Diagnosis and Treatment of Urinary and Fecal Incontinence in Women

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (15 February 2023) | Viewed by 8843

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Guest Editor
Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Interests: urogynecology; pelvic organ prolapse; stress incontinence; urge incontinence; mid-urethral slings; hysterectomy
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Special Issue Information

Dear Colleagues,

Urinary incontinence (UI) can be described as the complaint of the involuntary leakage of urine. Similarly, fecal incontinence (FI) is defined as the involuntary loss or passage of solid or liquid stool. Both conditions occur in both sexes, but they are found much more frequently in women.

UI and FI symptoms are highly prevalent and can have a substantial impact on personal health-related quality of life. They have significant social, physical, and psychological implications on patients' general wellbeing, which can ultimately lead to social isolation due to the fear and embarrassment of accidental urine and/or bowel leakage.

Two main types of UI bother women: stress urinary incontinence, in which urine leaks in association with physical exertion; and urgency urinary incontinence, in which urine leaks during or immediately following a sudden compelling desire to void.  

Common risk factors include age, ethnicity, BMI, parity, prior operative vaginal delivery or severe childbirth trauma, prior pelvic surgery, hysterectomy, spinal cord injuries, diabetes mellitus, and other multiple chronic comorbidities.

The management of UI or FI is often demanding, and needs to be tailored to the individual circumstances of the patient. Consequently, treatment plans are based on the severity of the incontinence, anatomical findings, and functional considerations.

An initial diagnostic evaluation involves obtaining the patient’s medical history, performing a physical examination, taking a urinalysis, and assessing the patient’s quality of life. Non-surgical interventions can consist of several options, including lifestyle modifications, pelvic floor muscle training, dietary changes, and medical therapy. When initial treatments fail, invasive urodynamics, anal manometry, and ultrasound examinations may be conducted before turning to surgery.

Undoubtedly, expanding our knowledge by completing further study of all aspects concerning pelvic floor control is greatly warranted. Future directions in this research area may target primary prevention by aiming to achieve a better understanding of the anatomical, environmental, and genetic risks for incontinence. Significantly, preliminary studies with local injections of muscle-derived or mesenchymal stem cells to the anal sphincter and urethral sphincter have demonstrated encouraging functional results.

This Special Issue on the diagnosis and treatment of urinary and fecal incontinence in women aims to collect reviews, original research, opinion papers, and innovative protocols to provide updates, new findings, and future perspectives on urinary and fecal incontinence research and care.

Prof. Dr. Shimon Ginath
Guest Editor

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Keywords

  • urinary incontinence
  • fecal incontinence

Published Papers (6 papers)

