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Urinary Incontinence in Elite Female Athletes and Dancers

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The aim of this study was, to determine the frequency of urinary loss in elite women athletes and dancers. Elite athletes in eight different sports, including ballet, filled in an evaluated questionnaire about urinary incontinence while participating in their sport/dancing and during daily life activities. A total of 291 women with a mean age of 22.8 years completed the questionnaire, providing a response rate of 73.9%. Overall, 151 women (51.9%) had experienced urine loss, 125 (43%) while participating in their sport and 123 (42%) during daily life. The proportion of urinary leakage in the different sports was: gymnastics 56%, ballet 43%, aerobics 40%, badminton 31%, volleyball 30%, athletics 25%, handball 21% and basketball 17%. During sport 44% had experienced leakage a few times, 46.4% now and then, and 9.6% frequently. During daily life the figures were: 61.7% a few times, 37.4% now and then, and 0.8% frequently. Of those who leaked during sport, 95.2% experienced urine loss while training versus only 51.2% during competition (P<0.001). The activity most likely to provoke leakage was jumping. Sixty per cent (91/151) occasionally wore pads or panty shields because of urine loss. Urinary leakage is common among elite athletes and dancers, particularly during training, but also during daily life activities.
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Original Article
Urinary Incontinence in Elite Female Athletes and Dancers
H. H. Thyssen, L. Clevin, S. Olesen and G. Lose
Glostrup County Hospital, University of Copenhagen, Glostrup, Denmark
Abstract: The aim of this study was, to determine the
frequency of urinary loss in elite women athletes and
dancers. Elite athletes in eight different sports, including
ballet, filled in an evaluated questionnaire about urinary
incontinence while participating in their sport/dancing
and during daily life activities. A total of 291 women
with a mean age of 22.8 years completed the question-
naire, providing a response rate of 73.9%. Overall, 151
women (51.9%) had experienced urine loss, 125 (43%)
while participating in their sport and 123 (42%) during
daily life. The proportion of urinary leakage in the
different sports was: gymnastics 56%, ballet 43%,
aerobics 40%, badminton 31%, volleyball 30%, athletics
25%, handball 21% and basketball 17%. During sport
44% had experienced leakage a few times, 46.4% now
and then, and 9.6% frequently. During daily life the
figures were: 61.7% a few times, 37.4% now and then,
and 0.8% frequently. Of those who leaked during sport,
95.2% experienced urine loss while training versus only
51.2% during competition (P<0.001). The activity most
likely to provoke leakage was jumping. Sixty per cent
(91/151) occasionally wore pads or panty shields
because of urine loss. Urinary leakage is common
among elite athletes and dancers, particularly during
training, but also during daily life activities.
Keywords: Female elite athletes; Urinary incontinence
Introduction
Urinary incontinence is a common problem even among
young women [1,2]. In a population of nulliparous elite
athletes, Nygaard et al. [3] found that 28% had urine loss
while participating in their sport. The frequency of
leakage varied from 0 to 67%, depending on the physical
stress involved in the different sporting activities. The
aim of this study was to elaborate on the problem of
urinary incontinence among elite athletes and dancers
while participating in their sport and during daily life
activities.
Materials and Methods
A questionnaire about urinary symptoms was distributed
to elite athletes in eight different sports, including
professional ballet. The sports clubs all competed at
Danish national level.
A total of 396 women were included in the study; 291
answered the questionnaire [4], providing a response
rate of 73.7%. The eight sports represented were
gymnastics (n = 158 women), badminton (n = 16),
basketball (n = 29), volleyball (n = 10), track athletics
(n = 12), handball (n = 28), aerobics (n = 15) and ballet
(n = 23).
The women were first asked if they experienced urine
loss while participating in their sport or in daily life. If
their answers to both these questions were negative they
did not complete the rest of the questionnaire. All
women who had experienced urine leakage completed
the questionnaire. They were asked about medication,
deliveries, incontinence during training, competition and
daily life activities, incontinence treatment, use of pads
and voiding habits. Statistic analysis was performed
using McNemars test. The study was approved by the
local scientific ethical committee, and informed consent
was obtained from all the women.
