Physiotherapist-supervised pelvic floor muscle (PFM) training is the recommended first-line treatment for women with stress urinary incontinence (SUI); however, only up to 50% of women are cured with this treatment. The primary objective of this study was to develop a predictive model of successful physiotherapy intervention outcomes among women with SUI using predictors that are accessible to clinicians. The secondary objective of this study was to run a preliminary investigation of morphologic differences between women with SUI who were cured with a physiotherapy intervention and those who were not cured, using a subset of ultrasound imaging data. Seventy-nine women with SUI were assessed at baseline on measures of demographic data (i.e. age, body mass index, etc.), 3-day bladder diary, 30-minute standardized pad test, clinical assessments of PFM strength and tone, and transperineal ultrasound assessments of PFM morphology. Women then attended a 12-week physiotherapy intervention and returned for a follow-up assessment. The multivariate logistic regression model was significant (p < .001) with two predictors: baseline ICIQ-FLUTS UI subscale (SUI severity; p = .01) and parity (p = .06). A significant ROC curve for the ICIQ-FLUTS UI subscale (p ˂ .01) predicts physiotherapy intervention outcomes with 55.6% sensitivity and 80.8% specificity at a cut-off score of 7.50. Women most likely to be cured with a physiotherapy intervention were those with lower scores on the ICIQ-FLUTS UI subscale and those who have given birth to fewer children. Significant differences were found in a subset of data between women with SUI who are cured with the physiotherapy intervention and women who are not cured on morphologic measures in standing of bladder neck height at peak cough (p = .03), descent of the bladder neck during maximal Valsalva maneuver (MVM; p = .04), levator hiatus circumference at rest (p = .03) and at maximal voluntary contraction in both standing and supine (MVC; p = .01; p = .03). Variables that were trending towards significance included bladder neck height in standing at rest, levator plate length (LPL) at maximal excursion during a cough and MVM in standing, and mid-urethral wall cross-sectional area. These significant differences indicate potential value in using ultrasound imaging outcomes as predictors of a cure with physiotherapy intervention in future models, and a combination of demographic, clinical, and morphologic variables may build a more robust predictive model.

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider. Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in athletes. Therefore, the purpose of this study is to assess the prevalence of stress urinary incontinence in collegiate female athletes. This study involved the development of an electronic survey tool to assess the prevalence of SUI in the female collegiate athlete. Female collegiate athletes from six different NCAA Division I schools were asked to complete the survey. The overall response rate for the survey was 32.6% (333/1020). Results indicate that SUI does in fact occur in NCAA Division I collegiate female athletes. Overall, 68.5% of female collegiate athletes surveyed reported ever experiencing SUI. During daily life activities (cough, sneeze, laugh), 54.2% of female collegiate athletes reported experiencing SUI. During participation in their sport, 40.0% of female collegiate athletes reported experiencing SUI, referred to as sports-related SUI. When reporting SUI experienced during either sport participation or during other exercise-based activities, 58.2% of female collegiate athletes reported SUI. The proportion of female athletes reporting sports-related SUI varied by sport. The highest prevalence of leakage in sport was reported by gymnasts (80%) and the lowest prevalence was reported by those who participated in rifle (0%). Over half (52.3%) of female athletes who reported sports-related SUI said their symptoms first began in high school. While majority of female collegiate athletes stated they did not avoid their sport because of SUI, one-fifth (20.5%) of athletes with sports-related SUI reported they alter how they move in their sport out of concern for leakage. The impact of sports-related SUI on other aspects of life (family, social, or school life) were reported to be minimal. Athletes who experience sports-related SUI are most likely to tell either a teammate (49%) or no one (36%). Very few female athletes have told someone in healthcare about this concern: doctor (3%), athletic trainer (4%); physical therapist (1%). Furthermore, only 3% of female collegiate athlete with sports-related SUI reported ever seeking treatment and only 25.8% reported they would find value in seeing a healthcare provider to discuss SUI. Most (76.7%) female collegiate athletes, whether they reported SUI or not, stated they had never been instructed on exercises to strengthen the pelvic floor muscles and 60.6% reported they would find educational programs involving exercises to decrease or prevent SUI beneficial. In conclusion, SUI does occur in the female collegiate athlete and is often not reported to healthcare providers. Based on this information, the general practice of screening athletes for relevant health conditions during pre-participation physicals may need to include additional questions for SUI. Further investigation needs to explore how to best engage and educate female collegiate athletes on the subject of SUI and how to successfully communicate with and address those with the condition.

The pathophysiology of stress urinary incontinence is poorly understood but bladder neck funneling (BNF) and posterior urethrovesical angle (PUVA) enlargement have been implicated. Methods to measure these phenomena are poorly established. The aim of this thesis was to develop and evaluate a semi-automated method to analyze BNF and PUVA from ultrasound images acquired transperineally and test its repeatability and concurrent validity compared to manual segmentation. Agreement between the semi-automated and manual methods was assessed by kappa statistics and intraclass correlation coefficients (ICCs). The repeatability of detection of BNF using the semi-automated approach was almost perfect (ĸC = 1.00 (p<0.001)), while the reliability of semi-automated detection of PUVA was good (ICC(3,1) = 0.860 (0.784 – 0.910)). Concurrent validity of BNF classification was almost perfect (ĸL = 1.00 (p<0.001)), while PUVA estimation was moderate (ICC(2,1) = 0.610 (0.514 – 0.705)). The method presented here is an acceptable proof of concept; further development is recommended.

