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Try out PMC Labs and tell us what you think. Learn More. Bowel symptoms, pelvic organ prolapse, and sexual dysfunction are common, but their frequency among women with lower urinary tract symptoms LUTS has not been well described. Our aims were to describe pelvic floor symptoms among women with and without urinary incontinence UI and among subtypes of UI.
Mean age among the women was Women presenting with LUTS with UI reported ificantly worse constipation, diarrhea, fecal incontinence, and sexual function compared to women without UI. Symptoms of pelvic-floor disorders including constipation, diarrhea, and fecal incontinence as well as pelvic organ prolapse and sexual dysfunction are common in women.
These disorders occur concurrently with urinary incontinence UI ; however, the relationship has not been well described. Pelvic floor dysfunction is common to all of these disorders which is why aging and childbirth which both affect the pelvic floor are factors that concurrently affect multiple pelvic floor organs in adult women.
It has been reported that women with difficult defecation have more urinary urgency Ladies seeking nsa Bradley Michigan frequency, but not UI; however, this is controversial 1. Women with obstetrical anal injury are at increased risk not only for fecal incontinence but also stress urinary incontinence SUI 2. Pelvic organ prolapse has consistently been associated with urinary urgency and urgency incontinence UUIwith the relationship possibly being causal since correction of the prolapse or placement of a pessary can relieve these bladder symptoms 3.
Also, the relationship between prolapse and SUI is complex, as SUI often occurs concurrently with prolapse, but prolapse may also be protective as correction of prolapse often unmasks occult SUI 4. The association between UI and sexual activity remains uncertain. Prior studies have provided conflictingwith patient age and partner status as possible ificant factors 56. The aims of this study were: 1 to determine the relationships between bowel symptoms including constipation, diarrhea, and fecal incontinence, prolapse symptoms, and sexual function among women seeking care for lower urinary tract symptoms LUTS ; and 2 to evaluate whether the presence of UI, or UI subtype, is associated with the severity of these symptoms.
Details of this cohort study have been ly reported 8. Data collection at the baseline visit for women included a standardized clinical examination including pelvic examination with Pelvic Organ Prolapse Quantitation POP-Qassessment of pelvic floor muscle strength with the Oxford scale, urinalysis, and measurement of post-void residual. Medical history including functional comorbidity index FCIpatient-reported symptoms of LUTS, pelvic floor symptoms, and psychological symptoms was also collected. Quality of life was obtained by validated questionnaires 10 — For each study participant, the weighted Euclidean length square root of sum of squared responses was calculated to form a UI severity score range 1.
Questions were weighted by the ratio of the average correlation between a given question and all other questions to the total average correlation so that less weight was Ladies seeking nsa Bradley Michigan to questions that had high correlation with other questions e.
Each scale is scored 0— with a higher score indicating greater bother. The PISQ-IR measures sexual function in women with pelvic floor disorders separately for sexually and not sexually active women. A higher score on the subscale indicates better sexual function. One exception was fecal incontinence, which uses a raw score as the metric. Characteristics of the participants are shown as means, standard deviations, frequencies, and percentages.
Tests for differences by group were performed using chi-square tests and Ladies seeking nsa Bradley Michigan two-sample tests or Kruskal-Wallis tests. Multivariable linear regression was used to test for associations between incontinence status Ladies seeking nsa Bradley Michigan vs. Candidate covariates included age, race, ethnicity, body mass index BMIeducation, employment status, smoking status, diabetes, sleep apnea, functional comorbidity index FCImenopausal status with and without hormone usehistory of psychiatric diagnosis, brain or spinal surgery, more than two urinary tract infections in the past year by self-report, hysterectomy, any vaginal births, and alcohol consumption.
Best subset selection guided covariate selection for all models. All p-values were adjusted for multiple comparisons using the false discovery rate FDR correction. All analyses were conducted using SAS 9. Among women recruited from the six sites, with complete responses to the 7 LUTS Tool questions required for UI subtyping were included in the present analyses.
Mean age was Mean BMI was A median of two vaginal births was reported. The mean functional comorbidity index was 2. UI Severity by subtype. UI severity was calculated as the weighted Euclidean distance square root of sum of squared responses of 7 LUTS Tool incontinence questions.
Weights were calculated using the ratio of average correlation of a given question to the average total correlation of all 7 questions in order to for potential redundancy in questions. In terms of sexual dysfunction, only a few of the PISQ subscales were ificantly different between groups.
These differences remained ificant after covariate adjustment Supplemental Table 1. On multivariable linear regression of these bowel function measures adjusted for other statistically ificant covariates Supplementary Table 2these were only minimally changed. Full models are available in Supplemental Table 3. We report the relationships between UI and other pelvic floor symptoms and quality of life measures, including bowel, prolapse, and sexual function, in over women seeking care for LUTS.
