International Urogynecology Journal

, Volume 23, Issue 9, pp 1231–1237 | Cite as

High prevalence of pelvic floor muscle dysfunction in hospitalized elderly women with urinary incontinence

  • Helena Talasz
  • Stephan C. Jansen
  • Markus Kofler
  • Monika Lechleitner
Original Article

Abstract

Introduction and hypothesis

The purpose of this study was to determine pelvic floor muscle (PFM) function in hospitalized elderly women with urinary incontinence (UI).

Methods

A cross-sectional study was performed using data of 704 patients, routinely collected by means of a clinical UI assessment.

Results

Only 25.5% of the patients were able to perform normal PFM contractions (Oxford grading scale score ≥3); 74.5% were unable to contract their PFM or showed weak PFM activity without circular contraction or elevation of the vagina. Vulvovaginal mucosal dystrophy was noted in 84% of the patients. A significant positive correlation of PFM function was found to cognitive status (MMSE score), mobility (Tinetti performance score), and history of previous PFM training; a negative correlation of PFM function was found to patients’ age and vulvovaginal mucosal dystrophy, and no significant correlation to body mass index, parity, or history of hysterectomy.

Conclusions

Targeted clinical UI assessment including digital vaginal palpation should be performed in all incontinent elderly women in order to detect PFM dysfunction and to optimize therapeutic measures.

Keywords

Elderly incontinent women Pelvic floor muscle function Urinary incontinence Urinary incontinence assessment 

References

  1. 1.
    DuBeau CE, Kuchel GA, Johnson T et al (2010) Incontinence in the frail elderly: report from the 4th International Consultation. Neurourol Urodyn 29:165–178PubMedCrossRefGoogle Scholar
  2. 2.
    Lifford KL, Townsend MK, Curhan GC et al (2008) The epidemiology of urinary incontinence in older women: incidence, progression, and remission. J Am Geriatr Soc 56:1191–1198PubMedCrossRefGoogle Scholar
  3. 3.
    Ouslander JG, Johnson TM (1998) Incontinence. In: Hazzard WR, Blass JP, Ettinger WH et al (eds) Principles of geriatric medicine and gerontology, 4th edn. McGraw-Hill, New York, pp 1595–1613Google Scholar
  4. 4.
    Goode PS, Burgio KL, Richter HE et al (2010) Incontinence in older women. JAMA 303:2172–2181PubMedCrossRefGoogle Scholar
  5. 5.
    Thüroff JW, Abrams P, Andersson KE et al (2011) EAU Guidelines on urinary incontinence. Eur Urol 59:387–400PubMedCrossRefGoogle Scholar
  6. 6.
    Fung C, Spencer B, Eslami M et al (2007) Quality indicators for the screening and care of urinary incontinence in vulnerable elders. J Am Geriatr Soc 55:443–449CrossRefGoogle Scholar
  7. 7.
    Woodford H, George J (2007) NICE guidelines on urinary incontinence in women. Age Ageing 36:349–350PubMedCrossRefGoogle Scholar
  8. 8.
    Messelink B, Benson T, Berghmans et al (2005) Standardisation of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the international continence society. Neurourol Urodyn 24:374–380PubMedCrossRefGoogle Scholar
  9. 9.
    Bo K, Sherburn M (2005) Evaluation of female pelvic-floor muscle function and strength. Phys Ther 85:269–282PubMedGoogle Scholar
  10. 10.
    Laycock J, Whelan MM, Dumoulin C (2008) Patient assessment. In: Haslam J, Laycock J (eds) Therapeutic management of incontinence and pelvic pain, 2nd edn. Springer, London, pp 57–66Google Scholar
  11. 11.
    Talasz H, Kofler M, Kalchschmid E, Pretterklieber M, Lechleitner M (2010) Breathing with the pelvic floor? Correlation of pelvic floor muscle function and expiratory flows in healthy young nulliparous women. Int Urogynecol J Pelvic Floor Dysfunct 21:475–481Google Scholar
  12. 12.
    Lawrence J, Lukacz E, Nager C et al (2008) Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol 111:678–685PubMedCrossRefGoogle Scholar
  13. 13.
    Bo K (2006) Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J 2:76–84Google Scholar
  14. 14.
    Ashton-Miller JA, Howard D, DeLancey JOL (2001) The functional anatomy of the female pelvic floor and stress continence control system. Scand J Urol Nephrol Suppl 207:1–7CrossRefGoogle Scholar
  15. 15.
    Theofrastus JP, Wyman JF, Bump RC et al (1997) Relationship between urethral and vaginal pressure during pelvic muscle contraction. Neurourol Urodyn 16:553–558CrossRefGoogle Scholar
  16. 16.
    Godec C, Cass AS, Ayala GF (1975) Bladder inhibition with functional electrical stimulation. Urology 6(6):663–666PubMedCrossRefGoogle Scholar
  17. 17.
    Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005654Google Scholar
  18. 18.
    Wagg A, Potter J, Peel P et al (2008) National audit of continence care for older people: management of urinary incontinence. Age Ageing 37:39–44PubMedCrossRefGoogle Scholar
  19. 19.
    Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126PubMedGoogle Scholar
  20. 20.
    Folstein MF, Robins LN, Helzer JE (1983) The mini-mental-state examination. Arch Gen Psychiatry 40:812PubMedCrossRefGoogle Scholar
  21. 21.
    Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 19:131–135Google Scholar
  22. 22.
    Bo K, Finckenhagen HB (2001) Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 80(10):883–887PubMedGoogle Scholar
  23. 23.
    Slieker-ten Hove MCP, Pool-Goudzwaard AL, Eijkemans MJC, Steegers-Theunissen RPM, Burger CW, Vierhout ME (2009) Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Neurourol Urodyn 28(4):295–300PubMedCrossRefGoogle Scholar
  24. 24.
    Resnick NM, Elbadawi A, Yalla SV (1995) Age and the lower urinary tract: what is normal? Neurourol Urodyn 14:577–579Google Scholar
  25. 25.
    Fritsch H (2006) Aging of pelvic floor muscles. In: Carriere B, Feldt CM (eds) The pelvic floor, 2nd edn. Thieme, New York, pp 19–20Google Scholar
  26. 26.
    MacBride MB, Rhodes DJ, Shuster LT (2010) Vulvovaginal atrophy. Mayo Clin Proc 85:87–94CrossRefGoogle Scholar
  27. 27.
    Leibovitz A, Kaplun V, Saposhnicov N et al (2000) Vulvovaginal examinations in elderly nursing home women residents. Arch Gerontol Geriatr 31:1–4PubMedCrossRefGoogle Scholar
  28. 28.
    Harris T (1998) Weight and age: paradoxes and conundrums. In: Hazzard WR, Blass JP, Ettinger WH et al (eds) Principles of geriatric medicine and gerontology, 4th edn. McGraw-Hill, New York, pp 967–972Google Scholar
  29. 29.
    Sherburn M, Bird M, Carey M, Bø K, Galea MP (2011) Incontinence improves in older women after antensive pelvic floor muscle Ttraining: an assessor-blinded randomized controlled trial. Neurourol Urodyn 30:317–324PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2011

Authors and Affiliations

  • Helena Talasz
    • 1
  • Stephan C. Jansen
    • 2
  • Markus Kofler
    • 3
  • Monika Lechleitner
    • 1
  1. 1.Department of Internal and Geriatric MedicineHochzirl HospitalZirlAustria
  2. 2.Department of Internal and Geriatric Medicine and Palliative CareDeggendorf HospitalDeggendorfGermany
  3. 3.Department of NeurologyHochzirl HospitalZirlAustria

Personalised recommendations