Ownership and Copyright
ß Springer-Verlag Limited
Int Urogynecol J (2002) 13:15–17
In ternat ional
Urog y necolog y
Journal
Correspondence and offprint requests to: Dr Hans Thyssen,
Department of Obstetrics and Gynecology, Glostrup County Hospital,
2600 Glostrup, Denmark. Tel: +45 4323 2300; Fax: +45 4323 3974;
E-mail: Hthy@glostruphosp.kbhamt.dk
Results
The average age of the 291 athletes answering the
questionnaire was 22.8 years (range 14–51 years). A
total of 151 (51.9%) had experienced urine loss while
participating in their sport or in daily life situations.
Thirteen (8.6%) of the 151 women had given birth. Forty
women took oral hormonal contraceptive treatment, 14
medication for asthma, 10 non-steroidal anti-inflamma-
tory agents and 1 woman insulin for diabetes.
A total of 125 women (43.0%) had experienced urine
loss while participating in their sport (Fig. 1), 55 women
(44%) had noted leakage a few times, 58 (46.4%) now
and then, and 12 (9.6%) frequently. Of the 125 women,
119 (95.2%) had experienced urine loss during training,
but only 64 (51.2%) during competition (P<0.001).
Eighty-two women had noticed the activity most likely
to provoke urine loss: 71 mentioned jumping and 7
running.
A total of 123 women (42.2%) had experienced urine
loss during daily life activities (Fig. 1), 76 (61.7%) had
noted leakage a few times, 46 (37.4%) now and then, and
1 (0.8%) frequently.
Fourteen athletes (11.4%) had experienced urine loss
without physical exertion.
Of the 151 athletes who had experienced urine loss
either during sport or during daily life activity, 91
(60.2%) occasionally wore a pad or panty shield because
of leakage. Ten (6.6%) claimed that they reduced their
liquid intake to reduce leakage.
Fifty-one (33.8%) considered the urine leakage as a
problem, 32 (21.1%) as a hygienic problem. Only 5
(3.3%) had discussed the problem with their doctor. Six
women (4.6%) had completed a pelvic floor training
program because of urine loss.
Twenty-two women (14.6%) reported a daytime
frequency between one and three voids; 3 women
(2.0%) had 11 or more voids per day; 43 women
reported one or two voids per night, and 2 (1.3%) had
three or more voids per night.
Discussion
This study demonstrates that more than 50% of elite
athletes and professional ballet dancers have experienced
urine loss. Approximately one-third of the women who
had experienced urine leakage considered it to be a
social or hygienic problem, and 60% occasionally wore
pads.
Of the total population, 4% had urine leakage
frequently when participating in their sport, whereas
only 0.3% had urine loss frequently during daily life
activities. Thus the physical exertion seems to be a
significant provocative factor. Only the incontinent
women completed the questionnaire, for which reason
we cannot make comparisons between incontinent and
continent athletes.
The prevalence of urinary incontinence in fertile
women varies according to definition and the design of
the study. Based on questionnaire studies, as in this one,
Samuelsson [5] found that 3.5% of women between 20
and 59 years of age had daily incontinence, and Højbjerg
et al. [6] found that 3% of women at 16 weeks of
gestation had leakage at least weekly. Compared to these
two studies, a prevalence of 0.3% of frequent leakage
during daily life activities seems to be low. This
difference may be explained by the fact that 91.2%
were nulliparous and all were physically well trained.
However, the present population may be subject to
selection bias, as some athletes may have quit their sport
because of stress urinary leakage. Nygaard [7] reported
that 20% of young women exercisers stopped because of
urine leakage. Consequently, the frequency of regular
urinary incontinence in a ‘normal population’ seems to
be significantly higher than the findings in the present
population of elite athletes and dancers.