Overall, our show that in women with LUTS: 1 the presence of UI is associated Ladies seeking nsa Bradley Michigan constipation and poor sexual function; 2 MUI is associated with worse fecal incontinence, diarrhea, pelvic organ prolapse symptoms, and sexual function compared to SUI; and 3 more severe Ladies seeking nsa Bradley Michigan symptoms, regardless of UI subtype, are associated with worse bowel function fecal incontinence, diarrhea, constipationpelvic organ prolapse symptoms, and sexual function.
Although it is well known that UI adversely affects sexual function in women, less is known about the effects of UI subtypes. Conflicting were reported in three studies, which identified UI subtypes by urodynamic testing and assessed sexual function in sexually active women through PISQ scores 67 The third study found no difference in sexual function between all three UI subtypes All of these studies were limited by small sample sizes and their were not adjusted for potentially important covariates, such as age, BMI, and comorbidities.
In contrast to these priorwe found poorer sexual function in women with MUI among sexually active women, but no large differences in function between stress and urgency UI subtypes using a much larger sample of women and multivariable analysis. The association between pelvic organ prolapse and UI has pathophysiological basis.
UUI may also have a strong relationship to pelvic organ prolapse 17 since POP may cause bladder outlet obstruction and overactive bladder symptoms. A large cystocele may also put traction on the urethra, resulting in an open urethra. Surgical repair of pelvic organ prolapse has been shown to improve UUI in the majority of patients 3. Thus, our finding that increasing UI severity was associated with more distress from prolapse symptoms was not surprising. Regarding bowel function, past studies have similarly demonstrated that constipation, difficult defecation, and fecal incontinence occur commonly in women with LUTS 20 — However, there have only been a few studies that have examined the effects of UI subtypes on bowel dysfunction.
Meschia et al. We have also demonstrated increased bowel dysfunction fecal incontinence and diarrhea in women with mixed UI, compared to SUI. Our strengthen these prior findings with the use of validated PROMIS questionnaires rather than a non-validated screening questionnaire to assess the bowel symptoms and multivariable analysis to adjust for potential confounding variables. There are several theoretical explanations for the association between bowel and bladder dysfunction. Both the bladder and bowel originate embryologically from the same cloaca and, given the proximity of the bowel and bladder in the pelvis, a distended rectal vault could have a mass effect on the bladder.
Both the distal bowel and bladder share afferent Ladies seeking nsa Bradley Michigan, as well, explaining why sacral neuromodulation is used to treat both bowel and bladder incontinence.
Studies on the treatments of one organ resulting in a positive impact on other pelvic organs are lacking in adults. Ladies seeking nsa Bradley Michigan, it has been clearly demonstrated that aggressive treatment of constipation in children with dysfunctional elimination without any Ladies seeking nsa Bradley Michigan intervention frequently in resolution of UI These theories may explain why women with MUI have worse bowel function since they likely have combined anatomic loss of support and neurologic deficits.
Our study has several important strengths. First, we used a condition-specific questionnaire PISQ to assess sexual function in women with pelvic floor disorders. The questionnaire has undergone validation in this patient population and assesses both sexually active and non-active women Finally, unlike many studies that were typically from a single center with small sample size, we have recruited a large of women prospectively across several sites; this may enhance the generalizability of our findings to other care-seeking women in different clinical care settings.
Our study has several limitations. As it entails cross-sectional comparisons, the causal relationship of one symptom to another cannot be inferred. Also, patients were recruited at tertiary academic centers with expertise in managing LUTS.
Thus, our may be less generalizable to women who seek treatment with community urologists, gynecologists, or primary care physicians. Finally, the UI severity measure reported here has not been validated and therefore regarding UI severity may not be reproducible in other populations.
Our findings suggest that health care providers should question their patients seeking care for LUTS to identify and manage co-occurring pelvic floor dysfunctions. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The following individuals were instrumental in the planning and conduct of this study at each of the participating institutions:. Helfand, Ms. Talaty, and Ms. Washington University in St. Louis, St. Andriole, MD, H. Disclosures: See separately ed forms. National Center for Biotechnology InformationU.
Neurourol Urodyn. Author manuscript; available in PMC Nov 1. Anne P. CameronMD, 1 Abigail R. SmithPhD, 2 H. GillespiePhD, 1 Cindy L. GriffithPhD, 7 Jonathan B. WisemanMS, 2 Karl J. HelmuthMA, 2 Matthew O. FraserPhD, 6 J. KusekPhD, 9 Nazema Y. Abigail Ladies seeking nsa Bradley Michigan. Louis, MO Find articles by H. Henry Lai. Catherine S. Alice B. Robert M. Brenda W. Cindy L. James W. Jonathan B. Karl J. Kimberly S.Ladies seeking nsa Bradley Michigan
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Bowel Function, Sexual Function, and Symptoms of Pelvic Organ Prolapse in Women with and Without Urinary Incontinence