symptoms of urinary incontinEncE in agEd practitionErs of physical activity Janeisa Franck Virtuoso1[email protected] Giovane Pereira Balbé1[email protected] Roges Ghidini Dias1[email protected] Giovana Zarpellon Mazo2[email protected]
Virtuoso JF, Balbé GP, Dias RG, Mazo GZ. Symptoms of urinary incontinence in aged practitioners of physical activity. Fit Perf J. 2009 Sep-Oct;8(5):366-71. ABSTRACT Introduction: The aim of this study was to describe the occurrence of symptoms of urinary incontinence in the
elderly practitioners of physical activities. Materials and Methods: The sample consisted of 123 elderly (100
women and 23 men) with mean age of 69.4±6.12 years. For data collection, a questionnaire regarding age, sex,
presence of comorbidities, physical activity and questions about urinary incontinence was used. Results: There
was a predominance of urinary incontinence stress (50.0%), followed by mixed urinary incontinence (26.6%) and urinary incontinence urgency (23.4%). Only 10.4% of elderly reported symptoms of loss of urine during physical activity. Discussion: The urinary incontinence stress was the predominant type in the sample, contrasting with
literature. Despite the small number of participants with urinary loss during physical activity, there are no conclusive studies yet, which report pelvic floor damage associated with the practice of it. KEYWORDS
Urinary Incontinence; Physical Activity; Elderly; Health Promotion. 1 Universidade do Estado de Santa Catarina – UDESC – Laboratório de Gerontologia do Centro de Ciências da Saúde e do Esporte – Florianópolis/ SC – Brazil 2 Universidade do Porto – Porto – Portugal Copyright 2009 by Colégio Brasileiro de Atividade Física, Saúde e Esporte
Fit Perf J | Rio de Janeiro | 8 | 5 | 366-371 | Sep/Oct 2009
Fit Perf J. 2009 Sep-Oct;8(5):366-71.
urinAry incontinence AnD PhysicAl Activity
sintomas dE incontinência urinária Em idosos praticantEs dE atividadE física RESUMO Introdução: O objetivo do presente estudo foi descrever a ocorrência de sintomas de incontinência urinária em idosos praticantes de atividade física. Materiais e Métodos: A amostra foi composta por 123 idosos (100 mulheres e 23 homens) com idade média de 69±6 anos. Para coleta de dados, utilizou-se um questionário sobre a idade, o sexo, a presença de morbidades e a atividade física que praticavam e questões quanto à incontinência urinária. Resultados: Observou-se o predomínio da incontinência urinária de esforço (50,0%), seguida da mista (26,6%) e da incontinência urinária de urgência (23,4%). Apenas 10,4% dos idosos relataram sintomas de perdas de urina durante a prática de atividade física. Discussão: A incontinência urinária de esforço foi o tipo predominante na amostra contrapondo-se ao relatado na literatura. Apesar do número reduzido de participantes com perdas urinárias durante a prática de atividade física, ainda não existem estudos conclusivos que relatem danos ao assoalho pélvico associado à prática desta. PALAVRAS-CHAVE
Incontinência Urinária; Atividade Física; Idoso; Promoção da Saúde. síntomas dE la incontinEncia urinaria En ancianos practicantEs dE la actividad física RESUMEN Introducción: El objetivo del estudio fue describir la aparición de los síntomas de la incontinencia urinaria en ancianos practicantes de actividad física. Materiales y Métodos: La muestra consistió de 123 ancianos (100 mujeres y 23 hombres) con edad media de 69,4±6,12 años. Para la recopilación de datos, se utiliza un cuestionario sobre edad, sexo, presencia de comorbilidades, la actividad física y preguntas sobre la incontinencia urinaria. Resultados: Se observó un predominio de la incontinencia urinaria de esfuerzo (50,0%), seguido de la mixta (26,6%) y de la incontinencia urinaria de urgencia (23,4%). Sólo el 10,4% de los ancianos informaron los síntomas de la pérdida de orina durante la actividad física. Discusión: La incontinencia urinaria de esfuerzo es lo predominante en la muestra a los informes contrastados en la literatura. A pesar del pequeño número de participantes con la pérdida de orina durante la actividad física, aún no existen estudios concluyentes que informen los daños del suelo pélvico asociado con la práctica de la misma. PALABRAS CLAVE
Incontinencia Urinaria; Actividad Física; Anciano; Promoción de la Salud. INTRODUCTION
notification5. It is estimated that 200 million people live
Aging is an inevitable natural process that expresses
with UI all over the world7, and that about 15 to 30% of
by physical, psychological, emotional and social char-
people with 60 years, or more than it, present some type
acteristics1, permeated by the greatest vulnerability to
of UI8, although it is a health and social problem, with
diseases, which can interfere in the autonomy and inde-
an increasing tendency due, among other reasons, to the
pendence2, producing undesirable events, such as the
aging of population7.
