Correlation of core muscle strength with urge incontinence in menopausal women: An observational study

Ashwini Bulbuli; Javiriya Mainuddin

doi:10.4103/ijptr.ijptr_110_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 5 | Issue : 1 | Page : 84-87

Correlation of core muscle strength with urge incontinence in menopausal women: An observational study

Ashwini Bulbuli, Javiriya Mainuddin
Department of Obstetrics and Gynaecology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission	08-Jul-2022
Date of Decision	24-Jun-2023
Date of Acceptance	26-Jun-2023
Date of Web Publication	11-Aug-2023

Correspondence Address:
Dr. Ashwini Bulbuli
Department of Obstetrics and Gynaecology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi - 590 010, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_110_22

Abstract

Context: Urogenital tract problems faced by menopausal women are of concern among which urinary incontinence is majorly considered, with the prevalence of 27.66% of urge incontinence affecting the quality of life and has significant cost implications. The core, including abdominal muscles as well as pelvic floor muscles, plays a critical role in continence maintenance. Urinary incontinence is caused by the weakness of these muscles in menopausal women.
Aim: The aim of the study is to establish the correlation between the quality and quantity of core muscle strength in menopausal women with urge incontinence.
Settings and Design: This is a correlational study conducted in a tertiary health-care center.
Materials and Methods: The present study consisted of 50 volunteered women of age group 45 years and above. The participants were recruited by screening with the help of the Patient Perception of Intensity of Urgency Scale and were given the International Consultation on Incontinence Questionnaire (ICIQ) and core strength was quantified using pressure biofeedback unit (PBU).
Statistical Analysis: Pearson's correlation was used to establish the association between urge incontinence and core muscle strength.
Results: Pearson's correlation revealed a significant correlation between the core strength in relation to urge incontinence in menopausal women with nonlinear association where PBU (P = 0.022*) and ICIQ (P = 0.001*) were found.
Conclusion: According to the findings, the present study showed a significant correlation between menopausal age and core muscle strength and hence concluded that the correlation of core muscle strength with urge incontinence in menopausal women.

Keywords: Core strength, International Consultation on Incontinence Questionnaire, Menopausal women, Patient Perception of Intensity of Urgency Scale, Pressure biofeedback unit, Urge incontinence

How to cite this article:
Bulbuli A, Mainuddin J. Correlation of core muscle strength with urge incontinence in menopausal women: An observational study. Indian J Phys Ther Res 2023;5:84-7

How to cite this URL:
Bulbuli A, Mainuddin J. Correlation of core muscle strength with urge incontinence in menopausal women: An observational study. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Oct 1];5:84-7. Available from: https://www.ijptr.org/text.asp?2023/5/1/84/383667

Introduction

Menopause is a stage of life where cessation of menstruation occurs as women go through fertile to infertile periods. Menopause is the complete stoppage of ovarian function and the end of the reproductive stage at the age of 45 years.^[1],[2] Menopause is said to approach when a woman undergoes 12 months of amenorrhea, considering the mean age of 51 years.^[3],[4],[5]

Menopause is divided into three phases: premenopause, menopause, and postmenopause. Premenopause is believed to start around the age of 40, when hormonal changes start to take place. Menopause is said to initiate around the age of 45, on average 51 years occurs. This is then followed by post-menopausal stage at the age of 55, when many problems are experienced while going through this which includes vasomotor symptoms, urogenital atrophy and osteoporosis and other co-morbidities.^[2],[4],[6]

According to the studies, urge incontinence is a significant health problem that can have an impact on an individual's quality of life, as the prevalence level peaks around menopause and continues to rise into later life.^[7],[8],[9] Decreased core muscle strength is a major concern in menopausal women, and it is a common condition in this population. The prevalence of urge incontinence is 27.66%.^[2] There are studies done which state stress incontinence, urge incontinence, prolapse as conditions associated with menopause but failed to quantify the urge incontinence, specifically in relation to menopause with core muscle strength.^{[10],[11],[12],[13],[14]}

There is a dearth of literature about the quality of urge and quantification of core muscle strength leading to urge incontinence. Hence, the present study aims to determine the correlation of core muscle strength with urge incontinence in menopausal women.

Subjects and Methods

The cross-sectional study, which recruited participants of 45 years and above, with natural menopausal those when screened and measured for urge incontinence according to the Patient Perception of Intensity of Urgency Scale (PPIUS) score of Grade 3 of sensation related to bladder diary were included in the study and those having urinary tract infections, any type of genital prolapse, history of cancer, any spinal cord injury or any other neurological diseases, or history of any recent abdominal surgery were excluded from the study, was then provided with the International Consultation on Incontinence Questionnaire (ICIQ) and core strength was quantified using pressure biofeedback unit (PBU). After the ethical clearance was obtained, from the Institutional ethical committee, all the precautions were taken related to COVID-19 infection, according to the ICMR guidelines. The participants were then introduced to the purpose of the study and written informed consent was obtained for their voluntary participation.

