Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis.

OBJECTIVE: Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth. DATA SOURCES: MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023. STUDY ELIGIBILITY CRITERIA: Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included. METHODS: Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies. RESULTS: Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months. CONCLUSION: This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.

Transabdominal ultrasound to assess the displacement of the bladder base during abdominal and pelvic floor contractions in continent parous versus nulliparous women.

INTRODUCTION AND HYPOTHESIS: The effect of different abdominal contractions on the position of pelvic organs in parous women during postpartum exercises has not been sufficiently assessed. The aim of this study was to evaluate the displacement of the bladder base (BB) during different pelvic floor and abdominal contractions in parous women compared to nulliparous women. We hypothesised that abdominal and perineal contractions will produce a disparate effect on the position of the BB between groups. METHODS: Cross-sectional study including a convenience sample of 63 volunteers (35 nulliparous vs. 28 postpartum women). Transabdominal ultrasound was used in mode B to image the displacement of the BB. The protocol included six different pelvic floor and abdominal contractions commonly used in postpartum rehabilitation. RESULTS: The BB elevated significantly more in the postpartum group compared to nulliparous women when performing submaximal contraction of pelvic floor and transversus abdominis muscles simultaneously with axial elongation of the back (0.93 ± 0.55 cm in parous women vs. 0.66 ± 0.46 cm in nulliparous women). In contrast, the BB was found to descend significantly during a curl-up contraction in both groups (0.93 ± 0.55 cm in parous women vs. 0.66 ± 0.46 cm in nulliparous women). CONCLUSIONS: The overall results of this study showed that perineal and superficial abdominal contractions produced different immediate effects compared to deep abdominal contractions on the displacement of BB in parous and nulliparous women. Further research is required to assess the long-term effects of these contractions.

Validity and Reliability of an Offline Ultrasound Measurement of Bladder Base Displacement in Women.

The effect of different exercises on the position of pelvic organs in women has not been sufficiently assessed. The objective was to analyze the validity and reliability of a new two-dimensional ultrasound algorithm to measure offline the displacement of the bladder base during abdominal exercises. This algorithm could be a useful method to future studies in determine the most appropriate exercises in sports and in rehabilitative program for the pelvic floor in women. All subjects were tested by transverse transabdominal ultrasound. The measurements were conducted offline using a customized code written in MATLAB (Ecolab) for image-processing, and manually on the ultrasound monitor using electronic calipers. The agreement was assessed with a paired t-test, Pearson's linear correlation coefficient (r), the Lin's concordance correlation coefficient (CCC), the intraclass correlation coefficient ICC (A,2) and a Bland-Altman plot. The reliability was confirmed by the interdays intra-rater ICC coefficient. The results were that Ecolab and ultrasound transducer measures did not differ statistically (p = 0.246). Furthermore, both methods showed a very strong relationship, and the Ecolab demonstrated to be a valid and reliable method. We concluded that Ecolab seemed to be a valid and reliable tool to assess the effect of abdominal contractions in the female pelvic floor.

The effect of alternating and biphasic currents on humans' wound healing: a literature review.

Although different types of currents, including bidirectional currents, have been used to promote healing, there is neither a summary about their effects nor consensus on best parameters to be used. The aim of this article is to provide an overview of current evidence on the effectiveness of bidirectional electrical stimulation on wound healing in accordance with the parameters used. Relevant articles were selected following a search of Medline, Cochrane, Embase, CINAHL, and PEDro for English, Spanish, Portuguese, Italian, or French articles published between 1980 and 2011. Ten trials and four case-series were found that deal with pressure ulcers, diabetic ulcers, venous ulcers, skin flaps, and amputation. Eight trials were of low-quality. Five of ten controlled trials found a statistically significant difference on wound healing, and another four trials found positive trends. Both of the two skin flap trials, one of two diabetic trials, and two of five pressure ulcer trials found a significant difference in bidirectional stimulated groups. Both TENS and NMES types of currents were used, but many parameters were not specified. In general, bidirectional currents appear to increase wound healing rates and reduce size of wounds, above all in skin flaps. However, there is a lack of well-designed studies on biphasic and alternating stimulation, and there is a need for improvement in description of parameters and in uniformity of nomenclature.