URINARY INCONTINENCE AMONG OBESE WOMEN: A CROSS- SECTIONAL STUDY

Transcription

1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Aisha et al. SJIF Impact Factor Volume 6, Issue 9, Research Article ISSN URINARY INCONTINENCE AMONG OBESE WOMEN: A CROSS- SECTIONAL STUDY Parveen Aisha 1 * and Nirupma Singh 2 1 Department of PSM, Faculty of Medicine (U), Jamia Hamdard. 2 Physiotherapist, Jamia Hamdard. Article Received on 05 July 2017, Revised on 26 July 2017, Accepted on 15 August 2017 DOI: /wjpps *Corresponding Author Dr. Parveen Aisha Department of PSM, Faculty of Medicine (U), Jamia Hamdard. ABSTRACT Background: Obesity and Urinary Incontinence (UI) are both common disorders. The prevalence of obesity is on the rise worldwide. Obesity is an independent risk factor for UI as compared to any other factor for daily urinary incontinence. But very few studies studies have been done in this regard ( or context). Aim: To examine the urinary incontinence (UI) and its type among obese women. Method: Thirtyfour subjects among age group of yrs. The study was done in a Health Care Unit of community center of south Delhi. Type of UI was assessed by using 3 IQ (3 Incontinence Questionnaire). Obesity was measured by calculating Body Mass Index (BMI). Other parameters like parity and lifestyle were also assessed. Result: Mean age of the subjects was yrs. The mean BMI was % subjects were suffering from mixed type of incontinence and 11.76% subjects were suffering from urge incontinence. Conclusion: UI is common in obese women. Factors like obesity are potentially modifiable. Occupational Therapists, by the virtue of their knowledge, can help in management of obesity and UI through behavior modification and changes in Activities of Daily Living. KEYWORDS: UI, Obesity, Lifestyle, BMI, Parity. INTRODUCTION Urinary incontinence is defined as involuntary loss of urine that is a social or hygienic problem and that is objectively demonstrable. [1] Urinary incontinence can leave a patient feeling ashamed, socially isolated, and depressed. According to latest survey in Asia, 53.7% population is bothered to certain degree due to Urinary Incontinence. [2] Urogenital problems Vol 6, Issue 9,

2 in female population are common and have significant impact on the physical, psychological and socio economic aspects of life. Obesity and urinary incontinence are both common disorders. The prevelance of obesity is on the rise worldwide. Specially in women around menopause, it is very common. Several studies have shown that obesity and overweight is directly associated with UI. Obesity is an independent risk factor for stress related and mixed UI as compared to any other factor. Animal studies shows that each 5 unit increase in Body Mass Index (BMI) is associated with % increased risk of daily UI. Deposition of fat around abdomen is one of the most important factors associating obesity and UI. [3,4] Pathology behind Obesity and UI The exact pathology that connects obesity and UI is not clear. Some studies suggest that excess body weight increases abdominal body pressure this in turn increases bladder pressure and mobility of the urethra. According to another theory, there is strong correlation between BMI and intra abdominal pressure which is a significant factor in the development of UI. Obese individual are also known to exhibit reduced nerve conduction velocity, potentially impacting upon the time taken for nerve signals controlling bladder functions to relay, which may play a part in overflow incontinence. Diabetes is another condition which is frequently associated with obesity. The elevated level of blood glucose observe with poorly controlled diabetes can lead to increased thrust and urine production while nerve damaged associated with diabetic neuropathy can affect bladder sensations and detruser activity. [5,6,7,8] In animal studies estrogen appears to help control body weight with lower estrogen levels. Animal tend to eat more and be less physically active. Reduced estrogen may also lower metabolic rate, the rate at which the body converts stored energy into working energy. [9.10,11] The same thing happens with women when estrogen level drops after menopause. Some evidence suggests that estrogen hormone therapy increases women s resting metabolic rate. [12] In this study researcher has attempted to find out about the presence and of type of UI in women around menopause. The results of this study can further be used for management of UI according to their type. Vol 6, Issue 9,