Outcome measures

The Patient Perception of Intensity of Urgency Scale

This PPIUS scale was used as a screening tool using which the participants were recruited post which all were explained about it. It is a 3-day bladder diary which includes – the Indevus Urgency Severity Scale (3-point scale), sensation-related bladder diary (3-point scale), and PPIUS (4-point scale). The greater the score the worse it is considered and the lesser the score the better it is considered. Its reliability is a high coefficient of 0.95.

International Consultation on Incontinence Questionnaire

The ICIQ questionnaire was provided to each one of them and was scored accordingly. It is a questionnaire that helps the individual to record the frequency of voiding in a day. The greater is the score the worse, it is considered and the lesser is the score the better, it is considered. Its reliability is moderate to very good – Cronbach's alpha of 0.95.

Pressure biofeedback unit

It is a device that is used to measure core strength and also plays a role in rehabilitation. It consists of an air pillow and a sensitive pressure gauge. Change in pressure will be visually indicated on the gauge. It analyzes movement of the lumbar spine associated with a deep abdominal contraction in relation to an air-filled reservoir to enhance muscle re-education.^[15],[16] The pressure biofeedback device, which measures 16.7 cm × 24 cm in length, is composed of nonelastic material and comprises with a pressure gauge (sphygmomanometer) with a range of 20–100 mmHg on a scale with 2 mmHg intervals. Subject is instructed to withdraw in the abdomen (tummy tuck) while using the pressure biofeedback in order to stimulate the deep abdominal muscles.^[17] Its reliability is 0.89 with 95% confidence interval (0.70–0.94). The core muscle strength was evaluated using PBU and the score was noted during which the subject was instructed to position themselves in a crook lying position and was said to draw their navel in and hold it for 10 s without holding breath and count till 10. Later, the total scores were calculated and considered. More the subject scored, the better was their condition considered and lesser the score the worse, it was considered.

Statistical analysis

The data for the study was recorded and tabulated in microsoft excel sheet and then analysed using statistical tests that included, descriptive statistics and Pearson's correlation test in order to analyse the baseline characteristics and find out correlation between core muscle strength and urge incontinence in women during their menopause respectively. The statistical analysis was executed with the help of the (Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp) to calculate the results. Data analysis was performed using appropriate descriptive statistics; for continuous data, various mathematical calculations such as mean and standard deviation were employed; and for categorical data, percentages were calculated.

Results

The descriptive statistics for patients' demographic and baseline characteristics for PPIUS, ICIQ, and PBU are depicted in [Figure 1] and [Figure 2].

Figure 1: Descriptive statistics of demographic data

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Figure 2: Mean and standard deviation of Patient Perception of Intensity of Urgency Scale, International Consultation on Incontinence Questionnaire, and pressure biofeedback unit

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Pearson's correlation revealed a significant correlation between the core strength in relation to to incontinence in menopausal women with nonlinear association, where PBU (P = 0.022*) and ICIQ (P = 0.001*) were found. The correlation between the age and the outcome measures is shown in [Table 1]. The results established correlation coefficient r-value for AGE and PPIUS have been recorded as −0.161, which is statistically nonsignificant at 5% level with nonlinear association. The correlation between AGE and ICIQ, PBU has been found to be statistically significant (P < 0.05) with nonlinear association. The result of the subject's core strength in relation to urgency and its perception is presented in [Table 2]. The result shows that correlation coefficient r-value for PBU with ICIQ and PPIUS has been recorded as P > 0.05 with nonlinear association. The correlation coefficient of ICIQ with PPUIS is found to be statistically significant at a 5% level with the linear association.

Table 1: Pearson's correlation analysis age and Patient Perception of Intensity of Urgency Scale, International Consultation on Incontinence Questionnaire, and pressure biofeedback unit

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Table 2: Person correlation analysis of pressure biofeedback unit with International Consultation on Incontinence Questionnaire and Patient Perception of Intensity of Urgency Scale

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Discussion

The present study was conducted with a goal to establish a correlation between the core muscle strength and urge incontinence in menopausal women, as to find out how much weak core can lead to urge incontinence. In the present study, 50 menopausal women of age group 45 years and above and those having urge incontinence were included and were evaluated for their core muscle strength and were screened and quantified for urge incontinence. Menopause is a physiological process that signifies the end of a woman's reproductive phase. As and how age advances, there is a significant incidence of stress and urge incontinence.

