Introduction and hypothesis
Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population.
This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the “Critical Review Form for quantitative studies” (McMaster University).
From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain.
Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice.
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Aoki Y, Brown HW, Brubaker L, et al. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. https://doi.org/10.1038/nrdp.2017.42.
Bell JA, Burnett A. Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review. J Occup Rehabil. 2009;19:8–24. https://doi.org/10.1007/s10926-009-9164-5.
Edwards J, Hayden J, Asbridge M, et al. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017;18:143. https://doi.org/10.1186/s12891-017-1511-7.
Vleeming A, Albert HB, Östgaard HC, et al. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17:794–819. https://doi.org/10.1007/s00586-008-0602-4.
Bush HM, Pagorek S, Kuperstein J, et al. The association of chronic back pain and stress urinary incontinence: a cross-sectional study. J Womens Health Phys Ther. 2013;37:11–8. https://doi.org/10.1097/JWH.0b013e31828c1ab.
Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17:E141–7.
Hodges PW, Sapsford R, Pengel LHM. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007;26:362–71. https://doi.org/10.1002/nau.20232.
Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:125–32. https://doi.org/10.1007/s001920200027.
Sapsford RR, Hodges PW, Richardson CA, et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20:31–42.
Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. Three dimensional preparatory trunk motion precedes asymmetrical upper limb movement. Gait Posture. 2000;11:92–101.
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(22):2640–50. https://doi.org/10.1097/00007632-199611150-00014.
Kim J-W, Kwon O-Y, Kim T-H, et al. Effects of external pelvic compression on trunk and hip muscle EMG activity during prone hip extension in females with chronic low back pain. Man Ther. 2014;19:467–71. https://doi.org/10.1016/j.math.2014.04.016.
Stockil L, Thompson J, Briffa K, et al. Urogenital symptoms: prevalence, bother, associations and impact in 22 year-old women of the Raine study. Int Urogynecol J. 2018;29:1807–15. https://doi.org/10.1007/s00192-018-3639-x.
Eisenstein SM, Engelbrecht DJ, el Masry WS. Low back pain and urinary incontinence. A hypothetical relationship. Spine. 1994;19:1148–52.
Welk B, Baverstock R. Is there a link between back pain and urinary symptoms? Neurourol Urodyn. 2020;39(2):523–32. https://doi.org/10.1002/nau.24269.
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. https://doi.org/10.1186/2046-4053-4-1.
Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmorland M. Guidelines for critical review form quantitative studies. 1998.
Higgins J, Green S (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011. Available from www.cochrane-handbook.org
Review Manager (RevMan). Version 5.3. Copenhagen: the Nordic Cochrane Centre, The Cochrane Collaboration; 2014.
RStudio. Integrated development for R. Boston: RStudio; 2015.
De Abreu DL, Rodrigues PTV, Corrêa LA, et al. The relationship between urinary incontinence, pelvic floor muscle strength and lower abdominal muscle activation among women with low back pain. Eur J Phys. 2018;0:1–6. https://doi.org/10.1080/21679169.2018.1435720.
Ashbrook JE, Shacklady C, Johnson S, et al. Is there an association between back pain and stress incontinence in adults with cystic fibrosis? A retrospective cross-sectional study. J Cyst Fibros. 2018;17:78–82. https://doi.org/10.1016/j.jcf.2017.04.006.
Cassidy T, Fortin A, Kaczmer S, et al. Relationship between back pain and urinary incontinence in the Canadian population. Phys Ther. 2017;97:449–54. https://doi.org/10.1093/ptj/pzx020.
Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain. Man Ther. 2008;13:206–12. https://doi.org/10.1016/j.math.2006.12.006.
Fitzgerald CM, Santos LR, Mallinson T. The association between pelvic girdle pain and urinary incontinence among pregnant women in the second trimester. Int J Gynaecol Obstet. 2012;117:248–50. https://doi.org/10.1016/j.ijgo.2012.01.014.
Kaptan H, Kulaksızoğlu H, Kasımcan Ö, Seçkin B. The association between urinary incontinence and low back pain and radiculopathy in women. Open Access Maced J Med Sci. 2016;4:665–9. https://doi.org/10.3889/oamjms.2016.129.
Kim H, Yoshida H, Hu X, et al. Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study. Neurourol Urodyn. 2015;34:322–6. https://doi.org/10.1002/nau.22567.
Kim JS, Kim SY, Oh DW, Choi JD. Correlation between the severity of female urinary incontinence and concomitant morbidities: a multi-center cross-sectional clinical study. Int Neurourol J. 2010;14:220–6. https://doi.org/10.5213/inj.2010.14.4.220.
Koskimäki J, Hakama M, Huhtala H, Tammela TL. Association of non-urological diseases with lower urinary tract symptoms. Scand J Urol Nephrol. 2001;35:377–81. https://doi.org/10.1080/003655901753224431.
Mens JMA, Huis in ‘t Veld YH, Pool-Goudzwaard A. Severity of signs and symptoms in lumbopelvic pain during pregnancy. Man Ther. 2012;17:175–9. https://doi.org/10.1016/j.math.2011.12.012.
