptoms, pelvic floor muscle strength, and quality of life in women with SUI.

     

The effect of concealed concomitant anal incontinence symptoms in patients with urinary incontinence on their quality of life

Introduction and hypothesis

We evaluated the bother of concomitant anal incontinence (AI) in women with urinary incontinence (UI) who do not primarily report their anal symptoms.

Methods

This prospective study assessed patients with complaings of primary UI without initially reporting anal symptoms. After urogynecological assessment, all patients were asked to complete the validated versions of the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Pelvic Floor and Incontinence Sexual Impact Questionnaire (PISQ-12), Wexner Incontinence Scale (WIS) score, and Beck Anxiety Inventory (BAI). Patients who scored nil in the WIS constituted the group of only UI, and patients with scores ≥1 were grouped as double incontinence (DI)., and the groups were compared.

Results

Among 136 women, 69.1 % (94) had only UI, whereas 30.9 % (42) had DI. There were no differences in age, parity, body mass index (BMI), and prolapse status between patients with UI and those with DI, except menopausal status. Women with DI scored worse for IIQ-7, PISQ-12, and BAI questionnaires compared with women with UI. This difference was not statistically significant for IIQ-7 only.

Conclusions

Our data show that concealed AI symptoms may contribute to the anxiety of the patient and even alter the perception of urinary symptoms. Actually, a significant number of women suffer from DI without reporting their anal symptoms, which results in underdiagnosing of concomitant AI. To prevent the suboptimal management of patients with lower urinary tract symptoms, standardized questionnaires for AI should be included in the evaluation of all patients with lower urinary tract symptoms.     

Impact of duloxetine on quality of life for women with symptoms of urinary incontinence

The objective of this study was to evaluate the effectiveness of duloxetine in improving quality of life among women with stress and mixed urinary incontinence. The study included 451 women with self-reported stress incontinence episodes (>or=1/week) who were randomized to duloxetine (40 mg BID) or placebo in a double-blind, usual care design. Patients and physicians were allowed to titrate, augment, and/or discontinue treatment. Concomitant treatments were permitted. The primary outcome was the Incontinence Quality of Life Questionnaire (I-QOL) score, with assessments at 3, 6, and 9 months. Other measures included the Patient Global Impression of Improvement (PGI-I) and adverse events. The adjusted mean change in I-QOL total score was greater in the duloxetine group than in the placebo group and at a level comparable to that found in previous clinical trials, but the difference between placebo and duloxetine was not statistically significant in the intent-to-treat, last observation carried forward (LOCF) analysis. The difference approached statistical significance in favor of duloxetine at 3 months (p=0.07). PGI-I ratings did not demonstrate significant superiority for duloxetine in LOCF analysis; however, study completers taking duloxetine were significantly more likely to rate themselves as "better" (70.2%) than completers taking placebo (50.8%, p<0.05). Women utilized a variety of treatment methods including pelvic floor muscle training, estrogen, anticholinergic medication, weight reduction, and smoking cessation. In this study, while mean I-QOL change scores were numerically higher for the duloxetine group than mean change scores for the placebo group, this difference was not statistically significant. Among women who completed the study on study drug, a significantly greater proportion of duloxetine women versus placebo women rated their condition to be better.     

Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction

Study Type – Symptom prevalence (prospective cohort) Level of Evidence 1b What’s known on the subject? and What does the study add? Few prevalence studies used current ICS LUTS symptom definitions and to our knowledge no studies exist that estimate total worldwide prevalence of reported LUTS symptoms. One of the primary goals of this analysis was to estimate current and future worldwide prevalence of LUTS among adults. Our estimation model suggests that LUTS are highly prevalent worldwide, with an increasing burden predicted over time.

OBJECTIVE

? To estimate and predict worldwide and regional prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence (UI) and LUTS suggestive of bladder outlet obstruction (LUTS/BOO) in 2008, 2013 and 2018 based on current International Continence Society symptom definitions in adults aged ≥20 years.

PATIENTS AND METHODS

? Numbers and prevalence of individuals affected by each condition were calculated with an estimation model using gender‐ and age‐stratified prevalence data from the EPIC study along with gender‐ and age‐stratified worldwide and regional population estimates from the US Census Bureau International Data Base.

RESULTS

? An estimated 45.2%, 10.7%, 8.2% and 21.5% of the 2008 worldwide population (4.3 billion) was affected by at least one LUTS, OAB, UI and LUTS/BOO, respectively. By 2018, an estimated 2.3 billion individuals will be affected by at least one LUTS (18.4% increase), 546 million by OAB (20.1%), 423 million by UI (21.6%) and 1.1 billion by LUTS/BOO (18.5%). ? The regional burden of these conditions is estimated to be greatest in Asia, with numbers of affected individuals expected to increase most in the developing regions of Africa (30.1–31.1% increase across conditions, 2008–2018), South America (20.5–24.7%) and Asia (19.7–24.4%).