The activity most likely to provoke leakage was
jumping. This expalins why gymnastics, which involves
many high-impact jumps, has the highest degree of
leakage of the different sports.
The study demonstrates that significantly more
athletes experienced urine loss during training rather
than competition: 95.2% versus 51.2%, respectively.
This is an interesting finding that may be explained by
the higher catecholamine levels during competition
versus training [8,9]. As the urethra contains a-receptors,
the higher catecholamine level during competition may
Fig. 1. The percentage of elite athletes who experienced urinary
leakage during daily life activities and while participating in their
sport/dance.
16 H. H. Thyssen et al.
tend to keep it closed. Other factors, such as the ritual
bladder and bowel emptying which is common before
competition, or changes in diuresis, may also play a role.
Our findings are partly similar to those reported by
Nygaard et al. [3], although the numbers in the different
subgroups are small. In their study 67% of the
gymnastics and 50% of the tennis players had
experienced urine loss while participating in their
sport, but no golf players had the problem. The golf
players were also completely dry during daily life
activities, whereas 83% of the tennis players and 53% of
the gymnasts had urine leakage. It is remarkable that the
golf players had leakage neither during sport nor during
daily life activities, as they must have been exposed to
some degree of physical exertion. In our study all the
different athletes had urine loss during both sport and
daily life activities, although the relative proportion was
not always parallel.
References
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EDITORIAL COMMENT: This article provides more
evidence as to the surprisingly high prevalence of urinary
incontinence in young, physically fit athletes. Even though
relatively few women experienced frequent symptoms, we
traditionally would not expect any incontinence at all in
this group. It seems that the relatively high pressure
generated by certain activities, especially jumping, is
sufficient to overcome the continence mechanism in these
women.
Now that we know the prevalence of incontinence is
higher in athletes than previously suspected, the next step
will be investigating the pathophysiology. Do repeated
impacts somehow damage pelvic supporting structures?
Despite their overall level of physical fitness, is their pelvic
muscle function abnormal for some reason? Just as isolated
enzyme deficiencies have led to a greater understanding of
cellular biochemistry, out of proportion to the actual
incidence of those clinical conditions, unraveling the
pathophysiology of incontinence in unusual study popula-
tions may help advance our understanding of continence
and incontinence.
Reviews of Current Literature
A Transvaginal Approach to Repair of Apical and other Associated
Sites of Pelvic Organ Prolapse with Uterosacral Ligaments
Shull BL, Bachofen C, Coates KW, Kuehl TJ
Scott and White Clinic and Memorial Hospital, Texas A&M University
System Health Sciences Center College of Medicine, Temple TX, USA
Am J Obstet Gynecol 2000;183:1365–1374
The purpose of the study was to assess a repair for pelvic organ prolapse
using uterosacral ligaments in 302 consecutive patients. Preoperatively
and postoperatively, prolapse was characterized by using the Baden–
Walker halfway scoring system. All cases were repaired using
permanent sutures in uterosacral ligament pedicles, and pubocervical
and rectovaginal fascia. Three sutures were used on each side to support
the fascial tissues to the uterosacral ligaments. Midline plication of
pubocervical and rectovaginal fascia added length to the fascial
segments and vaginal canal. Defects in the perineal body were repaired,
and stress incontinence was corrected by a Burch procedure. At follow-
up, 87% of patients had no prolapse and only 5% had grade 2 or greater
support defects. There were 10 patients with grade 2 or 3 defects in the
anterior segment. There was one ureteral injury requiring extensive
intraoperative repair, and 3 other cases of ureteral compromise treated
intraoperatively. Suture placement in the uterosacral ligaments was
always lateral to medial, and the site of initial suture placement was
identified posterior and medial to the ischial spines at 4 and 8 o’clock,
and held with a long Allis clamp. Subsequent sutures were placed on the
sacral side of the first suture.