Urge incontinence has a number of causes closely attributed to overactive bladder syndrome and urgency and frequency of micturition, with or without incontinence, are caused by over activity of the detrusor muscles and due to weak core muscle strength.^[18] A study on menopausal women found that various changes in the pelvic floor's anatomical support are what drive urge incontinence. These changes have also been linked to poor motor control in the local low back and pelvic floor muscles, which work together to manage continence and support the spine.^[18] In contrast, in the present study, the cause of the weakness was known, so the core muscle's weakness was measured. According to Alghadir et al., in addition to pelvic floor muscles, the core muscles, which include the abdominals and diaphragm, are crucial for trunk control and continence maintenance.

It stated as core muscle endurance plays a vital role in maintaining continence so weaker the core muscle endurance, the more severe the urinary incontinence, and the worse the impact on quality of life and also advocated of weaker core muscle endurance as a reason for increasing age^[11] but failed to quantify as to how much weaker core muscle strength will lead to urge incontinence whereas in the present study, core muscle strength was quantified using the pressure biofeedback device, which resulted that lesser the core muscle strength score, greater chances of urge incontinence. Another study done by Burgio KL et al. revealed urge incontinence symptoms to be more common in postmenopausal women, i.e. above the age group of 55 years.^[9]

However, contradicting to that, the present study revealed a significant correlation between age and weak core muscle strength, proving that urge incontinence is a problem faced by menopausal women in the age group of 45–55 years, as this study was conducted among menopausal women with weak core strength in the age group of 45–55 years.

The results of our study should be considered in light of its limitation. Although all participants in the study were from single-center tertiary care hospital, our sample size is relatively small. The small sample size may therefore affect the generalizability of the results to the population. Further studies can be done taking postmenopausal women into consideration with other menopausal symptoms. Future studies can be carried out using the same population with a larger sample size, multicentric, and other outcome measures as well and hence overcoming the limitations of the study.

Conclusion

The present study found that weak core muscle strength leads to urge incontinence in menopausal women when quantified using PBU and showed a significant correlation between menopausal age and core muscle strength and hence concluded that the correlation of core muscle strength with urge incontinence in menopausal women.

Financial support and sponsorship

Self-support.

Conflicts of interest

There are no conflicts of interest.

References

1.	Aaron R, Muliyil J, Abraham S. Medico-social dimensions of menopause: A cross-sectional study from rural south India. Natl Med J India 2002;15:14-7.
2.	Schneider HP. The quality of life in the post-menopausal woman. Best Pract Res Clin Obstet Gynaecol 2002;16:395-409.
3.	Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: A review. JAMA 2017;318:1592-604.
4.	Ganapathy T. Impact of urinary incontinence on quality of life among rural women. Muller J Med Sci Res 2018;9:71. [Full text]
5.	Nitti VW. The prevalence of urinary incontinence. Rev Urol 2001;3 Suppl 1:S2-6.
6.	Song YJ, Xu L. Prevalence and related factors of urinary incontinence in postmenopausal women. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2004;26:442-5.
7.	Woodman PJ, Misko CA, Fischer JR. The use of short-form quality of life questionnaires to measure the impact of imipramine on women with urge incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2001;12:312-5.
8.	Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil 2004;85:S86-92.
9.	Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: A randomized controlled trial. JAMA 2002;288:2293-9.
10.	O'Conor RM, Johannesson M, Hass SL, Kobelt-Nguyen G. Urge incontinence. Quality of life and patients' valuation of symptom reduction. Pharmacoeconomics 1998;14:531-9.
11.	Alghadir AH, Tse C, Iqbal A, Al-Khater M, Al-Rasheed G. The prevalence and association of stress urinary incontinence, core muscle endurance, and low back pain among married women in Saudi Arabia: A case-control study. Biomed Res Int 2021;2021:5533241.
12.	Notte SM, Marshall TS, Lee M, Hakimi Z, Odeyemi I, Chen WH, et al. Content validity and test-retest reliability of Patient Perception of Intensity of Urgency Scale (PPIUS) for overactive bladder. BMC Urol 2012;12:26.
13.	Steers WD. Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol 2002;4 Suppl 4:S7-18.
14.	Mitra M, Mande M. Effectiveness of core stabilization training with pressure biofeedback in the management of mechanical low back pain in subjects between age group of 20-25 years. Exec Ed 2019;13:82.
15.	Cairns MC, Harrison K, Wright C. Pressure biofeedback: A useful tool in the quantification of abdominal muscular dysfunction? Physiotherapy 2000;86:127-38.
16.	de Abreu DL, Rodrigues PT, Amaral Corrêa L, Lacombe AD, Andreotti D, Nogueira LA. The relationship between urinary incontinence, pelvic floor muscle strength and lower abdominal muscle activation among women with low back pain. Eur J Physiother 2019;21:2-7.
17.	Palmer SJ. Urge incontinence in postmenopausal women. Br J Community Nurs 2020;25:168-72.
18.	Clark AL. Overactive bladder, stress urinary incontinence, and menopause-what are the associations? Menopause 2022;29:125-6.