CONCLUSIONS

? This model suggests that LUTS, OAB, UI and LUTS/BOO are highly prevalent conditions worldwide. Numbers of affected individuals are projected to increase with time, with the greatest increase in burden anticipated in developing regions. ? There are important worldwide public‐health and clinical management implications to be considered over the next decade to effectively prevent and manage these conditions.     

北京地区成年女性膀胱过度活动症流行病学调查及对患者生活质量的影响

目的 调查北京地区成年女性膀胱过度活动症(OAB)的患病情况、相关危险因素及对患者生活质量的影响. 方法 对北京市西城、海淀、石景山及昌平区各3个社区≥18岁的2973名女性进行排尿情况问卷调查.符合2002年国际尿控协会(ICS)OAB最新定义的调查对象进一步填写King健康问卷,通过King健康问卷分数评估OAB对患者生活质量的影响程度. 结果 共获得完整有效问卷2379份(80.0%),被调查对象年龄18～90(43±12)岁.OAB总患病率为4.7%(112/2379),18岁～、30岁～、40岁～、50岁～、60岁～及≥70岁年龄组的患病率分别为2.2%、2.1%、4.7%、7.9%、9.8%及9.1%,城区患病率为2.0%,郊区为8.1%.多因素Logistic回归分析结果 显示:年龄(OR=1.033,95%CI=1.016～1.051)、居住地区(OR=3.479,95%CI=2.184～5.541)、BMI(OR=1.155,95%CI=1.031～1.294)、焦虑程度(OR=3.635,95%CI=1.947～6.785)是成年女性OAB患病的危险因素.King健康问卷得分较高的项目为:一般健康状况(33.7±19.8)、睡眠/精力(31.3±27.6)及尿失禁程度(26.8±28.2). 结论 北京地区≥18岁女性OAB患病率为4.7%,低于西方国家,郊区高于城区,并随着年龄、BMI及焦虑程度的增加而呈明显上升趋势.OAB严重影响了成年女性的生活质量.     

Efficacy of tolterodine on overactive bladder symptoms and sexual and emotional quality of life in sexually active women

We evaluated overactive bladder (OAB) symptoms and sexual and emotional health in sexually active women with OAB/urgency urinary incontinence (UUI) treated with tolterodine extended release (ER). Sexually active women with OAB symptoms were randomized to placebo or tolterodine ER. Five-day bladder diaries, Sexual Quality of Life Questionnaire—Female (SQOL-F), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), and Hospital Anxiety and Depression Scale (HAD) were completed at baseline and week 12. Tolterodine ER (n = 201; mean ± SD age, 49 ± 12 years) reduced UUI episodes (P = 0.0029), total (P = 0.0006) and OAB (P < 0.0001) micturitions, and pad use per 24 h (P = 0.0024), and was associated with improvements in SQOL-F (P = 0.004), PISQ total (P = 0.009), and HAD Anxiety (P = 0.03) scores versus placebo (n = 210; mean ± SD age, 47 ± 12 years). OAB symptoms improved with tolterodine ER as did the scores of sexual health and anxiety measures in sexually active women with OAB.     

Minimal clinically important change in urinary incontinence detected by a quality of life assessment tool in overactive bladder syndrome with urge incontinence

AIMS: The objective of this research was to detect a minimal clinically important change (MCIC) in frequency of incontinence episodes in Japanese patients with overactive bladder syndrome (OAB) based on the change in domain scores of health-related quality of life (HRQoL). METHODS: The patients (n = 659) enrolled for the 8 weeks, randomized, double-blind, placebo-controlled study of an oxybutynin transdermal patch were used for the analysis. The endpoints of the study were the change in frequency of incontinence episodes and the domain scores of King's health questionnaire (KHQ) from baseline to the end of treatment. To search a threshold of the change of incontinence frequency that apparently improves patient's quality of life (QOL), we calculated mean changes of selected five KHQ domain scores for nine patient groups divided by the amount of change of incontinence frequency. A minimum value of the change of incontinence frequency in the groups with apparent improvement in the QOL scores was defined as an MCIC of incontinence frequency. RESULTS: The apparent improvement of KHQ domain scores was seen in the patient groups whose incontinence episodes decreased more than three times per week (/w) after treatment. This result was common in almost all domain scores, but more relevant for the domains related to patients' life limitations. CONCLUSION: Japanese OAB patients can feel their QOL improved if their incontinence episodes decrease more than 3 times/w. This suggests that the reduction of '3 times /w' is an MCIC of incontinence frequency for Japanese OAB patients.     

Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women

Introduction and hypothesis  

This study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females.