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ORIGINAL ARTICLE
Adv Biomed Res 2015,  4:205

Potential risk factors associated with stress urinary incontinence among Iranian women


1 Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Urology, Kidney Transplantati on Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission18-May-2014
Date of Acceptance17-Aug-2014
Date of Web Publication28-Sep-2015

Correspondence Address:
Mahtab Zargham
Department of Urology, Kidney Transplantati on Research Center, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan
Iran
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Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.


DOI: 10.4103/2277-9175.166141

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  Abstract 

Background: Stress urinary incontinence (SUI) is considered as one of the major hygienic problems among women. The main aim of the study is to assess the potential risk factors associated with SUI among Iranian women.
Materials and Methods: This study was conducted on 90 married women with history of SUI diagnosed by an urologist and were selected randomly. Their pelvic muscles contraction (PMC) and the history of the subjects were assessed for some of risk factors such as age, height, weight, body mass index (BMI), pregnancy history, miscarriage, type of delivery (normal vaginal delivery or cesarean section), number of offspring born healthy in addition to other risk factors such as chronic cough, constipation and hypothyroidism by use of POP Questionnaire. Data were analyzed using Pearson correlation coefficient and SPSS version 18 Software.
Results: There was a significant relation between SUI and height (P < 0.05, r = 0.45), vaginal delivery (NVD) (P < 0.05, r = 0.2), number of genitourinary surgery (P < 0.05, r = 0.42), hypothyroidism and constipation (P < 0.05). An inverse relatively strong significant relation was found between SUI and cesarean section (P < 0.05, r = –0.50) No significant relation was found between SUI and weight, BMI, age, chronic cough and miscarriage, and other study parameters. An inverse significant relation between PMC and weight (P < 0.05, r = –0.52), BMI (P < 0.05, r = –0.42) and number of genitourinary surgery (P < 0.05, r = –0.18).
Conclusion: Cesarean section had a preventive effect on SUI versus normal vaginal delivery. The rate of SUI was higher in taller women or those suffering from hypothyroidism or constipation or who had genitourinary surgery. The women with high BMI had lower pelvic floor muscles strength.

Keywords: Biofeedback, risk factors, stress urinary incontinence


How to cite this article:
Vahdatpour B, Zargham M, Chatraei M, Bahrami F, Alizadeh F. Potential risk factors associated with stress urinary incontinence among Iranian women. Adv Biomed Res 2015;4:205

How to cite this URL:
Vahdatpour B, Zargham M, Chatraei M, Bahrami F, Alizadeh F. Potential risk factors associated with stress urinary incontinence among Iranian women. Adv Biomed Res [serial online] 2015 [cited 2019 Aug 22];4:205. Available from: http://www.advbiores.net/text.asp?2015/4/1/205/166141


  Introduction Top


Urinary incontinence is the unintentional passing of urine. It may not be so weighty in some situations and in slight volume, but it may result in disappointment and anxiety particularly among women. Since the disorder is more common among females compared to males due to the distinctions of their body structure and specifically pregnancy issue, there has been specific attention given to this disease among females. As some various changes occur after labor, the women are more susceptible to disease due to the decrease in their pelvic floor muscles contractions.[1],[2],[3] It has been confirmed that 10% to 30% of women of age group 15-46 years and 50% of patients in care centers suffer from urinary incontinence [4], with the number increasing with advancing age. As a result, we observe that 30% to 50% of women over 65 years complain of this disorder.[5] Various factors are involved in SUI occurrence, such as decrease pelvic floor muscles contractions, heavy exercises and physical activities, aging, menopause, number of deliveries, type of labor, increase weight, constipation, chronic coughs and many more factors.[6],[7] The risk of developing SUI among obese women with a body mass index of 30 or more (MBI ≥30) regardless of age and number of deliveries is twice compared to underweight women.[8] Thirty four percent of people diagnosed with SUI suffer from mental and social disorders such as depression, insomnia and other related problems. These factors negatively affect their social and sexual life.[9] Therefore, due to the substantial importance of these problems, it is vital to identify potential risk factors on developing the disorder with the intention of preventing them or at least lower their effects. Hence, the aim of the research is to assess and evaluate relation of potential risk factors and SUI among Iranian women.