Pool-Goudzwaard AL, Slieker ten Hove MCPH, Vierhout ME, et al. Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. Int Urogynecol J. 2005;16:468–74.
Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother. 2006;52:11–6.
Smith MD, Russell A, Hodges PW. The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women: a longitudinal cohort study. Clin J Pain. 2014;30:162–7. https://doi.org/10.1097/AJP.0b013e31828b10fe.
Toprak Çelenay Ş, Özer Kaya D. Relationship of spinal curvature, mobility, and low back pain in women with and without urinary incontinence. Turk J Med Sci. 2017;47:1257–62. https://doi.org/10.3906/sag-1609-67.
Yi J, Tenfelde S, Tell D, et al. Triathlete risk of pelvic floor disorders, pelvic girdle pain, and female athlete triad. Female Pelvic Med Reconstr Surg. 2016;22:373–6. https://doi.org/10.1097/SPV.0000000000000296.
Yoshimura K, Nakayama T, Sekine A, et al. Prevalence of postmicturition urinary incontinence in Japanese men: comparison with other types of incontinence. Int J Urol. 2013;20:911–6. https://doi.org/10.1111/iju.12074.
6th ICI Book. In: ICS. https://www.ics.org/education/icspublications/icibooks/6thicibook
Malfliet A, De Pauw R, Kregel J, et al. Gender differences in the association of brain gray matter and pain-related psychosocial characteristics. Pain Physician. 2019;22:E191–203.
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111:52–8. https://doi.org/10.1093/bja/aet127.
Hides JA, Stokes MJ, Saide M, et al. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 1994;19:165–72. https://doi.org/10.1097/00007632-199401001-00009.
Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain: different time points, observations, and mechanisms. J Orthop Sports Phys Ther. 2019;49:464–76. https://doi.org/10.2519/jospt.2019.8827.
Danneels LA, Vanderstraeten GG, Cambier DC, et al. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J . 2000;9:266–72. https://doi.org/10.1007/s005860000190.
Devreese A, Staes F, De Weerdt W, et al. Clinical evaluation of pelvic floor muscle function in continent and incontinent women. Neurourol Urodyn. 2004;23(3):190–7. https://doi.org/10.1002/nau.20018.
Smith MD, Coppieters MW, Hodges PW. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourol Urodyn. 2007;26:377–85. https://doi.org/10.1002/nau.20336.
Stuge B, Mørkved S, Dahl HH, Vøllestad N. Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain. Man Ther. 2006;211(4):287–96. https://doi.org/10.1016/j.math.2005.07.003.
Sjödahl J, Gutke A, Ghaffari G, et al. Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the active straight leg raise in women with and without pelvic girdle pain: an experimental study. Clin Biomech Bristol Avon. 2016;35:49–55. https://doi.org/10.1016/j.clinbiomech.2016.04.007.
Jones DL, Moore T. The types of neuropathic bladder dysfunction associated with prolapsed lumbar intervertebral discs. Br J Urol. 1973;45(1):39–43.
Dumoulin C, Lemieux MC, Bourbonnais D, et al. Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2004;104(3):504–10. https://doi.org/10.1097/01.AOG.0000135274.92416.62.
De Souza Abreu N, de Castro Villas Boas B, JMB N, Figueiredo AA. Dynamic lumbopelvic stabilization for treatment of stress urinary incontinence in women: controlled and randomized clinical trial. Neurourol Urodyn. 2017;36(8):2160–8. https://doi.org/10.1002/nau.23261.
Bi X, Zhao J, Zhao L, et al. Pelvic floor muscle exercise for chronic low back pain. J Int Med Res. 2013;41:146–52. https://doi.org/10.1177/0300060513475383.
ElDeeb AM, Abd-Ghafar KS, Ayad WA, Sabbour AA. Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: a randomized controlled trial. J Back Musculoskelet Rehabil. 2019;32:693–700. https://doi.org/10.3233/BMR-181258.
Ghaderi F, Mohammadi K, Amir Sasan R, et al. Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and urinary incontinence in women. Urology. 2016;93:50–4. https://doi.org/10.1016/j.urology.2016.03.034.
Teymuri Z, Hosseinifar M, Sirousi M. The effect of stabilization exercises on pain, disability, and pelvic floor muscle function in postpartum lumbopelvic pain: a randomized controlled trial. Am J Phys Med Rehabil. 2018;97:885–91. https://doi.org/10.1097/PHM.0000000000000993.
Taylor DA, Merten SL, Sandercoe GD, Gahankari D, Ingram SB, Moncrieff NJ, et al. Abdominoplasty improves low back pain and urinary incontinence. Plast Reconstr Surg. 2018;141(3):637–45. https://doi.org/10.1097/PRS.0000000000004100.
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Bertuit, J., Bakker, E. & Rejano-Campo, M. Relationship between urinary incontinence and back or pelvic girdle pain: a systematic review with meta-analysis. Int Urogynecol J (2021). https://doi.org/10.1007/s00192-020-04670-1
- Urinary incontinence
- Pelvic girdle pain
- Low back pain
- Back pain