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Biomedical subjects

Ingrid Nygaard

Publications and source records attributed to Ingrid Nygaard.

At least 19 recordsLinked to original sources
PubMed2006

Physical activity in women planning sacrocolpopexy.

This study describes preoperative physical activity in 314 stress-continent women with prolapse planning sacrocolpopexy. Seventy-six percent reported that they engaged in mild, 60% in moderate, and 26% in strenuous exercise (counts are not mutually exclusive). Activity frequencies did not generally differ by prolapse stage. Prolapse substantially interfered with exercise or recreation in 27% of women, household work or yard work in 19%, and work outside the home in 8%. Compared to women with less symptom distress, more women with greater symptom distress reported that prolapse interfered with household/yard work (43 vs 5%, p<0.0001), working outside the home (29 vs 8%, p<0.005), and recreation/exercise (51 vs 10%, p<0.0001). Prolapse stage was not associated with interference with household/yard work (p=0.28) or work outside home (p=0.89). Although prolapse stage is associated with interference with recreation (p=0.02), this association is not consistently positive : stage II, 42%; stage III, 22%; and stage IV, 32%.

Adult↗
PubMed2006

Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence.

BACKGROUND: We designed this trial to assess whether the addition of standardized Burch colposuspension to abdominal sacrocolpopexy for the treatment of pelvic-organ prolapse decreases postoperative stress urinary incontinence in women without preoperative symptoms of stress incontinence. METHODS: Women who did not report symptoms of stress incontinence and who chose to undergo sacrocolpopexy to treat prolapse were randomly assigned to concomitant Burch colposuspension or to no Burch colposuspension (control) and were evaluated in a blinded fashion three months after the surgery. The primary outcomes included measures of stress incontinence (symptoms, stress testing, or treatment) and measures of urge symptoms. Enrollment was stopped after the first interim analysis because of a significantly lower frequency of stress incontinence in the group that underwent the Burch colposuspension. RESULTS: Of 322 women who underwent randomization, 157 were assigned to Burch colposuspension and 165 to the control group. Three months after surgery, 33.6 percent of the women in the Burch group and 57.4 percent of the controls met one or more of the criteria for stress incontinence (P<0.001) [Corrected]. There was no significant difference between the Burch group and the control group in the frequency of urge incontinence (32.7 percent vs. 38.4 percent, P=0.48). After surgery, women in the control group were more likely to report bothersome symptoms of stress incontinence than those in the Burch group who had stress incontinence (24.5 percent vs. 6.1 percent, P<0.001). CONCLUSIONS: In women without stress incontinence who are undergoing abdominal sacrocolpopexy for prolapse, Burch colposuspension significantly reduced postoperative symptoms of stress incontinence without increasing other lower urinary tract symptoms.

Aged↗
PubMed2006

Urinary incontinence: is cesarean delivery protective?

About half of all women develop transient urinary incontinence during pregnancy. Three months postpartum, the prevalence and incidence rates of urinary incontinence are 9% to 31% and 7% to 15%, respectively. Antenatal incontinence increases the risk of postpartum incontinence, which in turn increases the risk of long-term persistent incontinence. After the first delivery, women delivered vaginally have two-fold more incontinence than those delivered by cesarean. The protective effect of cesarean on urinary incontinence may dissipate after further deliveries, decreases with age, and is not present in older women. Data are mixed about whether cesarean done before labor confers greater protection than cesarean done after labor. To understand the true impact of cesarean delivery on urinary incontinence, future studies must compare incontinence by planned (not actual) delivery modes, consider a woman's entire reproductive career, focus on leakage severe enough to be problematic, consider other bladder symptoms as well as incontinence, and take into account other risk factors, particularly antepartum urinary incontinence.

Cesarean Section↗
PubMed2006

Fecal and urinary incontinence in primiparous women.