A 66-year-old para III with a 20-year history of stress urinary incontinence underwent placement of tension-free vaginal tape. Intraoperative arterial bleeding occurred. An expanding hematoma was palpated postoperatively. Interventional radiology performed a pelvic arteriogram with selective bilateral internal iliac arteriograms, a supraselective anterior division and obturator arteriogram, a left external iliac arteriogram, coil embolization of a branch of the left obturator artery, and gel foam embolization of the anterior division of the left internal iliac artery.

Objective: To test the hypothesis that body mass index (BMI) is a factor associated with passing a voiding trial after midurethral sling procedures for stress urinary incontinence (SUI). Study Design: The medical records of 136 consecutive patients who underwent placement of either tension-free vaginal tape (TVT) or transobturator tape (TOT) for SUI during a 1-year period (September 1, 2007 to August 31, 2008) were retrospectively reviewed. Variables assessed were BMI, age, and passing or failing a postoperative urinary voiding trial. Patients with concomitant pelvic organ prolapse surgeries were not included in this analysis. Results: Sixty-seven patients underwent TVT, whereas 69 had TOT procedures. In the TVT group, 30 patients (42%) were unable to void immediately postoperatively compared with 11 patients (16%) in the TOT group (P = 0.0003). The mean (SD) age and BMI of patients who failed or passed voiding trials was 58.6 (12.0) years and 28.0 (4.9) kg/m2 or 53.5 (12.3) years and 29.8 (5.7) kg/m2, respectively. Of 38 patients who did not pass a voiding trial on the day of the procedure, 31 (82%) passed on postoperative day 1, and all patients had passed a voiding trial by postoperative day 11. The mean (SD) BMI for 7 patients who did not pass voiding trial by postoperative day 1 was 28.3 (5.2) kg/m2. Conclusions: Women with higher BMIs were more likely to pass voiding trials after midurethral sling procedures. Patients who had TOT placement had greater success passing a postprocedure voiding trial than did patients who had TVT placement.

Bakgrund Urininkontinens är ett av de vanligaste kroniska hälsoproblemen i samhället, där få söker vård för sina besvär, vilket innebär en försämrad livskvalitet. Resultatet huruvida träning påverkar urinläckage varierar i tidigare forskningsstudier.  Syfte Att undersöka punktprevalensen av ansträngningsinkontinens hos fysiskt aktiva nulliparous totalt och uppdelat på olika träningsformer, samt analysera korrelationen mellan upplevd besvärsgrad av urininkontinens och volymen av måttlig till hög aktivitetsnivå bland fysiskt aktiva nulliparous med ansträngningsinkontinens.  Metod Kvantitativ observationsstudie som utfördes via en webbaserad enkät baserad på IPAQ-SF och PFIQ-7. Fysiskt aktiva kvinnor mellan 16–55 år, som var födda med kvinnligt kön, ej fått barn eller varit gravida efter vecka 13 samt ej var elitidrottare inkluderades. Resultat 215 personer besvarade enkäten, 61 exkluderades. Av 154 deltagare upplevde 37 kvinnor besvär av ansträngningsinkontinens (prevalens 24%). De vanligaste aktiviteterna var löpning (prevalens 26%) och gym/styrketräning (prevalens 18%). Högintensiv träning hade en prevalens av ansträngningsinkontinens på 31–38%. Lågintensiv träning hade en prevalens på 19%. Ingen korrelation kunde påvisas mellan upplevda besvär av urininkontinens och volym av måttlig till hög aktivitetsnivå bland kvinnor med ansträngningsinkontinens (r = -0,0489) (p = 0,8). Konklusion Ansträngningsinkontinens är vanligt hos tränande nulliparous. Det är vanligare med ansträngningsinkontinens vid högintensiva aktiviteter jämfört med lågintensiva. Ingen korrelation kunde påvisas mellan upplevd besvärsgrad av urininkontinens hos kvinnor med ansträngningsinkontinens och aktivitetsnivå. Mer forskning kring träning som eventuell riskfaktor och som eventuell behandlingsmetod krävs. / Background Urinary incontinence is one of the most common chronic health issues in society where few seek care meaning a decreased quality of life. Research regarding how exercise affects urinary incontinence varies.  Purpose On one occasion examine the prevalence of stress urinary incontinence (SUI) in physically active (PA) nulliparous in total and divided by activity, and the correlation between perceived level of discomfort of urinary incontinence (UI) and volume of moderate to high activity level amongst PA nulliparous with SUI. Method Quantitative observational study conducted via a web-based survey based on IPAQ-SF and PFIQ-7. PA women, age 16-55, who were born with a female gender, hadn’t given birth or been pregnant after week 13 and weren’t elite athletes were included.  Result 215 women responded to the survey, 61 were excluded. Of 154 participants 37 women experienced SUI (prevalence 24%). Strength training (prevalence 18%) and running (prevalence 26%) were the most common activities. High-intensity training had a prevalence of 31–38%. Low intensity training had a prevalence of 19%. No correlation between experienced level of discomfort of UI and volume of moderate to high level of physical activity amongst women with SUI could be revealed. (r = -0,0489, p = 0,8).   Conclusion  SUI is common amongst exercising women without known risk factors. It is more common with SUI during high-intensity activities compared with low-intensity. No correlation was demonstrated between UI amongst women with SUI and activity level. Research regarding exercise as risk factors and treatment for UI is required.

