Interdisciplinary Evaluation of Older Women with Urinary Incontinence: Preliminary Data

Objectives: Urinary Incontinence (UI) is a common pelvic floor disorder and geriatric syndrome. The shared pathophysiology risk factors for UI as a geriatric syndrome include older age, baseline functional impairment, and impaired mobility. Our overarching goal is to explore bidirectional relationship between UI, functional, and mobility impairments at the level of shared risk factors and mechanisms and to determine the most effective treatment for UI in older women. The objective of this study was to develop an interdisciplinary approach to evaluate UI, physical performance, and pelvic floor and gluteal muscles quality before and after a 12-week multimodal exercise UI program.

Methods: The interdisciplinary approach included 1) UI and pelvic floor muscle strength evaluation, 2) physical performance assessment of strength and mobility, and 3) magnetic resonance imaging (MRI) analysis of levator ani and gluteal muscles. The multimodal 12-week UI program was a randomized clinical trial of pelvic floor muscles training with and without multimodal strengthening and aerobic conditioning rehabilitation. The primary outcome was total UI episodes based on a 3-day bladder diary after the intervention. Women underwent detailed evaluation of UI (Table1). Physical performance included the evaluation of strength and mobility (Table2). Pelvic floor muscles were assessed on Oxford scale. Pelvis MRI 3-Tesla with 3D SPACE and 6-point Dixon fat fraction map sequences evaluated levator muscle defects and gluteal muscles fatty infiltration (FI). A blinded radiologist determined composite levator muscle defect score (0-best; 6-worst); and also FI (0%-best; 100%-worst) of composite gluteus medius/gluteus minimus (Gmed/Gmin) and composite gluteus maximus (Gmax) muscles. Descriptive statistics for baseline demographics and MRI outcomes were performed. Paired sample t-test compared the means in UI and physical performance measures pre- and post-intervention. The p-value ≤0.05 was statistically significant.

Results: Total of 7 women completed the intervention. Women were 73.3±6.2 years old with mean body mass index 27.7±6.4 kg/m2. There were 57.1% (n=4) Black, 28.6 (n=2) Hispanic, and 14.3 (n=1) African-Dominican (mixed race) women. Ethnic distribution included 42.9% (n=3) non-Hispanic and 57.1% (n=4) Hispanic.



Table 1 demonstrated a significant reduction in total UI episodes after the intervention. All UI questionnaire outcomes and pelvic floor muscles strengths significantly improved.

Table 2 revealed no improvement in physical performance, except the time needed to put on and off jacket decreased.



Baseline MRI evaluation showed that participants demonstrated moderate levator ani muscle defects (mean 3.3; range 2-5) and moderate FI for composite Gmed/Gmin (mean 21.2%; range: 14.4-35.1%) and composite Gmax (mean 22.8%; range: 12.8-39.9%) muscles.

Conclusions: Our interdisciplinary approach allows the evaluation of shared pathophysiology risk factors in UI as geriatric syndrome. Women reported improvement in UI but not in physical performance after the intervention. Baseline MRI evaluation revealed moderate levator ani muscle defects and moderate gluteal muscle fatty infiltration.