OBJECTIVE: To prospectively investigate the relationship between anal sphincter tears and postpartum fecal and urinary incontinence. METHODS: The Childbirth and Pelvic Symptoms study was a prospective cohort study performed by the Pelvic Floor Disorders Network to estimate the prevalence of postpartum fecal and urinary incontinence in primiparous women: 407 with clinically recognized anal sphincter tears during vaginal delivery, 390 without recognized sphincter tears (vaginal controls), and 124 delivered by cesarean before labor. Women were recruited postpartum while hospitalized and interviewed by telephone 6 weeks and 6 months postpartum. We assessed fecal and urinary incontinence symptoms using the Fecal Incontinence Severity Index and the Medical, Epidemiological, and Social Aspects of Aging Questionnaire, respectively. Odds ratios were adjusted for age, race, and clinical site. RESULTS: Compared with the vaginal control group, women in the sphincter tear cohort reported more fecal incontinence (6 weeks, 26.6% versus 11.2%; adjusted odds ratio [AOR] 2.8, 95% confidence interval [CI] 1.8-4.3; 6 months, 17.0% versus 8.2%; AOR 1.9, 95% CI 1.2-3.2), more fecal urgency and flatal incontinence, and greater fecal incontinence severity at both times. Urinary incontinence prevalence did not differ between the sphincter tear and vaginal control groups. Six months postpartum, 22.9% of women delivered by cesarean reported urinary incontinence, whereas 7.6% reported fecal incontinence. CONCLUSION: Women with clinically recognized anal sphincter tears are more than twice as likely to report postpartum fecal incontinence than women without sphincter tears. Cesarean delivery before labor is not entirely protective against pelvic floor disorders. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed2005

Prevalence, management and impact of urinary incontinence in the workplace.

BACKGROUND: The few prior studies of urinary symptoms in the workplace have been small investigations of women in specific occupations (e.g. nursing) or industries (e.g. pottery manufacture). In this study, the aims were to describe the prevalence, management and impact of urinary incontinence for a large cross-section of employed women in the USA. METHODS: Five-page questionnaires were mailed to 5130 American households selected from the National Family Opinion survey panel during the spring of 2004. Usable questionnaires were returned by 3364 women in the target age range of 18-60 years. RESULTS: About 37% of the 2326 employed respondents reported urine loss during the last 30 days. The most common strategies for managing incontinence at work included frequent bathroom breaks and wearing pads. The use of urine control methods increased with the severity of urine loss. The effect of incontinence on workplace activities also increased with the severity of urine loss: 88% of employed women with the most severe symptoms reported at least some negative impact on concentration, performance of physical activities, self-confidence or the ability to complete tasks without interruption. CONCLUSION: Urinary incontinence is prevalent among employed women. Those who experience severe symptoms report that it has a negative effect on aspects of work. Programs on the prevalence and impact of urinary incontinence would help educate both employers and employees, and may lead to the development of better management techniques in the workplace.

Adolescent↗
PubMed2005

Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years.

OBJECTIVE: Pelvic floor muscle training effectively treats female stress urinary incontinence. However, data on long-term efficacy and adherence are sparse. Our aims were to assess current lower urinary tract symptoms and exercise adherence 15 years after ending organized training. METHODS: Originally, 52 women with urodynamic stress urinary incontinence were randomly assigned to home or intensive exercise. After 6 months, 60% in the intensive group were almost or completely continent, compared with 17% in the home group. Fifteen years later, all original study subjects were invited to complete a postal questionnaire assessing urinary symptoms (using validated outcome tools) and current pelvic floor muscle training. RESULTS: Response rate was 90.4%. There were no differences in any urinary outcomes or satisfaction between the 2 study groups as a whole or when restricted to those without intervening stress urinary incontinence surgery. One half of both groups had stress urinary incontinence surgery during the 15-year follow-up period. Twenty-eight percent performed pelvic floor muscle training at least weekly; this rate did not differ by original group assignment or operated status. More operated women reported severe incontinence (P = .03) and leakage that interfered with daily life (P = .04) than did nonoperated women. There were no other differences between operated and nonoperated women. CONCLUSION: The marked benefit of intensive pelvic floor muscle training seen short-term was not maintained 15 years later. Long-term adherence to training is low. Urinary symptoms were equally common in both operated and nonoperated women. Further studies are needed to understand factors associated with long-term effectiveness of stress urinary incontinence treatments.

Adult↗
PubMed2005

Menopausal symptoms and treatment-related effects of estrogen and progestin in the Women's Health Initiative.

