Society For Pediatric Urology

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Urinary and fecal incontinence varies during the menstrual cycle among women with spina bifida
Joshua D. Roth, MD1, Rosalia Misseri, MD1, Devon J. Hensel, PhD, MS2, John S. Weiner, MD3, Konrad Szymanski, MD, MPH1.
1Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA, 2Indiana University School of Medicine and Indiana University Purdue University Indianapolis, Indianapolis, IN, USA, 3Duke University Medical Center, Durham, NC, USA.

BACKGROUND: Healthy women experience variations in bladder and bowel habits during the menstrual cycle. Anecdotal clinical experience suggests that women with spina bifida (SB) experience changes in urinary and fecal incontinence (UI, FI) at some point in the menstrual cycle. Our aim was to determine the prevalence, nature and timing of these changes among women with SB.
METHODS: An international online survey to adults with SB was administered over 12-months. Collected data included demographic and clinical variables. Baseline incontinence was defined as any leaking in the last 4 weeks. Changes during a menstrual cycle were assessed for UI and FI (options: no changes, I leak more, I leak less,) and bowel movement frequency (options: no changes, I have more, I have less). Each indicated change was rated as occurring before, during and/or after menses. Women with a urostomy or colostomy were excluded from analyses of urinary and fecal outcomes, respectively. Fisher’s exact test was used. RESULTS: Median age of 104 women participating was 35 years old (63.5% community ambulators, 43.7% shunted). UI was reported by 67.5% of women, while 58.0% had FI. Among those with UI, 23.4% reported variation at some point in the menstrual cycle: 22.3% had worsened UI and 1.1% improved. UI worsened either before (71.4%) or during menses (81.0%), but not after (0.0%, p<0.001). Among those with FI, 24.8% reported changes at some point in the menstrual cycle: 20.8% had worsened FI and 4.0% improved. FI worsened before (61.9%) or during menses (76.2%), but rarely after (4.8%, p<0.001). Women with worsening of UI tended to report worsening FI, although this did not reach statistical significance (p=0.053). Overall, 48.4% of women reported changes in bowel movement frequency: 36.8% increased, 11.6% decreased. Frequency increased before (65.7%) or during menses (60.0%), but rarely after (8.6%, p<0.001). If frequency decreased, this tended to occur during menses (72.7%), rather than before (27.5%) or after (18.2%, p=0.03). Women with worsening FI reported more frequent bowel movements, while those with improving FI reported fewer (p<=0.01).
CONCLUSIONS: Changes in bladder and bowel function at some point in the menstrual cycle are common among women with SB. They typically consist of premenstrual and menstrual worsening UI, FI and more frequent bowel movements.

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