Comment
The success of this approach to the repair of apical defects is excellent at
1 year follow-up. It is noted that those patients followed for over 2 years
had a greater number of support defects. One must ponder the duration
of the desired effect, and would look forward to a 5-year follow-up. The
most frequent site of defect was the anterior segment, which is very
similar to results from other support operations, especially sacrospinous
vault suspension. It is vital to extend the repair fully across the fascia of
the pubocervical and rectovaginal defects, because if the center portion
is not supported equally as well as the lateral portion there will be a
rapid reucrrence of the midline defects. It is noteworthy that specific
repair for enterocele was included by reapproximating anterior and
posterior fascial segments.
Incontinence in Elite Athletes 17
... However, much lower prevalence rates of UI (12-13%) have been reported in large studies of nulliparous young women [13,14], and female athletes/exercisers have been found to have a three times increased risk of UI compared to nonexercisers [3]. In previous studies of UI in artistic gymnasts, slightly lower prevalence rates (56 and 67%) have been reported [15,16]. The extremely high prevalence rates of UI found in our study, especially in gymnasts, is comparable to those (73 and 80%) reported among young female trampolinists [17,18]. ...
... Strengths of the present study were the inclusion of toplevel athletes from different high-impact gymnastic and acrobatic sports and assessment of possible risk factors, bother and athletes' knowledge about the pelvic floor. We used valid and reliable questionnaires to collect data on UI and AI [7], and the total number of participants compares favorably with other studies of young female athletes [10,[15][16][17][18]20]. ...
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Introduction and hypothesis Artistic gymnastics, team gymnastics and cheerleading are sports including high-impact activities. It is presumed that the athletes’ pelvic floor must be functioning well to prevent urinary (UI) and anal incontinence (AI) during sports. The aim of this study was to investigate the prevalence and risk factors for UI and AI in female artistic gymnasts, team gymnasts and cheerleaders; the influence of UI and AI on daily living and sport performance; and the athletes’ knowledge about the pelvic floor muscles (PFM). Methods All female athletes ≥ 12 years of age competing in ≥ 1 National Championship in artistic gymnastics, team gymnastics or cheerleading in 2018/2019 were invited. International Consensus on Incontinence Questionnaires were used to assess the prevalence/bother of UI and AI. Results Among the 319 gymnasts and cheerleaders who participated, the prevalence of UI and AI was 67% and 84%, respectively. Age, training ≥ 4 days/week and straining to void were significantly associated with stress urinary incontinence (SUI) and years of training with AI. Eighty-three percent of athletes with SUI reported a negative effect on sports performance, 22% would occasionally avoid training or specific exercises because of leakage, and 28% used pads for protection. Forty-one percent of the athletes had never heard about the PFM, and 74% reported an interest in PFM training to prevent/treat UI or AI. Conclusions UI and AI were prevalent in female gymnasts and cheerleaders, and SUI negatively influenced sport performance. The athletes’ knowledge about the PFM was limited.
... Eating disorders, constipation, family history of urinary incontinence, history of urinary tract infections and decreased flexibility of the plantar arch are associated with an increased risk of UI in elite female athletes. Pelvic floor physiotherapy as a treatment for urinary incontinence in elite female athletes, former elite female athletes and pregnant athletes who engage in regular aerobic activity leads to a higher continence gain than that obtained by nonathlete women [28] (Thyssen et al., 2002). ...
... Eating disorders, constipation, family history of urinary incontinence, history of urinary tract infections and decreased flexibility of the plantar arch are associated with an increased risk of UI in elite female athletes. Pelvic floor physiotherapy as a treatment for urinary incontinence in elite female athletes, former elite female athletes and pregnant athletes who engage in regular aerobic activity leads to a higher continence gain than that obtained by nonathlete women [28] (Thyssen et al., 2002). ...