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Research

9 pages, 872 KiB  
Article
The Investigation of Percutaneous Tibial Nerve Stimulation (PTNS) as a Minimally Invasive, Non-Surgical, Non-Hormonal Treatment for Overactive Bladder Symptoms
by Connor McPhail, Robert Carey, Sidharth Nambiar, Nadia Willison, Saghi Bahadori, Pouria Aryan, Tran Nguyen and Fariba Behnia-Willison
J. Clin. Med. 2023, 12(10), 3490; https://doi.org/10.3390/jcm12103490 - 16 May 2023
Cited by 1 | Viewed by 1628
Abstract
Background: Overactive bladder (OAB) syndrome affects 10–15% of women, severely impacting their quality of life. First-line treatments include behavioural and physical therapy, and second-line medical treatments include medications such as vaginal oestrogen, anticholinergic medications, and ß3-adrenergic agonists—with potential adverse side effects including dizziness, [...] Read more.
Background: Overactive bladder (OAB) syndrome affects 10–15% of women, severely impacting their quality of life. First-line treatments include behavioural and physical therapy, and second-line medical treatments include medications such as vaginal oestrogen, anticholinergic medications, and ß3-adrenergic agonists—with potential adverse side effects including dizziness, constipation, and delirium, particularly affecting elderly populations. Third-line treatments include more invasive measures, including intradetrusor botulinum injections or sacral nerve modulation, with percutaneous tibial nerve stimulation (PTNS) being a potential alternative treatment. Aims: The aim of this study was to explore the long-term efficacy of PTNS treatment for OAB in an Australian cohort. Materials and Methods: This is a prospective cohort study. Patients underwent Phase 1 treatment, whereby women received PTNS treatment once per week for 12 weeks. Following Phase 1, women entered Phase 2, whereby they received 12 PTNS treatments over 6 months. Their response to treatment was measured by obtaining data before and after each phase using ICIQ-OAB and the Australian Pelvic Floor Questionnaire (APFQ). Results: Phase 1 included 166 women, with 51 completing Phase 2. There was a statistically significant reduction in urinary urgency (29.8%), nocturia (29.8%), incontinence (31.0%), and frequency (33.8%) compared to the baseline. Patients who completed Phase 2 also showed a statistically significant reduction in urinary frequency (56.5%). Conclusions: Overall, the results from this study are positive and support that PTNS is a minimally invasive, non-surgical, non-hormonal, and effective treatment for OAB. These results suggest that PTNS may be a second-line treatment for patients with OAB not responding to conservative management or for patients aiming to avoid surgical approaches. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)
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8 pages, 242 KiB  
Article
Urinary Incontinence in Parous Women Practicing Non-Extreme Competitive Sports Compared to the General Population
by Masha Ben Zvi, Maya Arad Cohen, Matan Friedman, Hadas Ganer Herman, Eran Weiner and Shimon Ginath
J. Clin. Med. 2023, 12(8), 2803; https://doi.org/10.3390/jcm12082803 - 10 Apr 2023
Cited by 2 | Viewed by 1271
Abstract
Introduction and objective: This cross-sectional study aimed to compare the prevalence of urinary symptoms in physically active females to the general population represented by medical staff. Materials and methods: We conducted a survey utilizing the UDI-6 questionnaire on women playing catchball for at [...] Read more.
Introduction and objective: This cross-sectional study aimed to compare the prevalence of urinary symptoms in physically active females to the general population represented by medical staff. Materials and methods: We conducted a survey utilizing the UDI-6 questionnaire on women playing catchball for at least one year and training twice a week or more in an official Israeli competitive league. The control group consisted of women practicing medicine (physicians and nurses). Results: The study group consisted of 317 catchball players and the control group consisted of 105 medical staff practitioners. Both groups were similar in most of the demographic characteristics. Urinary symptoms represented by UDI-6 scores were higher in women in the catchball group. Frequency and urgency symptoms were common in women playing catchball. Stress urinary incontinence (SUI) was insignificant between the groups (43.8% in the catchball group and 35.2% in the medical staff group, p = 0.114). However, severe symptoms of SUI were more common in catchball players. Conclusions: The rates of all urinary symptoms were higher in in catchball players. SUI symptoms were common in both groups. However, severe symptoms of SUI were more common in catchball players. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)