  Materials and Methods Top


This is a cross-sectional study, which was carried out from November 2012 to May 2013 among the married women who had more than 18 years of age that were referred to Urology Clinics of affiliated hospitals of Isfahan Medical Sciences, Iran, and were diagnosed with SUI by use of clinical examination (Marshall Test and Positive Cough Test), Pad Test (the weight gain of more than 8 g/24 h has been considered to be significant) and if the previous test results were not reliable, urodynamic tests was done for the cases. Among them, 90 women were selected by simple random sampling and by biofeedback device using a computer and electronic instruments to let an individual know when the pelvic muscles are contracting. The pelvic floor muscles strength were measured through the vaginal probes, which were specified for each patients. POP Questionnaire was completed for each patient consisting of information such as age, height, weight, body mass index (BMI), history of pregnancy and delivery (number of conceptions, number of offspring delivered healthy, number of miscarriage, genitourinary surgery, and other potential risk factors such as smoking cigarette, hypothyroidism, chronic cough and constipation. Collected data were recorded and analyzed using SPSS 18 Software and relevant statistical tests, such as Pearson correlation coefficient, were applied to assess the relationship between these factors and SUI. A P < 0.05 was considered as significant level in these statistical methods.


  Results Top


The total number of patients in this study was 90 individuals, aging 43 to 53 years (mean: 48 years). The range of the sample height was 156-167 cm (mean: 162 cm). The range of our subjects' weight was 60.4-79 kg (mean: 69.9 Kg). Average BMI was 26.7 ± 3.5. Given the results in [Table 1], we evaluate the relation between risk factors and SUI and PMC.
Table 1: Pearson correlation coefficient for pelvic floor contractions and SUI with some risk factors

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Pearson correlation coefficient revealed a direct significant relation between SUI and height (P < 0.05, r = 0.45), vaginal delivery (NVD) (P < 0.05, r = 0.2), number of genitourinary surgery (P < 0.05, r = 0.42), hypothyroidism and constipation (P < 0.05). On the other hand, an inverse relatively strong significant relation was found between SUI and cesarean section (P < 0.05, r = –0.50). That is, as the number of cesarean section increases, likelihood of developing SUI decreases. In addition, No significant relation was found between SUI and weight, BMI, age, chronic cough and miscarriage, and other study parameters. Also, this correlation demonstrated an inverse significant relation between PMC and weight (P < 0.05, r = –0.52), BMI (P < 0.05, r = –0.42) and number of genitourinary surgery (P < 0.05, r = –0.18).


  Discussion Top


The study provides evidences that there is a direct and significant relation between height and rate of urine leakage. However, it has not been proven that there is a relationship between height and having bigger pelvic bone but it seems, taller women have pelvic bone with higher diameter. Increase of pelvic bone diameter results on higher consistency between anatomic position of pelvic internal organs and pelvic floor muscles and levator ani muscle. So with aging and increasing number of delivery, taller women with wider pelvic bone are more prone to develop prolapse and weakening of pelvic floor muscles and consequently the possibility for urinary incontinence and increase severity of the complications.[10],[11],[12],[13] There was an direct relation between NVD and SUI and also inverse relation between urine leakage and number of cesarean section among sample patients, and because actually, NVD considers an actual factor in causing prolapse of pelvic floor muscles and increasing SUI development, cesarean section which considers a replacement to NVD and there has been a tendency toward cesarean section selectively forfirst pregnancy or consecutive pregnancies in hope to prevent or decrease urinary incontinence and involuntary stool elimination, vaginal prolapse or hemorrhoids.[14],[15],[16],[17] Other obtained result from this study was the inverse relation between pelvic floor muscle contractions and BMI among patients. Other study has also shown a significant relation between urinary incontinence and BMI increase that affect the quality of life of patients negatively, and obese women and those women that do not exercise regularly are more susceptible to urinary incontinence.[18],[19],[20] In fact, it is expected a decrease on pelvic floor muscles contractions with BMI increase, which was agreed by our study too, and consequently more potential risk for urine leakage. However, the result was not fruitful in this second part of study as no significant relation was found between BMI and urine leakage and a need for in depth study was felt.[11],[21] In this research population, we had found 16% for incidence of hypothyroidism; in comparison with general women population (about 10%)[22] direct significant relationship between hypothyroidism and the SUI had been demonstrated. So according to the previous studies there is a definite relation between thyroid and voiding dysfunction.[23]

Complications in pelvic floor muscles function affect women with various ages and have a wide range of signs and symptoms that is rarely separable and some predisposing factors include pregnancy, birth trauma, increase age, hysterectomy and lifestyle.[18],[24] Therefore, it is fundamental to provide some guidance in educational programs for women health benefit.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Lemone P, Burke K. Medical-Surgical Nursing. 3rd ed. New Jersey: Pearson Education; 2004. p. 733-5.  Back to cited text no. 1
    