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... Despite this finding, our results showed that female athletes specializing in vertical jump events had the lowest prevalence of UI. To explain this difference, it is worth noting that vertical jump events, which include high jump and pole vault, are track and field jump events that completely differ from those considered to be "highimpact" jumps [6,32]. Because the landing phase for vertical jumps is not carried out through the support of body weight on the lower limbs, vertical ground reaction forces are not as high as those produced during horizontal jumps. ...
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... In contrast, Eliasson et al. [29] studied 35 female trampoline jumpers aged 12-22 years and found that UI occurred in up to 80% of them, which may also confirm that episodes of urinary incontinence are more common in sports accompanied by a large volume of jumping [29]. More extensive research was conducted by Thyssen [30] in which UI in different areas of physical activity was as follows: gymnastics (56%), ballet (43%), aerobics (40%), badminton (31%), volleyball (30%), athletics (25%), handball (21%) and basketball (17%). When analyzing the studies of many researchers, it can be pointed out that runners most often report UI, women attending CrossFit classes, fitness centres, gyms, women practising trampoline sports, or team sports such as basketball and volleyball. ...
... Similarly, an imbalance in the abdominal force can lead to a change in the physiological urethrovesical angle leading to UI, primarily SUI in high-impact athletes [6]. However, most athletes experience leakage during training and not during a competition (95.2% vs 51.2%, respectively), probably due to higher catecholamine levels affecting the urethral alpha receptors, maintaining urethral closure during competitions [7]. ...
... Furthermore, fewer subjects reported experiencing UI during competition (N 5 34) than in training (N 5 49) despite being more likely to lift heavier weights in competition; a similar scenario has been found in powerlifters (29). A possible explanation is that higher levels of catecholamine during competition and in some women during training act on receptors in the urethra keeping it closed (28). In practice, this means that a small number of women may be incontinent during everyday activities but continent during training because of increased stress levels. ...
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... Stress urinary incontinence (SUI), a condition characterised by the unintentional loss of urine, is reported to affect 52% of elite female athletes and is associated with long-term physical and emotional consequences 1,2 . The International Continence Society (ICS) defines SUI as "the complaint of involuntary loss of urine on effort or physical exertion, including sporting activities or on sneezing or coughing" 3 . ...
... O estudo que investigou a presença de IU em mulheres atletas de esportes de alto impacto identificou uma relação entre o tempo de prática do esporte e a presença de IU. Porém essa relação só foi observada quando o tempo de prática foi dicotomizado em: menor ou igual a oito anos e maior que oito anos (OR=2,7; IC95%: 1,4 a 4,98) 24 . A amostra do presente estudo foi composta essencialmente por mulheres que praticavam Crossfit há menos de dois anos. ...
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Two female student groups, one studying sports and physical education, mean age 22.9 (range 19-37) years, and the other studying nutrition, mean age 25.6 (range 19-59) years, answered a questionnaire about age, childbirth, participation in different sports activities and prevalence of stress urinary incontinence during different types of physical exertion. Twenty-six percent of the physical education students and 19% of the nutrition students reported urinary leakage. The difference between the two groups was not significant. However, when the nutrition students who did not participate in any sports activities were compared with the physical education students, a significantly higher prevalence of stress urinary incontinence was found for the physical education group (p = 0.05). Furthermore, the physical education students exercising more than three times a week (mean age 22.3 years) showed a 31% prevalence of stress urinary incontinence compared to the prevalence of the sedentary nutrition group (10%) (p = 0.02). In conclusion, in this study, there was a tendency towards a higher prevalence of stress urinary incontinence among young women who regularly engaged in physical activity.
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Background. The aim was to study urinary incontinence (UI) and nocturia in a female population: prevalence, effect on well-being, wish for treatment and result of treatment in primary health care. Methods. A postal questionnaire was sent to all women aged 20-59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well-being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor. Results. Of the included 641 women. 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%). 12 of whom were also incontinent. Self-assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well-being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type. Conclusions. Urinary incontinence and nocturia affect well-being in a negative way. Well-being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it; only about a quarter of incontinent women, or 6-7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.