7 pages, 241 KiB  
Article
High Incidence of Obstetric Anal Sphincter Injuries among Immigrant Women of Asian Ethnicity
by Yoav Baruch, Ronen Gold, Hagit Eisenberg, Hadar Amir, Lee Reicher, Yariv Yogev and Asnat Groutz
J. Clin. Med. 2023, 12(3), 1044; https://doi.org/10.3390/jcm12031044 - 29 Jan 2023
Cited by 3 | Viewed by 1458
Abstract
(1) Background: Obstetric anal sphincter injuries (OASI) may complicate vaginal deliveries. The aim of the present study was to explore the incidence and clinical characteristics of OASI among Asian women living in a Western country compared to local Caucasian women. (2) Methods: A [...] Read more.
(1) Background: Obstetric anal sphincter injuries (OASI) may complicate vaginal deliveries. The aim of the present study was to explore the incidence and clinical characteristics of OASI among Asian women living in a Western country compared to local Caucasian women. (2) Methods: A retrospective cohort study of 380 women diagnosed with OASI, following singleton vaginal deliveries, during a 10-year period (January 2011 to December 2020). Exclusion criteria: age < 18 years, stillbirth, and breech presentation. Demographic, clinical, and obstetrical data were obtained, and a comparison between Asian and Caucasian women was performed. (3) Results: There were 35 cases of OASI among 997 women of Asian ethnicity compared to 345 cases of OASI among 86,250 Caucasian women (3.5% vs. 0.4%, respectively, p < 0.001). Asian women endured a significantly higher rate of fourth-degree OASI (17.1%) even though they bore smaller newborns (3318 g vs. 3501 g, p = 0.004), and birth weights rarely exceeded 3800 g (2.8% vs. 25.8%, p < 0.001). Asian ethnicity was also associated with a significantly higher risk for blood transfusion following OASI and a lower tendency for postpartum follow up. (4) Conclusions: Immigrant women of Asian ethnicity had a nine-fold higher rate of OASI, much higher than previously reported. Furthermore, Asian women had higher rates of fourth-degree OASI. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)
6 pages, 224 KiB  
Article
Substantial Obstetric Anal Sphincter Injury during Vacuum Assisted Delivery: An Obstetrical Issue or Device Related?
by Yoav Baruch, Ronen Gold, Hagit Eisenberg, Hadar Amir, Yariv Yogev and Asnat Groutz
J. Clin. Med. 2022, 11(23), 6990; https://doi.org/10.3390/jcm11236990 - 26 Nov 2022
Viewed by 1008
Abstract
Background: Obstetric anal sphincter injuries (OASIS) might be associated with long-term urinary and anorectal morbidities. The aim of the study was to investigate the risk factors and clinical implications of OASIS associated with vacuum-assisted deliveries versus normal vaginal deliveries. Methods: A series of [...] Read more.
Background: Obstetric anal sphincter injuries (OASIS) might be associated with long-term urinary and anorectal morbidities. The aim of the study was to investigate the risk factors and clinical implications of OASIS associated with vacuum-assisted deliveries versus normal vaginal deliveries. Methods: A series of 413 consecutive OASIS cases were retrospectively analyzed. A comparison was made between OASIS cases diagnosed following vacuum-assisted deliveries versus OASIS cases diagnosed following normal vaginal deliveries. Multivariable analysis was used to study the association between vacuum-assisted deliveries and superficial (3A and 3B) versus deep (3C and 4) perineal tears. Results: The study population comprised 88,123 singleton vaginal deliveries. Diagnosis of OASIS was made in 413 women (0.47% of the total cohort), 379 (91.8%) of whom had third-degree tears and 34 (8.2%) of whom had fourth-degree tears. Among the 7410 vacuum-assisted deliveries, 102 (1.37%) had OASIS, whereas, among the 80,713 normal vaginal deliveries, only 311 (0.39%) had OASIS. In a multivariate analysis, only vacuum-assisted delivery was found to be associated with a significant risk of deeper (3C or 4) perineal tears (OR = 1.72; 95% CI 1.02–2.91; p = 0.043). Conclusions: Vacuum-assisted instrumental intervention is a significant risk factor for OASIS and especially for deeper tears, independent of other maternal and obstetric risk factors. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)
12 pages, 1279 KiB  
Article
Clinical Outcomes of Mid-Urethral Sling (MUS) Procedures for the Treatment of Female Urinary Incontinence: A Multicenter Study
by Karolina Chmaj-Wierzchowska, Grzegorz Raba, Piotr Dykczyński, Maciej Wilczak, Karolina Turlakiewicz, Ilona Latańska and Witold Sujka
J. Clin. Med. 2022, 11(22), 6656; https://doi.org/10.3390/jcm11226656 - 09 Nov 2022
Cited by 2 | Viewed by 1605