OBJECTIVE: To estimate the effects of estrogen plus progestin (E+P) therapy on menopausal symptoms, vaginal bleeding, gynecologic surgery rates, and treatment-related adverse effects in postmenopausal women. METHODS: Randomized, double-blind, placebo-controlled trial of 16,608 postmenopausal women, ages 50-79 (mean +/- standard deviation 63.3 +/- 7.1) years, with intact uterus, randomized to one tablet per day containing 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (n = 8,506) or placebo (n = 8,102), and followed for a mean of 5.6 years. Change in symptoms and treatment-related effects were analyzed at year 1 in all participants. Bleeding and gynecologic surgery rates were analyzed through study close-out. RESULTS: Baseline symptoms did not differ between the treatment groups. More women assigned to E+P than placebo reported relief of hot flushes (85.7% versus 57.7%, respectively; odds ratio 4.40; 95% confidence interval 3.40-5.71), night sweats (77.6% versus 57.4%; 2.58; 2.04-3.26), vaginal or genital dryness (74.1% versus 54.6%; 2.40; 1.90-3.02), joint pain or stiffness (47.1% versus 38.4%; 1.43; 1.24-1.64), and general aches or pains (49.3% versus 43.7%; 1.25; 1.08-1.44). Women asymptomatic at baseline who were assigned to E+P more often developed breast tenderness (9.3% versus 2.4%, respectively; 4.26; 3.59-5.04), vaginal or genital discharge (4.1% versus 1.0%; 4.47; 3.44-5.81), vaginal or genital irritation (4.2% versus 2.8%; 1.52; 1.27-1.81), and headaches (5.8% versus 4.7%; 1.26; 1.08-1.46) than women on placebo. Estrogen plus progestin treatment prevented the onset of new musculoskeletal symptoms. Vaginal bleeding was reported by 51% of women on E+P and 5% of women on placebo at 6 months; most bleeding was reported as spotting. Gynecologic surgeries (hysterectomy and dilation and curettage) were performed more frequently in women assigned to E+P (3.1% versus 2.5% for hysterectomy, hazard ratio = 1.23, P = .026; 5.4% versus 2.4% for dilation and curettage, hazard ratio = 2.23, P < .001). CONCLUSION: Estrogen plus progestin relieved some menopausal symptoms, such as vasomotor symptoms and vaginal or genital dryness, but contributed to treatment-related effects, such as bleeding, breast tenderness, and an increased likelihood of gynecologic surgery.

Administration, Oral↗
PubMed2005

Is urinary incontinence a barrier to exercise in women?

OBJECTIVE: To describe the prevalence of urinary incontinence during exercise in women, estimate whether exercise intensity is related to leakage severity, and report women's assessments of incontinence as a barrier to exercise. METHODS: Questionnaires were mailed to 5,130 women aged 18-60 years drawn from National Family Opinion research panels. Physical activity levels were assessed by the International Physical Activity Questionnaire. Urinary incontinence, defined as involuntary leakage in the last 30 days, was assessed with the Sandvik Severity Index and a global measure of bother. Prevalence estimates were adjusted via post-stratification weighting. RESULTS: A total of 3,364 eligible women responded (68%), of whom 34.6% were insufficiently active (95% confidence interval [CI] 32.7-36.5%), 29.7% were sufficiently active (95% CI 27.9-31.5%), and 35.7% were highly active (95% CI 33.8-37.6%). Urinary incontinence prevalence was 34.3% (95% CI 32.5-36.1%). One in seven women experienced urinary leakage during physical activity; this was more common among highly active (15.9%) than less active women (11.8%) (P = .01). After adjusting for age, comorbidities, education, and race, women with very severe incontinence were 2.64 times (95% CI 1.25-5.55) more likely to be insufficiently active than continent women. Incontinence was a moderate or substantial barrier to exercise for 9.8% (95% CI 8.8-10.9%) of women. Of incontinent women, the proportion for whom incontinence was a moderate or substantial barrier to exercise increased with each severity category: 9.2%, slight; 37.8%, moderate; 64.6%, severe; and 85.3%, very severe (P < .01). CONCLUSION: Urinary incontinence is perceived as a barrier to exercise, particularly by women with more severe leakage.