urinary incontinence (UI)1.
A Brazilian study of prevalence and risk factors as-
According to the International Continence Society,
sociated with UI was carried out in Vassouras, in the state
the UI is defined as any involuntary loss of urine3. The
of Rio de Janeiro, with 1,042 women over 15 years old
most common types are: effort UI (EUI), which is the loss
from 1999 to 2000. In this study, a medium prevalence
of urine associated with physical activities that increase
of UI of 26.6% among women from 60 to 69 years old,
the intra-abdominal pressure; the urinary urge inconti-
34% between 70 and 79 years, and 46.2% over 80 years
nence (UUI), involuntary loss of urine associated with a
old, being UUI with 38.6%, EUI with 26.4% and MUI of
strong desire of urinating; and the mixed UI (MUI), when
3.7%, was found9.
both types are present4.
Transversal and revision studies concluded that the num-
Most of the prevalence studies of UI point an oscil-
ber of cases of UI can be much higher, since many people
lation between 5 to 59%5, although there is no consen-
do not look for help10 for unknowing the possible treatments
sus in the literature6. This variability happens due to the
and loss of orientations by health professionals11,12,13,14, be-
choice of the sample, according to the age, sex, cul-
sides shame or omission15 or the belief that the problem is a
tural level, gravity of the disease, type of UI and its low
normal consequence of the aging process8,16. Fit Perf J. 2009 Sep-Oct;8(5):366-71.
During this process, the inferior urinary tract presents
To define symptoms related to EUI, questions about
some changes, even in the absence of diseases, like the
the urinary loss during the sneeze or cough were asked to
decrease of the strength of vesical musculature contrac-
the subjects. In the identification of symptoms of UUI, the
tion and ability in delaying the micturition and increase of
question concerned the difficulty of getting to a bathroom
the involuntary vesical contractions17. These factors asso-
when there is a micturitional desire. They were consid-
ciated with hypoestrogenism, in women, let elderly more
ered MUI symptoms when there was their mention. The
propense to UI, be it for EUI due to the weakness of the
presence of urinary losses was investigated from ques-
muscles of pelvic floor or for the UUI when non-inhibited
tions about the use of hygienic protectors to avoid dis-
comforts with the leakage of urine during the practice of
According to Caetano, Tavares and Lopes17, eui
physical activity. The investigated were invited to partici-
is very common among women who practice physical
pate in the study, after the explication of the objectives
activities, provoking about 26 to 33% of this group6. A
of the research, its importance and applicability. When
lot of the studies try to analyze the urinary losses in ath-
they agreed in participating, two copies of the informed
letes14,18, however few studies evalute this type of symp-
The interviews were carried out in a site assigned by
Thus, there is the need of analyzing the presence of
Universidade do Estado de Santa Catarina (UDESC), ap-
urinary losses in elderly, once they are responsible for the
plied by scholars and professors of Geti, duly trained.
high rates of abandonment of physical activities, repre-
For the data analysis, a descriptive statistics was used
senting the want of inhrent benefits for this practice19.
by mean, standard deviation and frequency values.
