When the literature was examined, it was observed that there were studies on parameters such as quality of life, pelvic floor muscle strength in women with urinary incontinence, but there were not enough studies on posture, respiratory function, constipation and cough strength. Therefore, in this study, the researchers aimed to investigate posture, constipation, core muscle stabilisation, respiratory muscle strength and function, cough strength and quality of life of women with urinary incontinence and to compare these parameters with women without urinary incontinence.
Urinary incontinence (UI) is involuntary urinary leakage and may lead to social and economic problems. There are different types of UI such as stress type, urge, mixed type. Risk factors include age, gender, genetics, menopause, obesity, labour and surgical history. Posture is the position of the body during movement or posture and can also be defined as muscle balance. Studies have reported that there may be a relationship between UI and respiratory problems and postural motor control disorder. Various methods are used in posture assessment, but there is no study evaluating posture with artificial intelligence in women with UI in the literature.Constipation is a particularly serious risk for the development of stress urinary incontinence (SUI). Severe constipation in women leads to differences in the neural function of the pelvic floor by reducing the neural effect of the external anal sphincter and pelvic floor muscles (PFM). Many conditions that increase intra-abdominal pressure (IAB) cause the onset or development of UI. Constipation also leads to an increase in intra-abdominal pressure and thus an increase in intra-bladder pressure. Recently, researchers have investigated the relationship between constipation and urinary incontinence, but the results have been inconsistent. Core stabilisation is the ability to regulate the posture and movement of the body over the pelvis. During forced exhalation activities (Valsalva, coughing, laughing, etc.), the pelvic floor muscles (PFM), abdominal muscles and diaphragm work together to increase intra-abdominal pressure and prevent incontinence. The trunk stabilisation muscles work in concert to keep the abdomen and lumbopelvic region stable by regulating intra-abdominal pressure during various activities of daily living. The activity of these muscles alters intra-abdominal pressure, which in turn can affect the activity of the pelvic floor muscles. Cough is associated with urinary incontinence in women by affecting the concerted contraction of thoracic, abdominal and pelvic muscles. Women with chronic cough are 55-63.3% more likely to develop severe UI than women without chronic cough. Chronic cough has been shown to be one of the common risk factors for UI, along with advanced age, high BMI, history of vaginal delivery and surgical interventions. Urinary incontinence is a public health problem that seriously affects women's quality of life and social participation, as well as being common among older women. UI has a negative impact on individuals' sleep, sexual function, work performance and psychosocial aspects. As symptoms increase, quality of life decreases, but women usually realise the effects of UI years later by seeking professional help. When the literature was reviewed, it was observed that there were studies on parameters such as quality of life and pelvic floor muscle strength in women with urinary incontinence, but there were not enough studies on posture, respiratory functions, constipation and coughing strength. Therefore, in this study, the researchers aimed to investigate posture, constipation, core muscle stabilisation, respiratory muscle strength and function, cough strength and quality of life of women with urinary incontinence and to compare these parameters with women without urinary incontinence.
Study Type
OBSERVATIONAL
Enrollment
62
Izmir Democracy University
Izmir, Karabağlar/İzmir, Turkey (Türkiye)
Maximal inspiratory pressure (MIP)
The MIP which shows respiratory muscle strength will be evaluated using a portable mouth pressure measuring device based on American Thoracic Society and European Respiratory Society criteria.
Time frame: 1 year
Maximal expiratory pressure (MEP)
The MEP which shows respiratory muscle strength will be evaluated using a portabl mouth pressure measuring device based on American Thoracic Society and European Respiratory Society criteria.