Training and competitive epinephrine and norepinephrine levels and proportions were compared in two groups of women athletes to determine whether changes in catecholamine excretion reflect the added mental stress of athletic competition on physical effort. An intercollegiate basketball team and a group of track and field athletes volunteered as subjects. Competitive epinephrine urinary levels were significantly (P less than 0.01) higher than training levels. A concomitant rise in the norepinephrine with an increase in physical effort was observed in both groups of athletes following training sessions as well as after athletic competition. Track and field athletes trying to qualify for an international team exhibited significantly ( less than 0.01) higher epinephrine levels than the team members; thus suggesting that anticipation of competition imposes a mental stress on an athlete. Constant changes in the catecholamine pattern as against a normal work load have yet to be established.
Article
Table tennis, like tennis, squash and badminton, is a racket sport. All these sports have in common a rapid succession of mostly short-term maximal or submaximal efforts and short recovery phases. The goal of this paper is to investigate the psychophysical stress in table tennis by means of the stress hormones epinephrine and norepinephrine. The catecholamines were determined from urine samples. 16 Austrian top-level table tennis players were examined. There were 8 female and 8 male players in this group. The catecholamine excretion at rest (R), training (TR), practice competition (PC), competition (C) and treadmill ergometry (TE) are indicated in ng/min of collecting time. When the group is divided according to sex, we find marked differences in the catecholamine release. While the epinephrine excretion during and after training and practice competition is basically the same, it is lower during and after treadmill ergometry and higher after competition. The same result was found with respect to norepinephrine excretion. The ratio between norepinephrine and epinephrine was 4:1 at rest and during and after treadmill ergometry, 6:1 during and after training, 5:1 during and after the practice competition and 2:1 during and after the competition. The investigation showed that a table tennis competition puts high stress on the player. The mental component should therefore receive much more importance in order to keep the stress low.
Article
Three hundred twenty-six women filled out questionnaires to assess the relationship between exercise and incontinence. Two hundred ninety participants stated that they exercised regularly. Overall, 152 (47%) noted some degree of incontinence, which correlated positively with the number of vaginal deliveries (P less than .0005). Eighty-seven exercisers (30%) noted incontinence during at least one type of exercise. Incontinence exclusively during exercise was seen in only one woman. Exercises involving repetitive bouncing were associated with the highest incidence of incontinence. Seventeen incontinent exercisers (20%) stopped an exercise because of incontinence, whereas 16 (18%) changed the way a specific exercise was done and 48 (55%) wore a pad during exercise. Thirty-five percent had discussed their incontinence with a health care professional. These data suggest that incontinence during exercise is a common, although little known, problem. In addition to the behavioral adaptations which women initiate on their own, surgical and nonsurgical treatments may be of benefit.
Article
To determine the prevalence of the symptom of urinary incontinence during athletic endeavors among a group of nulliparous, elite college varsity female athletes. All women currently participating in varsity athletics at a large state university were asked to fill out a questionnaire about the occurrence of urinary incontinence while participating in their sport and during activities of daily life. One hundred forty-four of 156 eligible women (92%) responded. The mean age was 19.9 years, and all women were nulliparous. Overall, 40 athletes (28%) reported urine loss while participating in their sport. The proportions in different sports were: gymnastics 67%, basketball 66%, tennis 50%, field hockey 42%, track 29%, swimming 10%, volleyball 9%, softball 6%, and golf 0%. Two-thirds of the women who noted urine loss during athletics were incontinent more often than rarely. There were no statistically significant relations between incontinence and amenorrhea, weight, hormonal therapy, or duration of athletic activity. Activities most likely to provoke incontinence included jumping, high-impact landings, and running. Forty percent and 17% of the women first noted incontinence during their sport while in high school and junior high school, respectively. Incontinence during physical stresses is common in young, highly fit, nulliparous women. This suggests that there is a continence threshold which, when exceeded, can result in urine loss, even in the absence of known risk factors for incontinence.