Adolescent↗
PubMed2004

Physiologic outcome measures for urinary incontinence.

Physiologic outcome measures are divided into 2 groups: (1) measures that visualize, quantify, and analyze the reasons for urine loss and (2) measures that assess the anatomy and neuromuscular function of continence-related structures. Few of the frequently used physiologic outcome measures have been rigorously tested. The evidence in support of their use derives mainly from case series information and expert opinion. Perineal pad testing is used to quantify urine leakage associated with stress incontinence. One-hour pad tests are commonly used for clinical trials and office visits; 24- and 48-hour tests are more reliable and reproducible. Urodynamic testing simultaneously assesses bladder and urethral function during bladder filling and emptying to help guide therapy and identify patients who are at risk for surgical failure. Testing usually includes (1) uroflowmetry, an assessment of voiding without catheters in place; (2) cystometry, which assesses bladder sensation, capacity, compliance, and inappropriate detrusor activity during filling; (3) urethral pressure profilometry, to gauge urethral closing pressures and pressure transmission ratios; (4) leak-point pressure, the minimum intra-abdominal pressure required to cause incontinence, which serves as a measure of urethral function; and (5) pressure flow studies, which diagnose obstruction by evaluating detrusor pressure and flow rate during voiding. The cotton swab test is used to assess bladder neck mobility after surgical interventions. Using the Pelvic Organ Prolapse Quantification system, researchers can describe pelvic support in a standardized, reproducible fashion. Applications of ultrasonography and magnetic resonance imaging in urogynecology are promising but remain in the investigational stages.

Clinical Trials as Topic↗
PubMed2004

Pelvic organ prolapse in older women: prevalence and risk factors.

OBJECTIVE: We sought to estimate the prevalence of pelvic organ prolapse in older women using the Pelvic Organ Prolapse Quantification examination and to identify factors associated with prolapse. METHODS: Women with a uterus enrolled at one site of the Women's Health Initiative Hormone Replacement Therapy randomized clinical trial were eligible for this ancillary cross-sectional study. Subjects underwent a Pelvic Organ Prolapse Quantification examination during a maximal Valsalva maneuver and in addition completed a questionnaire. Logistic regression was used to identify independent risk factors for each of 2 definitions of prolapse: 1) Pelvic Organ Prolapse Quantification stage II or greater and 2) the leading edge of prolapse measured at the hymen or below. RESULTS: In 270 participants, age (mean +/- SD) was 68.3 +/- 5.6 years, body mass index was 30.4 +/- 6.2 kg/m(2), and vaginal parity (median [range]) was 3 (0-12). The proportions of Pelvic Organ Prolapse Quantification stages (95% confidence intervals [CIs]) were stage 0, 2.3% (95% CI 0.8-4.8%); stage I, 33.0% (95% CI 27.4-39.0%); stage II, 62.9% (95% CI 56.8-68.7%); and stage III, 1.9% (95% CI 0.6-4.3%). In 25.2% (95% CI 20.1-30.8%), the leading edge of prolapse was at the hymen or below. Hormone therapy was not associated with prolapse (P =.9). On multivariable analysis, less education (odds ratio [OR] 2.16, 95% CI 1.10-4.24) and higher vaginal parity (OR 1.61, 95% CI 1.03-2.50) were associated with prolapse when defined as stage II or greater. For prolapse defined by the leading edge at or below the hymen, older age had a decreased risk (OR 0.50, 95% CI 0.27-0.92) and less education, and larger babies had an increased risk (OR 2.38, 95% CI 1.31-4.32 and OR 1.97, 95% CI 1.07-3.64, respectively). CONCLUSION: Some degree of prolapse is nearly ubiquitous in older women, which should be considered in the development of clinically relevant definitions of prolapse. Risk factors for prolapse differed depending on the definition of prolapse used.

Aged↗
PubMed2003

Urinary incontinence and depression in middle-aged United States women.

OBJECTIVE: To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression. METHODS: This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50-69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders. RESULTS: Approximately 16% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80% (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.26, 2.63) and 40% (OR 1.41; 95% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates. CONCLUSION: Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression.

Activities of Daily Living↗