3 AIMS AND OBJECTIVES To study the presence and type of urinary incontinence in obese women between years. METHODOLOGY Thirty four [34] subjects with complaints of Urinary Incontinence (UI) were taken for the study. Study design: Single center, prospective, cross sectional study. Inclusion criteria 1. Women between age group of years with at least three episopdes of urine leakage / week. 2. Subject within age group of yrs. 3. Subject having BMI between Exclusion criteria 1. Having UI of neurological or functional origin. 2. Medical or surgical treatment for incontinence. 3. Prior medical therapy for incontinence and obesity. Outcome measures used 1.3IQ (Three incontinence questionnaire) : It is an questionnaire which is shown to be a quick and accurate way of diagnosing sterss, urge or mixed type of urinary incontinence. [13] 2. BMI ( Body Mass Index) : BMI is a measure of body fat based on height and weight that applies to both men and women. [14] METHOD This crosssectional study was done in a Health Care Unit of a Community centre of South Delhi. Thirty four subjects within age group of were taken for the study. They were explained about intent and content of the study and written consent was taken. Apart from demographic data other parameters like medical history (Diabetes and Hyper Tension), parity, FTND or LSCS and lifestyle (specially use of indian or western toilet) were noted. Data was taken from all subjects and analysed. Vol 6, Issue 9,

4 RESULTS AND DISCUSSION The 34 subjects had mean age 54.11yrs. 97 % subjects were menopausal, rest 3 % were around perimenopause. Fig. 1. The mean BMI was The median BMI index for women around 50 years is around 27 (Bump RC et al, 1992). As noted there is slight weight gain around menopause. Most of the subjects were having abdominal adiposity. When UI was measured it was found that the results of 3IQ showed that 88% subjects were suffering from mixed type of incontinence, 12% subjects were suffering from urge type of UI and no subject reported pure stress type of UI. As it is common that mixed and urge UI is prevalent in older women (Anderson G et al, 2004). Fig Vol 6, Issue 9,

5 Out of 34 subjects 29% were suffering from Diabetes Mellitus and 12% were from HT (controlled). Fig % subjects had Full Term Normal Delivery (FTND) and 6% subjects had Lower Segment Cesarean Section (LSCS). FTND cause pathophysiological changes in the muscles and fascial structures of the pelvic floor (Ceruto MA, 2013). Fig % subjects had > 3 children and 21% subject had <= 2 children. As it is known that parity is associated with weakend pelvic musculature. Vol 6, Issue 9,

6 Fig % subjects were using Indian toilet seat and did most of their IADL and BADL in floor sitting or squattng position. 18% subjects were using western toilet and did most of their IADL and BADL in standing or chair sitting position. Fig. 6. Limitations of the study 1. Sample size was small. 2. Objective measures like ultrasound can be used for measuring abdominal fat thickness. Future recommendations 1. Study can be done on disable women. 2. Correlation of UI with other risk factors like diabetes and hyper tension can be assesed. 3. Effect of weight loss on reduction in UI can be done. Vol 6, Issue 9,

7 CONCLUSION Obesity and UI are strongly associated. Since obesity is an potencially modifiable risk factor, measures towards weight reduction should be taken as first line of treatment of UI. REFERENCES 1. Abram P et al. Standardization Sub committee of the Incontinence Continence Society. The standardization of terminology of lower urinary tract infection report from the Sub committee of the International Continence Society. Neurourol Urodyn, 2002; 21: Anderson G et al. Urinary incontinence prevalence. Impact on daily life and desire for treatment: A populatation based study. Scand J Urol Nephro, 2004; 38: Bump RC, Sugerman HJ, Fantl JA, McClish DK. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol, 1992; 167: Botlero R, Urquhart DM, Davis SR, Bell RJ. Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues. Int J Urol, 2008; 15: Burgio KL, Robinson JC, Engel BT. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am J Obstet Gynecol, 1986; 154: Cerruto MA, D Elia C, Aloisi A, Fabrello M, Artibani W. Prevalence, incidence and obstetric factors impact on female urinary incontinence in Europe: a systematic review. Urol Int, 2013; 90: Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol, 2007; 110: Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Taylor JR, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA, 1991; 265: Fantl JA, Newman DK. Coiling J et al. Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline, No. 2, 1996 Update. Rockland, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Publication No March Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS. Weight loss: A novel and effective treatment for urinary incontinence. J Urol, 2005; 174: Vol 6, Issue 9,

8 11. Amir Qaseem et al. Neurological management of Urinary Incontinence in Women; Clinical Guideline. American College of Physicians, Fred Kirss et al. Prevalence and Risk Factors of UI among Estonian Postmenopausal women. Springerplus, 2013; 2: http;// Summary.pdf Vol 6, Issue 9,