The abandonment or loss of physical activity can lead to sedentary habits, apparition of other diseases18 and collaboration of functional immobility5. Concerning the
theme’s importance, the objective of the present study is
In Table 1 the characteristics of the sample about the
to describe the occurrence of the UI symptoms in elderly
age, sex, self-reported diseases and practiced physical
who practice physical activities, in order that possible
interventions appear in terms of orientation and health
The most prevalent morbities in the sample were the
osteoarticular diseases, followed by arterial hyperten-sion, hypercholesterolemy and diabetes. And the less prevalents were: Parkinson’s disease, hepatitis, epilepsy
MATERIALS AND METHODS
and renal insufficiency, all with only one case, according
The authors declare that there is no conflict of inter-
to Table 1. It can also be observed that most of the old-
aged practiced hydrogimnastics, followed by swimming
This research was approved by the Ethics and Re-
search Committee of Universidade do Estado de Santa
In relation to UI, of the 38 aged interviewed (30.8%),
Catarina, under the number 185/07. It is an observa-
who reported symptoms of urinary losses, 37 were wom-
tional study of a descriptive type20. In the studied popula-
en and 1 was a man. This man referred Parkinson’s dis-
tion, 190 elderly practitioners of physical activities took
part in the Program of Extension of the Group of Studies
In Graphic 1, it is possible to note the classification of
of Third Age (Geti). The sample had 100 women and 23
UI according to the presence of symptoms in the sample.
men, with a mean age of 69±6 years old, participating
The symptoms of EUI were the most seen in the sample,
in the Geti program. Geti is a permanent program of
they are represented by urinary loss during cough or
extension developed for the third age, specially to the
practice of physical, educational, cultural, artistic, of
The difficulty of getting to a bathroom due to the
physiotherapeutical and psychological evaluation and of
micturition urgency was reported by 17 incontinent aged
intervention activities. Participants with less than 60 years
(44.2%), and the inability for such by only 2 (5.2%). Still,
old or that had completed other modalities which do not
ten (26.6%) subjects presented symptoms of MUI and
represent physical activity were used as exclusion criteria
Among the old-aged with symptoms of UI, it was not-
In the data collection, a semistructured questionnaire
ed that 11 (28.6%) always used some protection as tam-
for the identification of the sample was used, applied as
pons or “covering” to avoid discomforts with the loss of
individual interviews with questions regarding age, sex,
urine, and only 7 (18.2%) used these during the practice
presence of self-referred morbities, physical activity that
of physical activities. The urinary losses during physical
practiced in the program and questions referring to UI.
activities was reported in four (10.4%) of the researched. Fit Perf J. 2009 Sep-Oct;8(5):366-71.
urinAry incontinence AnD PhysicAl Activity
Graphic 1 - Classification of UI according to the presence
As can be noted, there was one report of male UI.
of symptoms in the sample.
Especially in this case, the urinary losses were associated
Presence of the UI symptoms in the sample
with Parkinson’s disease, which causes changes in the mechanism of urinary continence24, once UI is hardly
found in men with associated diseases25.
For a cultural disease, women complain more than
men26. This statement can justify the low prevalence of
urinary losses among they, since gynecological problems are part of the routine of women, while urological dis-
turbances are still a “tabu” for men. The realization of
questions by an interview and the low number of men in the sample can also explain such prevalence. Some stud-
ies, however, point to a two times higher probability of UI
in women with ages over 60 years-old relative to men8,
increasing with age1,10,26.
Due to the increase of life expectation in the popu-
Table 1 - Sample characteristics: age, sex, diseases and
lation, a woman spends about one third of her life in
practiced physical activity
a hypoestrogenism situation, suffering its eventual con-
sequences27. The hypoestrogenism affects evidently the
urinary tract, causing trophic changes that worsen or
unleash the EUI in the post-menopause28. Hence, the
decrease of elasticity of the conjunctive tissue, the def-
ficiency of strogens and the consequences of previous
gestations and childbirths result in weakness of the mus-
cles of the pelvic floor conveying to the involuntary loss
In the gestation, some damages happen in the
muscles of the pelvic floor and, consequently, can
cause UI. Grau et al.30 followed 531 women in a year
after the childbirth and noticed that 26.8% of the in-
vestigated persisted with EUI symptoms in the end of
the period. These results fortified the association be-
tween the childbirth, be it normal or caesarean, as a
risk factor for UI31.
UI can also be associated with some diseases, for
example, diabetes mellitus, that in virtue of microvascular
complications can cause neurovascular damages to the
urethral sphincter and alterations in the detrusor mus-
culature, becoming an unleash factor or worsening the
UI32. Such understanding is necessary with elderly, once
the presence of diabetes is common in this age. The use
of diuretics by hypertenses can also associated with the
involuntary loss of urine33.