Time frame: 1 year
Forced vital capacity (FVC)
Pulmonary function (Forced vital capacity (FVC)) will be evaluated with a spirometer. In the study, measurements will be made using the Cosmed Omnia microQuark 1.5 (Cosmed, Rome, Italy) device. Considering that dizziness may occur during forced expiration, measurements will be made while individuals are in a sitting position. While participants are sitting in a comfortable position in a chair with a backrest, nose clip will be attached and they will be asked to bite the mouthpieces with their teeth and close their lips in a way that does not allow air to escape. The tests will be performed at least 3 times by the participants and care will be taken to ensure that the expiration time is at least 6 seconds and the plateau time is 1 second. Due to the device software that records all three data, it saves the average of the two best data and processes it as a value.
Time frame: 1 year
Forced expiratory volume in the first second (FEV1)
Pulmonary function (Forced expiratory volume in the rst second (FEV1)) will be evaluated with a spirometer.
Time frame: 1 year
FEV1/FVC
Pulmonary function (FEV1/FVC) will be evaluated with a spirometer.
Time frame: 1 year
Flow rate 25-75% of forced expiratory volume (FEF 25-75%)
Pulmonary function (Flow rate 25-75% of forced expiratory volume (FEF 25-75%)) will be evaluated with a spirometer.
Time frame: 1 year
Peak flow rate (PEF)
Pulmonary function (Peak ow rate (PEF)) will be evaluated with a spirometer.
Time frame: 1 year
Posture Assessment
Posture assessment will be performed using an artificial intelligence based posture analysis package developed by Fizyosoft and Becure.
Time frame: 1 year
Core Stabilization Assessment
Stabilizer Pressure Biofeedback Unit (Chattanooga, USA) will be used for core stabilization assessment. The five-level core stabilization test developed by Sahrmann will be used to assess the participants' core stabilization levels.
Time frame: 1 year
Cough Force Assessment
Cough force will be measured using a portable peak flow meter (PEF meter) (ExpiRite Peak Flow Meter, China). During the test, participants cough vigorously into the device following a deep inspiration in an upright position. The peak flow rate (PEF) reached is recorded and a disposable mouthpiece is used for each participant. Three measurements are taken and the highest value is taken for analysis, with a 30 second rest period between measurements.
Time frame: 1 year
Modified Constipation Assessment Scale
This scale was developed by McMillan et al. in 1989 to determine the status and severity of constipation. It is a valid and reliable questionnaire consisting of nine questions and can be used in children and adults. Respondents rate each question as "no problem" (0), "some problem" (1) or "severe problem" (2). The total score ranges from zero (no constipation) to 18 (most severe constipation).
Time frame: 1 year
Rome IV Criteria
It is a clinical guideline defining the presence of constipation. The Rome IV criteria have been modified with regard to the frequency of abdominal pain, emphasizing the need for more frequent episodes of abdominal pain for diagnosis. At least two of these symptoms must occur at least once a week for a month, without any other underlying medical condition.
Time frame: 1 year
Bristol Stool Scale
Developed in 1990 by Lewis and Heaton at the University of Bristol, the Bristol Stool Scale (BGS) is a scale that assesses the physical properties and intestinal transit time of stool. Stool is divided into seven types: Types 3, 4 and 5 indicate normal stools; Types 1 and 2 indicate constipation; and Types 6 and 7 indicate diarrhea. Low scores indicate slow and high scores indicate fast intestinal transit.
Time frame: 1 year
Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7)
UDI-6 and IIQ-7 are short forms that assess the quality of life in urinary incontinence. The UIQ-6 consists of 6 questions including symptoms of urge, stress and emptying and the score is between 0-18. The IIQ-7 consists of 7 questions assessing physical activity, travel, social relationships and emotional health, with a score between 0-21. Higher scores indicate a reduced quality of life.
Time frame: 1 year
Global Pelvic Floor Bother Questionnaire
This questionnaire is a scale that assesses women's pelvic floor symptoms and severity. It covers symptoms such as urinary incontinence, pelvic organ prolapse and fecal incontinence. It consists of nine questions; respondents answer "yes/no" and rate severity from 1-5. The total score is 0-100, with a higher score indicating more symptoms.
Time frame: 1 year
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