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Holroyd-Ledue JM, Straus SE. Management of urinary incontinence in women. Scientific review. JAMA 2004;297:986-95.  Back to cited text no. 2
    
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Abreu NS, Baracho ES, Tirado MG, Dias RC. Quality of life from the prespective of elderly women with urinary incontinence. Rev Bras Fisioter, São Carlos 2007;11:429-36.  Back to cited text no. 3
    
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Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29:4-20.  Back to cited text no. 4
    
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Jonathan BF. Novak's Gynecology. 13th ed. Wolters Cluver, Alphen aan den Rijn, South Holland, Netherlands, 2002 p. 637-86.  Back to cited text no. 5
    
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Littleton L, Engebretson J. Maternal, Neonatal and Women's Health Nursing. Albany, NY: Delmar Thomson Learning Inc.; 2002. p. 245.  Back to cited text no. 6
    
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Henalla SM, Kirwan P, Castleden CM, Hutchins CJ, Breeson AJ. The effect of pelvic floor exercises in the treatment of genuine urinary stress incontinence in women at two hospitals. Br J Obstet Gynaecol 1998;95:602-6.  Back to cited text no. 8
    
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Wilson PD, Al Samarrai T, Deakin M, Kolbe E, Brown AD. An objective assessment of physiotherapy for female genuine stress incontinece. Br J Obstet Gynaecol 1987;94:575-82.  Back to cited text no. 9
    
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Mouritsen L. Pelvic floor exercise for female stress urinary incontinece. Int Urogynecol J 1994;5:44-51.  Back to cited text no. 10
    
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Cammu H, van Nylen M. Pelvic floor muscle exercises: 5 years later. Urology 1995;45:113-8.  Back to cited text no. 11
    
12.
Berghmans LC, Frederiks CM, de Bie RA, Weil EH, Smeets LW, van Waalwijk van Doom ES, et al. Efficacy of biofeedback, when included with pelvic floor muscle exercise treatment, for genuinc stress incontinence. Neurourol Urodyn 1996;15:37-52.  Back to cited text no. 12
    
13.
Glavind K, Nøhr SB, Walter S. Biofeedback and physiotherapy versus physiotherapy alone in treatment of genuine stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996;7:339-43.  Back to cited text no. 13
    
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Bastana KN. Electrotherapy Simplifield. 1st ed. India: Jaypee Brothers Medical Publishers; 2008. p. 148-206.  Back to cited text no. 14
    
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Fantl JA, Newman DK, Colling J, DeLancey JO, Keeys C, Loughery R, et al. Urinary incontinence in adults: Acute and chronic management. Clinical Practice Guideline No. 2. US Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. Rockville, MD: AHCPR Publication; 1996. p. 16.  Back to cited text no. 15
    
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Stein M, Discippio W, Davia M, Taub H. Biofeedback for the treatment of stress and urge incontinence. J Urol 1995;153:641-3.  Back to cited text no. 16
    
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Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of kegel muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 1991;165:322-9.  Back to cited text no. 17
    
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Wyman JF, Fantl JA, McClish DK, Harkins SW, Uebersax JS, Ory MG. Quality of life following bladder training in older women with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1997;8:223-9.  Back to cited text no. 18
    
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Burns PA, Pranikoff K, Nochajski TH, Hadley EC, Levy KJ, Ory MG. A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. J Gerontol 1993;48:M167-74.  Back to cited text no. 19
    
20.
Glavind K, Nøhr SB, Walter S. Pelvic floor training using biofeedback for muscle awareness in the treament of stress urinary incontinence: Preliminary results. Int Urogynecol J 1992;3:288-91.  Back to cited text no. 20
    
21.
Sung MS, Hong JY, Choi YH, Baik SH, Yoon H. FES-Biofeedback versus intensive pelvic floor muscle exercise for the prevention and prevention and treatment of genuine stress incontinence. J Korean Med Sci 2000;15:303-8.  Back to cited text no. 21
    
22.
Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull 2011;99:39-51.  Back to cited text no. 22
    
23.
Alizadeh F, Zargham M, Nouri-Mahdavi K, Khorrami MH, Izadpanahi MH, Sichani MM. Bladder involvement in thyroid dysfunction. J Res Med Sci 2013;18:167.  Back to cited text no. 23
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24.
Burns PA, Pranikoff K, Nochajski TH, Desotelle P, Harwood MK. Treament of stress incontinence with pelvic floor exercises and biofeedback. J Am Geriatr Soc 1990;38:341-4.  Back to cited text no. 24
    



 
 
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