Relationship of spinal curvature, mobility, and low back pain in women with and without urinary incontinence

Relationship of spinal curvature, mobility, and low back pain in women with and without urinary incontinence

Background/aim: This study aimed to investigate the relationship of sagittal spinal curvature, mobility, and low back pain (LBP) in women with and without urinary incontinence (UI). Materials and methods: Thirty-two women with UI (incontinence group) and 41 women without UI (control group) were included in this study. The sagittal spinal curvature and mobility were assessed with a Spinal Mouse device (IDIAG, Fehraltorf, Switzerland). Urogenital symptom distress, LBP, and disability caused by LBP were assessed using the Urogenital Distress Inventory-6 (UDI-6), a visual analog scale (VAS), and the Oswestry Disability Index (ODI), respectively. Results: It was seen that the sagittal thoracic curvature, lumbar curvature, and pelvic tilt were increased in the incontinence group in comparison to the control group (P < 0.05). An increase in sagittal lumbar mobility and pelvic mobility was found in the incontinence group (P < 0.05). It was observed that 71.9% of the women with UI and 12.2% of the women without UI had LBP. There were positive correlations of the UDI-6 with the VAS (r = 0.363, P = 0.041) and the ODI (r = 0.511, P = 0.003). Conclusion: The sagittal spinal alignment and lumbopelvic hypermobility should be taken into consideration in the existence of UI.

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  • 1. Hunskaar G, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int 2004; 93: 324-330.
  • 2. Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2000; 11: 301-319.
  • 3. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 1994; 170: 1713-1723.
  • 4. Raizada V, Mittal RK. Pelvic floor anatomy and applied physiology. Gastroenterol Clin North Am 2008; 37: 493-509.
  • 5. Dean N, Wilson D, Herbison P, Glazener C, Aung T, MacArthur C. Sexual function, delivery mode history, pelvic floor muscle exercises and incontinence: a cross-sectional study six years post-partum. Aust N Z J Obstet Gynaecol 2008; 48: 302-311.
  • 6. Cholewicki J, Silfies SP, Shah RA, Greene HS, Reeves NP, Alvi K, Goldberg B. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine 2005; 30: 2614-2620.
  • 7. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine 1996; 21: 2640-2650.
  • 8. Barbic M, Kralj B, Cor A. Compliance of the bladder neck supporting structures: importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia. Neurourol Urodyn 2003; 22: 269-276.
  • 9. Pool-Goudzwaard A, van Dijke GH, van Gurp M, Mulder P, Snijders C, Stoeckart R. Contribution of pelvic floor muscles to stiffness of the pelvic ring. Clin Biomech (Bristol, Avon) 2004; 19: 564-571.
  • 10. Lind LR, Lucente L, Kohn N. Thoracic kyphosis and the prevalence of advanced uterine prolapse. Obstet Gynecol 1996; 87: 605-609.
  • 11. Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil 2008; 89: 1741-1747.
  • 12. Capson AC, Nashed J, Mclean L. The role of lumbopelvic posture in pelvic floor muscle activation in continent women. J Electromyogr Kinesiol 2011; 21: 166-177.
  • 13. Sapsford RR, Richardson CA, Stanton WR. Sitting posture affects pelvic floor muscle activity in parous women: an observational study. Aust J Physiother 2006; 52: 219-222.
  • 14. Mattox TF, Lucente V, McIntyre P, Miklos JR, Tomezsko J. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol 2000; 183: 1381-1384.
  • 15. Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain. Man Ther 2008; 13: 206-212.
  • 16. Kulig K, Powers CM, Landel RF, Chen H, Fredericson M, Guillet M, Butts K. Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI. BMC Musculoskelet Disord 2007; 8: 8.
  • 17. Grosdent S, Demoulin C, Souchet M, Tomasella M, Crielaard J, Vanderthommen M. Trunk muscle profile in elite tennis players with and without low back pain. J Sports Med Phys Fitness 2015; 55: 1354-1362.
  • 18. Mannion AF, Knecht K, Balaban G, Dvorak J, Grob D. A new skin-surface device for measuring the curvature, and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature. Eur Spine J 2004; 13: 122-136.
  • 19. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 1995; 14: 131-139.
  • 20. Cam C, Sakalli M, Ay P, Cam M, Karateke A. Validation of the short forms of the incontinence impact questionnaire (IIQ7) and the urogenital distress inventory (UDI-6) in a Turkish population. Neurourol Urodyn 2007; 26: 129-133.
  • 21. Clark P, Lavielle P, Martínez H. Learning from pain scales: patient perspective. J Rheumatol 2003; 30: 1584-1588.
  • 22. Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D, Firat T, Kiraz S, Kirdi N, Kayhan H et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976) 2004; 29: 581-585.
  • 23. Troyanovich SJ, Harrison DE, Harrison DD. Structural rehabilitation of the spine and posture: rationale for treatment beyond the resolution of symptoms. J Manipulative Physiol Ther 1998; 21: 37-50.
  • 24. Christensen, ST, Hartvigsen J. Spinal curves and health: a Systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther 2008; 31: 690-714.
  • 25. Nakipoglu GF, Karagoz A, Ozgirgin N. The biomechanics of the lumbosacral region in acute and chronic low back pain patients. Pain Physician 2008; 11: 505-511.
  • 26. Levine D, Whittle MW. The effects of pelvic movement on lumbar lordosis in the standing position. J Orthop Sports Phys Ther 1996; 24: 130-136.
  • 27. Del Valle A, Thomas CK. Motor unit firing rates during isometric voluntary contractions performed at different muscle lengths. Can J Physiol Pharmacol 2004; 82: 769-776.
  • 28. Smith MD, Russell A, Hodges PW. Do incontinence, breathing difficulties, and gastrointestinal symptoms increase the risk of future back pain? J Pain 2009; 10: 876-886.