Sammanfattning Bakgrund Urininkontinens är ett av de vanligaste kroniska hälsoproblemen i samhället, där få söker vård för sina besvär, vilket innebär en försämrad livskvalitet. Resultatet huruvida träning påverkar urinläckage varierar i tidigare forskningsstudier.  Syfte Att undersöka punktprevalensen av ansträngningsinkontinens hos fysiskt aktiva nulliparous totalt och uppdelat på olika träningsformer, samt analysera korrelationen mellan upplevd besvärsgrad av urininkontinens och volymen av måttlig till hög aktivitetsnivå bland fysiskt aktiva nulliparous med ansträngningsinkontinens.  Metod Kvantitativ observationsstudie som utfördes via en webbaserad enkät baserad på IPAQ-SF och PFIQ-7. Fysiskt aktiva kvinnor mellan 16–55 år, som var födda med kvinnligt kön, ej fått barn eller varit gravida efter vecka 13 samt ej var elitidrottare inkluderades. Resultat 215 personer besvarade enkäten, 61 exkluderades. Av 154 deltagare upplevde 37 kvinnor besvär av ansträngningsinkontinens (prevalens 24%). De vanligaste aktiviteterna var löpning (prevalens 26%) och gym/styrketräning (prevalens 18%). Högintensiv träning hade en prevalens av ansträngningsinkontinens på 31–38%. Lågintensiv träning hade en prevalens på 19%. Ingen korrelation kunde påvisas mellan upplevda besvär av urininkontinens och volym av måttlig till hög aktivitetsnivå bland kvinnor med ansträngningsinkontinens (r = -0,0489) (p = 0,8). Konklusion Ansträngningsinkontinens är vanligt hos tränande nulliparous. Det är vanligare med ansträngningsinkontinens vid högintensiva aktiviteter jämfört med lågintensiva. Ingen korrelation kunde påvisas mellan upplevd besvärsgrad av urininkontinens hos kvinnor med ansträngningsinkontinens och aktivitetsnivå. Mer forskning kring träning som eventuell riskfaktor och som eventuell behandlingsmetod krävs. / Abstract Background Urinary incontinence is one of the most common chronic health issues in society where few seek care meaning a decreased quality of life. Research regarding how exercise affects urinary incontinence varies.  Purpose On one occasion examine the prevalence of stress urinary incontinence (SUI) in physically active (PA) nulliparous in total and divided by activity, and the correlation between perceived level of discomfort of urinary incontinence (UI) and volume of moderate to high activity level amongst PA nulliparous with SUI. Method Quantitative observational study conducted via a web-based survey based on IPAQ-SF and PFIQ-7. PA women, age 16-55, who were born with a female gender, hadn’t given birth or been pregnant after week 13 and weren’t elite athletes were included.  Result 215 women responded to the survey, 61 were excluded. Of 154 participants 37 women experienced SUI (prevalence 24%). Strength training (prevalence 18%) and running (prevalence 26%) were the most common activities. High-intensity training had a prevalence of 31–38%. Low intensity training had a prevalence of 19%. No correlation between experienced level of discomfort of UI and volume of moderate to high level of physical activity amongst women with SUI could be revealed. (r = -0,0489, p = 0,8).   Conclusion SUI is common amongst exercising women without known risk factors. It is more common with SUI during high-intensity activities compared with low-intensity. No correlation was demonstrated between UI amongst women with SUI and activity level. Research regarding exercise as risk factors and treatment for UI is required.

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Masters of Science - Msc (Physiotherapy) / Post-operative physiotherapy plays a vital role in the management of patients with incontinence in order to optimise the outcome of obstetric fistula surgery. Women who suffer residual urinary incontinence continue to experience shame, social isolation and institutional rejection. Incontinence continues to impair them leading to lower levels of role participation and restriction in most activities. Gynocare Fistula Center, Eldoret, receives a number of referrals for women with obstetric fistula requiring surgical and physiotherapy care. Many studies have focused on the determinants of surgical outcomes and social reintegration but none have focused on woman's perceptions and experiences with postoperative physiotherapy. While continence is not always achieved immediately after surgery, this study was designed to explore women's perceptions and experience of postoperative physiotherapy management at an obstetric fistula center in Eldoret,Kenya. Participants were then asked about their experiences and related perceptions and perceived challenges regarding the physiotherapy service following discharge from the Center. An explorative qualitative method was used to explore the women's perceptions and experiences of the post-operative physiotherapy management, as well as their perceived challenges regarding access to physiotherapy post discharge.