Article
A self-administered questionnaire assessing female lower urinary tract symptoms and their impact on quality of life is described and validated, on 56 females in six participating departments. The patients answered two identical questionnaires on separate occasions before treatment. Test-retest reliability of the questionnaire, correlation between the symptoms and their troublesomeness, and the reproducibility of this correlation were assessed. The percentage of mistakes in answers to each of the questions varied from 1.8% to 49.1%, mainly owing to missing answers in the item groups: appliances, sexual function and social activities. Test-retest showed a repeat frequency of 50.0%-91.0% for symptoms and 44.6%-82.1% for trouble. A highly significant positive correlation was found between symptoms and trouble, which was most pronounced for questions concerning pain and incontinence. This correlation was consistent within time. The primary validation of this questionnaire is good. Its relevance as a basis for medical priority and clinical decision making remains to be investigated.
Article
To evaluate the prevalence of urinary incontinence at 16 weeks of gestation and to identify possible maternal and obstetric risk factors. Cross-sectional study and cohort study. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark. Cross-sectional study: 7795 women attending antenatal care. Cohort study: a sub-group of 1781 pregnant women with one previous delivery at our department. Prevalence and maternal risk factors: the prevalence of urinary incontinence within the preceding year was 8.9% among women at 16 weeks of gestation (nulliparae, 3.9%, para 1, 13.8%, para 2+, 16.2%). Stress or mixed incontinence occurred at least weekly in 3% of all the women. After adjusting for age, parity, body mass index, smoking, previous abortions, and previous lower abdominal or urological surgery in a logistic regression model, primiparous women who had delivered vaginally had higher risk of stress or mixed urinary incontinence than nulliparous women (OR 5.7; 95% CI 3.9-8.3). Subsequent vaginal deliveries did not increase the risk significantly. Young age, body mass index > 30, and smoking were possible risk factors for developing urinary incontinence. Obstetric factors: weight of the newborn > 4000 g (OR 1.9; 95% CI 1.0-3.6) increased the risk of urinary incontinence; mediolateral episiotomy in combination with birthweight > 4000 g also increased the risk (OR 3.5; 95% CI 1.2-10.2); a number of other intrapartum factors did not increase the risk of urinary incontinence. The first vaginal delivery was a major risk factor for developing urinary incontinence; subsequent vaginal deliveries did not increase the risk significantly. Birthweight > 4000 g increased the risk; episiotomy in combination with birthweight > 4000 g also increased the risk.
Article
To evaluate the prevalence of anal incontinence at 16 weeks of gestation and to identify possible maternal and obstetrical risk factors. Cross sectional study and cohort study. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark. Cross sectional study: 7,557 women attending antenatal care. Cohort study: a subgroup of 1,726 pregnant women with one previous delivery at our department. The prevalence of anal incontinence within the preceding year was 8.6%. Incontinence of liquid and solid stools was reported in 2.3% and 0.6%, respectively. Isolated flatus incontinence at least once a week was reported in 4.2%. The risk of flatus incontinence at least once a week was increased with age > 35 years (OR 1.6; 95% CI 1.1-2.4) and with previous lower abdominal or urological surgery (OR 1.5, 95% CI 1-1-2.1) in a logistic regression model controlling for maternal factors. Increasing parity did not increase the risk. The risk of flatus incontinence was increased after anal sphincter tear and birthweight > 4,000 g in a logistic regression model controlling for maternal and obstetric variables. Episiotomy was insignificantly associated, while spontaneous perineal tear > 3 cm and a number of other intrapartum factors were not associated. CONCLUSION True faecal incontinence is rare among younger women. However, an age > 35 years and previous lower abdominal or urological surgery increased the risk of flatus incontinence in contrast to increasing parity. This suggests that childbirth plays a minor role compared with age. However, when analysing obstetric variables separately, a birthweight > 4,000 g, and anal sphincter tears were significant risk factors for flatus incontinence.