Loss of bladder, bowel control common among CF adults: Study
Incontinence issues may impair patients' life quality, breathing care
Loss of bladder or bowel control is common among adults with cystic fibrosis (CF), and such incontinence problems may impair patients’ quality of life and respiratory (breathing) care, regardless of the severity of their lung symptoms, a study found.
“Persistent coughing” — a common symptom in cystic fibrosis — “induces pelvic floor dysfunction [problems],” the researchers wrote, noting that “this study reported a high prevalence of [incontinence] in men and women with CF.”
The findings highlight the need to address incontinence issues with tailored treatment, according to the team of scientists, from across France.
“Multidisciplinary teams must have knowledge of symptoms, the diagnostic tools and management strategies to provide specific treatment,” they wrote.
Most patients do not report bladder, bowel control issues to clinicians
For people with CF, constant coughing can put repeated pressure on the pelvic floor, a group of muscles located between the tailbone, or coccyx, and the pubic bone within the pelvis. These muscles help support the bladder and the bowel.
While changes to the pelvic floor can lead to an inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the bowel (fecal incontinence), it is unknown how common these issues are among men and women with CF.
To know more, the researchers surveyed 178 adults with a confirmed diagnosis of CF for symptoms of bladder or bowel incontinence and their impact on quality of life and respiratory care. The survey involved 93 men and 85 women, with a mean age of 30.6.
Based on the results of self-report questionnaires, 105 patients (64.8%) had an overactive bladder, 91 (52%) had fecal incontinence, and 61 (34.3%) had stress urinary incontinence, or leakage of urine during moments of physical activity, including coughing or sneezing.
Stress urinary incontinence was significantly more common in women than men (63.5% vs. 7.5%), as was fecal incontinence (63.5% vs. 41.1%). The mean overactive bladder score, ranging from 0 to 21, with a higher score indicating more severe symptoms, also was higher for women (2.29 vs. 1.03 points).
Neither urinary nor fecal incontinence were linked to more severe lung function impairment, which was evaluated based on the forced expiratory volume in one second (FEV1), a measure of the amount of air that can be forcefully breathed out in one second.
Urinary incontinence impaired quality of life, measured using the SF Qualiveen questionnaire, in which a higher score indicates worse quality of life. Mean total SF Qualiveen scores were higher for women with urinary incontinence than for those without (0.54 vs. 0.11 points).
The majority of people with [urinary or fecal incontinence] have never discussed their problems with their medical team despite the fact effective treatments and management strategies exist. It is probably considered too intimate or embarrassing to discuss, or secondary to other symptoms that are more directly related to the disease.
In both men and women, the presence of stress urinary incontinence affected respiratory symptoms. It also had a moderate to strong negative impact on respiratory care, particularly during physiotherapy — treatment to help with mucus clearance in CF patients — as well as on coughing. In women, it affected the results of lung function tests.
In men, stress urinary incontinence was linked to diabetes and a history of genital mycosis, an infection caused by a fungus. In women, the only risk factor for stress urinary incontinence was older age.
While loss of bladder or bowel control have an impact on quality of life and respiratory care, “the majority of people with [urinary or fecal incontinence] have never discussed their problems with their medical team despite the fact effective treatments and management strategies exist,” the researchers wrote.
“It is probably considered too intimate or embarrassing to discuss, or secondary to other symptoms that are more directly related to the disease … and their management, which is often a heavy burden,” they added.
At the time the study was done, CFTR modulators, a class of medications that address the root cause of CF, were not widely available. Now that the use of such treatments is known to improve lung function and reduce coughing and sneezing, urinary or fecal incontinence is likely to be less common, according to the team.
Even so, “it is important to regularly screen for pelvic floor dysfunction [problems], regardless of the severity of … lung disease, even in individuals treated with [CFTR] modulators,” the researchers concluded.