In perimenopausal women with overactive bladder (OAB), pelvic floor electrical stimulation (PFS) in combination with local vaginal estrogen effectively reduces symptoms, a new study finds. A research team led by Ahmed Abdelbary, MD, of Bani Swaif University in Cairo, Egypt recruited 315 perimenopausal women suffering with symptoms such as frequency, nocturia, urgency, and urge incontinence. Investigators randomly assigned women to 1 of 3 treatments for 6 weeks: PFS alone, local estrogen alone (2 grams daily of 0.625 mg/g estrogen cream), or a combination of PFS and estrogen. Clinicians administered PFS treatment (pulses of 20 Hertz for 320 milliseconds to the vaginal area) twice a week for 30 minutes. Using patient reports along with laboratory and clinical results, the investigators recorded the effects of treatment on day and nighttime frequency, incontinence episodes, urgency, detrusor overactivity, and functional bladder capacity. Starting 1 week into treatment, all 3 groups showed significant improvement in their OAB symptoms, according to results published in Urology. Except for detrusor overactivity, PFS monotherapy produced better symptom relief overall than estrogen alone. Patients receiving a combination of PFS and local estrogen fared the best, however, experiencing reductions in both urgency and incontinence. Estrogen appears to enhance the effect of PFS and can delay the recurrence of urge incontinence. “The sustained effect may be due to the improvement in tissue quality which may lead to better conductivity that can augment the results of PFS and make improvement more stable,” the investigators explained. Symptom relief may be temporary, however. After 6 weeks of active therapy, benefits deteriorated over the following 6 months in all treatment groups, with the exception of incontinence episodes in the combination therapy group. “Further long-term studies are needed to evaluate the best dosing of estrogen, the proper schedule of PFS, the ideal period of treatment, and the possible retreatment methods,” the researchers noted. The studies should include the addition of third-line treatment with anticholinergics. Among the study's limitations, the placebo effect cannot be ruled out, since depression plays a role in OAB.
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Five years after delivering their first child, symptoms related to stress urinary incontinence (SUI) and overactive bladder (OAB) are more common and of greater severity after vaginal than cesarean birth, a study found. These differences, however, lessen with increasing time since childbirth. The study, by Victoria L. Handa, MD, of Johns Hopkins University in Baltimore, and colleagues, included 1,481 parous women enrolled 5-10 years after their first delivery. The women completed up to 5 annual assessments. During follow-up, the incidence of highly bothersome SUI and OAB were 2.5 per 100 woman-years and 1.7 per 100 woman-years, respectively. The estimated prevalence of leakage related to activity, coughing, or sneezing among women in the study's reference group (5 years after delivery, 30 years old at first delivery, non-obese, and non-black) was 54% among those who had at least 1 vaginal birth versus 20% among women who only had cesarean delivery, Dr. Handa's group reported online ahead of print in Neurourology and Urodynamics. The vaginal birth group also had a higher estimated prevalence of leakage of “drops” (37% vs. 17%), frequent urination (27% vs. 17%), need to rush to the bathroom for urination (17% vs. 7%), and leakage related to a feeling of urgency (17% vs. 7%). The relative odds of leakage related to activity, coughing, or sneezing increased by 6% per year since first birth in the cesarean section group, but did not change in the vaginal birth group. In both groups, the relative odds of urinary urgency (the need to rush to the bathroom for urination) increased significantly with increasing time from first birth (7% per year in the cesarean group and 6% in the vaginal birth group). “This study suggests a substantial impact of vaginal delivery on the presence and on the severity of urinary symptoms, especially 5 years from delivery,” the authors concluded. “However, over the subsequent 5 years, the odds for urinary symptoms increase annual among those who delivered by cesarean, especially for symptoms related to SUI.” The researchers also found that obesity was strongly associated with symptoms related to SUI and OAB. In the vaginal birth group, obese women had a significant 47% increased likelihood of leakage related to activity, coughing, or sneezing and a significant 43% increased likelihood of nocturia compared with non-obese women. In the cesarean group, obese women, compared with non-obese women, had a significant 2.5 times increased likelihood of leaking related to activity, coughing, or sneezing. They also had a significant 2.9 and 2.6 times increased odds of needing to rush to the bathroom for urination and leaking related to a feeling of urgency, respectively, as well as a significant 67% increased likelihood of frequent urination an a significant 62% increased likelihood of nocturia. The authors concluded that obesity is an important risk factor for bladder symptoms “and therefore obesity control should be a primary target for reduction of incontinence and incontinence severity among parous women.” |
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