Prevalence, impact and specialised treatment of urinary incontinence in women with chronic lung disease
Introduction
Symptoms of pelvic floor dysfunction are commonly experienced in women in the general population, are known to be underreported and have an adverse impact on quality of life [1]. These include urinary incontinence (incontinence) which is defined as the complaint of involuntary loss of urine and may be classified in conjunction with urgency, or as stress incontinence if associated with physical exertion, sneezing or coughing [2]. Known risk factors for the development of incontinence include increasing age, obesity and sex. Prevalence estimates range from 7 to 37% in women aged 20 to 39 years, up to 30 to 61% in women aged 60 to 79 years, and are also affected by parity [3]. Women with chronic lung conditions may have disease-specific features, particularly chronic cough, which may result in the frequent report of symptoms of incontinence observed in clinical practice; however, to date there has been no direct comparison to healthy age-matched contemporaneous women without chronic lung disease.
Cystic fibrosis (CF) is characterised by the production of tenacious pulmonary secretions and chronic cough ultimately resulting in respiratory failure [4]. Significant improvements in treatment mean that people with CF may now live into their sixth decade. Current emphasis of treatment is not only increasing survival, but also improving quality of life. Previous work investigating incontinence in women with CF has reported predominantly stress incontinence and prevalence rates ranging between 30% and 76% [5], [6], [7], [8], [9], [10] and an association with impaired quality of life [9], [10].
Chronic obstructive pulmonary disease (COPD) is characterised by persistent and usually progressive airflow limitation leading to the development of symptoms including dyspnoea, chronic cough and sputum production [11]. ‘Urinary incontinence’ has a notable association with worse self-rated health in people with COPD, amongst other comorbid conditions which include diabetes and arthritis [12]. One group has previously demonstrated 49% prevalence of UI in women with COPD [13] with an adverse impact on quality of life [14].
There has also been limited investigation of the effect of treatment in women with chronic lung disease. It is not clear whether standard pelvic floor strengthening programs would be as effective in this group as in other populations, given the higher load on pelvic floor muscles generated by chronic cough. Improved pelvic floor muscle endurance has been demonstrated following physiotherapy intervention in women with CF [15], but there are no studies reporting pelvic floor muscle function and quality of life before and after specialised physiotherapy treatment in these patient populations.
The aims of the study were: (1) to determine the prevalence of incontinence symptoms in women with chronic lung disease (CF and COPD) compared to healthy women; (2) to assess the impact and ‘bother’ associated with these symptoms; (3) to identify risk factors for the development of incontinence; and (4) to provide preliminary data for the impact of a standard course of specialised physiotherapy treatment on symptoms of incontinence in women with chronic lung disease.
Section snippets
Design
These prospective observational and pilot intervention studies received institutional ethics approvals from Alfred Health, La Trobe University and the University of Melbourne. All participants provided informed written consent.
Participants
Inclusion criteria were women aged 18 to 70 years who were able to read and write in English so to enable self-completion of the questionnaires. Women with a medical diagnosis of COPD or CF (conventional methods) were eligible in the absence of current symptoms suggestive
Prevalence study
Questionnaires were completed by 134 participants (CF n = 38, COPD n = 27, healthy women n = 69). Demographic features of the groups of women with chronic lung disease were similar to the clinic profiles. Of these participants, four women with CF and six women with COPD went on to participate in the treatment study.
The majority of women in all three groups reported episodes of incontinence (CF 27/38, 71%; COPD 19/27, 70%; healthy women 38/69, 55%; Table 1). Only 3/38 (8%) of women with CF were
Discussion
This is the first study to compare the prevalence of different types of pelvic floor dysfunction in women with chronic lung disease (CF and COPD) with contemporaneous age-matched healthy women. Women with CF reported more incontinence than the age-matched group, with stress incontinence the most common type. Whilst women with COPD were not significantly different from their age-matched group in terms of prevalence of symptoms, these women reported higher levels of bother with their symptoms of
Acknowledgements
We are greatly indebted to all of the women who underwent demanding assessments and treatment and paved the way for effective treatment of incontinence in the future.
Ms Zoe McLachlan for assistance in recruitment of patients and assessment with ultrasound.
Ethical approval: This study received approval from the Human Research Ethics Committees at the Alfred Hospital (108/01).
Funding: Department of Health and Aged Care. National Continence Foundation of Australia.
Conflict of interest: None
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