In this study, the most prevalent symptoms of the el-
derly were the EUI, that with the ones of MUI, totalized
about ¾ of the old-aged incontinents with urinary losses
The present study observed a predominance of the
female sex in the sample, and it may be justified because
Although EUI is the most prevalent type of UI in the
old-aged are from a group of systematic and regular
overall population, among the elderly it can be seen that
physical activities, which most of them is composed by
the values are higher for the UUI symptoms27. UUI in
women. Confirming this findings, several studies referred
elderly is justified by the presence of involuntary vesical
that in programas supervised of physical activity for elder-
contractions that happen within the ages. The compo-
ly is common the predominance of elderly women21,22,23.
nent of micturition urgency which characterizes this type
Fit Perf J. 2009 Sep-Oct;8(5):366-71.
of UI seems to be what bring the highest impact in the
ing the micturition was more incident with 56.7% of the
life of patients34.
Sanchez et al.25, when researching 195 cases be-
UI affects the social, psychological and family ac-
tween men and women with more than 65 years and
quaintance of people5 and the sexual relations1,12,37
clinical diagnostic of UI, stated that 68% of they pre-
and contributes for the dismissal or abandonment of the
sented UUI, 26% with EUI and 6% MUI. Differently from
practice of sports or physical activites, becoming an ob-
the data found in this study, EUI was the most prevalent
stacle for this practice by the old-aged38. Thus, although
in the sample, followed by MUI and UUI. Such fact may
UI does not cause a significant morbidity or mortality, it
be justified by being performed with UI symptom and not
can lead to sedentarism restrincting the inherent benefits
to the practice of physical exercises19. The use of hygienic
A fair relation between symptoms of urinary losses
protectors, mentioned by 28.6% of the sample of this
and the practice of physical activities is still unknown.
study, can also be considered as an obstacle in the prac-
Some researchers believe that, during the physical ex-
tice of physical activity. Some women search for alterna-
ercise, the increase of intra-abdominal pressure is fol-
tives to keep themselves dry, as the use of coverings and
lowed by a simultaneous contraction or pre-contraction
absorbents39 or the hydric restriction17.
of the muscles of the pelvic floor19,35. Based on these
In the present study, the predominance of EUI (50.0%)
facts, physical activity can prevent or even treat the UI.
was observed, because of cough or sneeze, followed by
It is also believed that by the training of the abdominal
MUI (26.6%) and UUI (23.4%). This disposition was dif-
musculature during the physical activity occurs indirect
ferent from that one found in literature, in which UUI is
strengthening of the muscles of the pelvic floor35. Such
predominant among the old-aged population. It is also
explanation could, in any way, justify the incidence of
emphasized that a reduced number of old-aged in the
urinary losses of only 30.8% among elderly of the pres-
sample (10.4%) reported symptoms of losses of urine
during the practice of physical activity.
Yet, some women loose urine during the physical ac-
Even when there are divergences about the real ben-
tivity, mentioned by 10.4% of the subjects in the present
efits of the physical activity to the pelvic floor, it is of great
study. Such event lead to the formulation of a second
importance that the professional of Physical Education
hypothesis19,35, in which the authors believe that the
know the signs and symptoms of the UI, aiming at guid-
muscles of the pelvic floor can danify cronically, due to
ing the old-aged about the treatment and prevention.
the repetitive increase of the intra-abdominal pressure.
The need of new studies that compare the presence
Actually, when the old-aged population is analyzed, it
of urinary losses between active old-aged and sedentary,
is difficult to identify the genesis of UI, since other risk
in order to verify the influence of physical activity over the
factors, resulting from the aging itself, are evolved. How-
ever, the mentioned hypothesis are to guide an explica-
The authors of this study thank the Coordenação
tion of the UI symptoms in this sample of practicers of
de Aperfeiçoamento de Pessoal de Ensino Superior
(Capes), for master’s scholarship received by Janeisa
The most relevant question in this context is to know
Franck Virtuoso, Giovane Pereira Balbé and Roges
if the specific exercises weaken the muscles of the pelvic
floor, and which sport or physical activity represents a greater risk for UI36. In a research of bibliographic re- view on the prevalence of UI in women who are athlete, REFERENCES
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