Abstract
Introduction: Stress urinary incontinence (SUI) has a significant impact on the quality of life of many women. Due to embarrassment, most women do not seek medical attention for this condition. The treatment of this problem includes preventive therapies, and in the more advanced [...] Read more.
Introduction: Stress urinary incontinence (SUI) has a significant impact on the quality of life of many women. Due to embarrassment, most women do not seek medical attention for this condition. The treatment of this problem includes preventive therapies, and in the more advanced stage of urinary incontinence, surgery is a solution. Despite doubts regarding the implantation of urological tapes, the use of tension-free minimally invasive methods constitutes the “gold standard” in the treatment of stress urinary incontinence in women. Objective: The purpose of this article was to evaluate the efficacy and safety of ultralight, polypropylene urogynecological tape (Dallop® NM ULTRALIGHT, Tricomed S.A., Poland) in the surgical treatment of female stress urinary incontinence and mixed urinary incontinence. Methods: This is a multicenter, retrospective cohort study. The included women were adults with stress urinary incontinence (Grade 2 with a positive cough test or Grade 3) or had mixed urinary incontinence and who had undergone “retropubic” or “transobturator” surgery and completed a postoperative follow-up. Results: The study included 68 women from three hospitals. All women completed <6-month and >6-month follow-ups. The median age was 55 (range 36–80). The average value of BMI in the “retropubic” group was 28.6 ± 5.58, and in the “transobturator” group, it was 26.1 ± 4.60. Sixty-three percent (63%, n = 43) of patients were operated on using the “transobturator” method, while thirty-seven percent (37%, n = 25) were operated on using the “retropubic” method. Both the “retropubic” and “transobturator” groups had comparable results in the treatment of SUI. The study showed efficiencies of 84% for the “transobturator” method and 80% for the “retropubic” method. In the “retropubic” group, intraoperative complications were reported in three patients (7%), in comparison to none in the “transobturator” group. There were no tape-related adverse events or infections reported in any case. Conclusions: The presented research confirms the safety and efficacy of retropubic and transobturator tape methods in both short- and long-term follow-up—the success rate was over 80%. In addition to the surgical method used, the experience of the surgeons also has an impact on the final outcome of the surgery. The conducted multi-center study offers the opportunity to eliminate the influence of the human factor on the effectiveness of the procedure. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)
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9 pages, 741 KiB  
Article
The Clinical Effects of Pixel CO2 Laser on Bladder Neck and Stress Urinary Incontinence
by Cheng-Yu Long, Jennifer Po-Ning Lee, Zi-Xi Loo, Yi-Yin Liu, Chang-Lin Yeh, Chien-Wei Feng and Kun-Ling Lin
J. Clin. Med. 2022, 11(17), 4971; https://doi.org/10.3390/jcm11174971 - 24 Aug 2022
Cited by 3 | Viewed by 1416
Abstract
Background: Our study aims to assess Pixel CO2 laser efficacy for female stress urinary incontinence (SUI). Methods: In the study, 25 women with SUI were included and scheduled for vaginal Pixel CO2 Laser (FemiLift™, Alma Lasers, Israel) treatment. All subjects had [...] Read more.
Background: Our study aims to assess Pixel CO2 laser efficacy for female stress urinary incontinence (SUI). Methods: In the study, 25 women with SUI were included and scheduled for vaginal Pixel CO2 Laser (FemiLift™, Alma Lasers, Israel) treatment. All subjects had a baseline and 6-month post-treatment assessment that included three-dimensional perineal ultrasound and validated questionnaires. Results: Data showed that monthly three-session vaginal Pixel CO2 Laser treatment significantly improved SUI symptoms, as evidenced by validated questionnaires, including UDI-6, IIQ-7, ICIQ, and vaginal laxity questionnaire (p < 0.05). The Pixel CO2 Laser efficacy in vaginal treatment was 20/25 (80%), and the perineal sonography showed that laser treatment significantly decreased bladder neck mobility and middle urethral area (during resting and straining). Permanent adverse events were not found. Conclusions: The results of our study suggested that for the treatment of mild to moderate SUI symptoms, Pixel CO2 Laser is effective and safe; however, more studies and a longer follow-up should be conducted to confirm its efficacy and durability. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)
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