Prevalence and conservative treatment of urinary incontinence and other urogynecological conditions in women with spinal cord injury

Marlene Elmelund

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Spinal cord injury (SCI) is associated with multiple complications, including urinary incontinence (UI). However, there is a knowledge-gap on the prevalence and treatment of UI in women with SCI. Furthermore, it has been questioned if pelvic organ prolapse (POP) occurs more frequently in women with SCI, primarily because of the weakened pelvic floor muscles (PFMs), but this has never been investigated.
Hence, the overall aim of this thesis was to increase our knowledge on urogynecological conditions in women with SCI. Specifically, we aimed at investigating the prevalence of UI, factors associated with UI and the effect of pelvic floor muscle training (PFMT) with and without intravaginal electrical stimulation (IVES) on UI in women with SCI. An additional aim was to examine the occurrence of POP after SCI and to evaluate the need for specialized urogynecological assessments offered to women with SCI.
Study I was a cross-sectional study. It included 609 women and was based on standardized questionnaires that had been filled out and registered in a database by the clinician during each consultation at the SCI-clinic. We found a 49% prevalence of daily to monthly UI, and UI was associated with reduced quality of life, unmarried/non-cohabiting status and impaired mobility.
In the cross-sectional Study II, 98 women with SCI underwent a urogynecological assessment. Information on urogynecological symptoms was obtained, and the occurrence of POP was investigated during a pelvic examination. We found that 21% had anatomical POP and that POP was associated with increasing age, vaginal delivery, parity and menopause but not with time after injury or severity of injury. Nonetheless, UI and bladder/bowel emptying problems were highly prevalent, affecting 63-71% of the women. Study III was a randomized trial,
investigating the effect of 12-weeks daily PFMT or PFMT and IVES on UI. Outcome measures included a UI questionnaire, daily UI episodes and urethral opening pressure measured with urethral pressure reflectometry. A total of 26 women completed the study. We found that PFMT+IVES was not superior to PFMT alone. Only PFMT improved the symptoms of UI with a persistent effect after 3 months follow-up.
This thesis shows that although anatomical POP does not occur frequently after SCI, symptoms of UI are highly prevalent in this group of women. Further, it demonstrates that urogynecological consultations should be included in the standardized follow-up program, especially in women with UI after SCI. Finally, PFMT without IVES is an effective conservative treatment of UI in women with incomplete SCI.
Antal sider101
StatusUdgivet - 2018


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