Incontinence & Intimate Partners: Assessing the Contribution of Treatment

Urge Urinary Incontinence Clinical Trial

— IIMPACT  

Official title:

Incontinence & Intimate Partners: Assessing the Contribution of Treatment

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01559389
• Other study ID #: 203952
• Status: Completed
• Phase: Phase 4
• Start date: March 9, 2012
• Est. completion date: June 29, 2017

Study information

• Verified date: November 2019
• Source: Loyola University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Urge urinary incontinence (UUI) is a socially debilitating disease due to its inherently unpredictable nature and sometimes large volumes of urine loss. Women with UUI may experience anxiety over public episodes of incontinence and concerns about odor and, as a result, isolate themselves socially. This isolation affects both partners in the relationship and may be a source of discord. The impact of UUI also moves into personal relationships where fears or actual episodes of incontinence during physical intimacy, including but limited to intercourse, may result in limited interactions and changes in the relationship satisfaction for both partners. Few studies have examined the role of urinary incontinence, particularly UUI, in the dynamics of an intimate partner relationship and none have evaluated the impact of successful UUI treatment.

The long-term goal of our research is to understand the social and emotional impact of pelvic floor disorders, particularly UUI, on the well-being of an intimate relationship. Ultimately, we aim to evaluate the role that successful treatment plays in the alleviation of discord in intimate partner relationships that are affected by UUI and other pelvic floor disorders.

Our objective for this proposal is to characterize, using validated, quantifiable methods the quality of the relationship in couples affected by UUI and to identify the role that treatment plays in improving this relationship. Our central hypothesis is that UUI has a negative impact upon the emotional and physical well-being of a relationship and that effective treatment will result in improvement in areas of the relationship that have been detrimentally affected by UUI. Our rationale for this study is that an understanding of UUI in the context of a couple, particularly from the perspective of the male partner, will improve our ability to holistically treat UUI, thus improving patient outcomes and satisfaction.

Description:

Chronic illness places emotional, physical, and financial burdens upon both the patient and her partner and can be a significant source of stress in a relationship. The symptoms of UUI inherently pose greater social challenges than those faced by women other forms of pelvic floor disorders. For example, women with UUI may avoid social situations due to fear of having an accident or may be reluctant to participate in activities during which it may be difficult to find a bathroom. The resulting social isolation impacts both members of the dyad and may serve as a source of relationship discord. Changes in sexual function and perceived intimacy, including non-intercourse intimacy, as well as communication may be new sources of stress in a previously healthy relationship or may serve to amplify pre-existing relationship problems.

Sexual function is another area in which UUI may cause a negative impact. Studies of coital incontinence among incontinent clinic populations report prevalence ranging from 10%-56% with a median of 22%. The prevalence of coital incontinence may be related to the type of incontinence as well as the severity of symptoms. Stress incontinence has been associated with leakage of urine during intercourse, while detrusor instability and urge incontinence have been correlated with leakage during orgasm. A cross-sectional study of women with UUI and urinary incontinence found that among women reporting low sexual desire, stress incontinence was common (47%), while 46% of women reporting orgasmic phase dysfunction reported symptoms of urge incontinence. Qualitative data corroborates the negative impact of UUI on dyadic and sexual relations.

Another mechanism by which UUI may affect satisfaction with dyadic relations is through depressive symptomatology. Urinary incontinence is associated with a decrease in overall health-related quality of life and is positively correlated with depression, anxiety, and stress. Studies of other chronic illnesses demonstrate a correlation between the patient's level of depression and that of their spouse; level of depression shows an inverse relationship with degree of satisfaction with the relationship.

One of the two studies in the published literature that use quantitative methods to evaluate the impact of urodynamic stress incontinence and detrusor overactivity on the marital relationship concluded that both sexual function and marital relationships are negatively affected by incontinence. This study, like others, is based upon the perspective of the female partner. A recent study of Swedish women with urinary incontinence and urgency is the only study which includes the perspective of the male partner to examine the impact of UUI on the relationship. It concludes that, "Female urinary incontinence, urgency and frequency significantly impair the quality of life in both younger and older women, and also have negative effects on the partner relationship and the partner's life".

The perspective of intimate partners of women with UUI and other forms of PFD is largely missing from the literature. Any analysis of the role of UUI in intimate partner relationships is incomplete without this perspective.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 138
• Est. completion date: June 29, 2017
• Est. primary completion date: June 29, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Healthy male partners may volunteer to participate in this study along with their affected female partners. There are no inclusion or exclusion criteria for male partners.

For affected female participants, the following inclusion criteria apply:

• Age = 18 years

• In a relationship with a male partner for at least 3 months

• Not pregnant or planning to become pregnant

• Have a diagnosis of UUI or Mixed Urinary Incontinence (MUI) that is urge predominant based on a 3 day voiding diary

• Are interested in medical management of their symptoms

• Are candidates for solifenacin

• Are able to provide informed consent

• Are able to complete written questionnaires.

For affected female partners, the following exclusion criteria apply:

• Post Voided Residual (PVR) > 200 ml at the initial visit

• History of a significant outflow obstruction

• History of persistent/recurrent Urinary Tract Infection (UTI)

• History of bladder stones

• History of a diagnosis of chronic interstitial cystitis

• History of pelvic irradiation

• Current pelvic malignancy

• Narrow angle glaucoma

• Urinary or gastric retention

• Current use of a tricyclic antidepressant

• A neurologic diagnosis that could affect bladder function

• History of chronic pelvic pain

• Active psychotic disorder

• Male partner does not speak English

• Declines permission for the study team to recruit their male partner for the study

Related Conditions & MeSH terms

• Enuresis
• Urge Urinary Incontinence
• Urinary Incontinence
• Urinary Incontinence, Urge

Intervention

Drug:
• Solifenacin
Women presenting with UUI symptoms receive 5 to 10 milligrams (mg) of daily solifenacin for up to 16 weeks

Locations

Country	Name	City	State
United States	Loyola University Medical Center	Maywood	Illinois

Sponsors (2)

Lead Sponsor	Collaborator
Loyola University	Astellas Pharma US, Inc.

Country where clinical trial is conducted

United States, 

References & Publications (19)

Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005 Jul;193(1):103-13. — View Citation

Bovbjerg VE, Trowbridge ER, Barber MD, Martirosian TE, Steers WD, Hullfish KL. Patient-centered treatment goals for pelvic floor disorders: association with quality-of-life and patient satisfaction. Am J Obstet Gynecol. 2009 May;200(5):568.e1-6. doi: 10.1016/j.ajog.2008.11.020. Epub 2009 Feb 23. — View Citation

Coyne KS, Matza LS, Brewster-Jordan J. "We have to stop again?!": The impact of overactive bladder on family members. Neurourol Urodyn. 2009;28(8):969-75. doi: 10.1002/nau.20705. — View Citation

Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, Aiyer LP. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009 Apr;103 Suppl 3:4-11. doi: 10.1111/j.1464-410X.2009.08371.x. — View Citation

Daneker B, Kimmel PL, Ranich T, Peterson RA. Depression and marital dissatisfaction in patients with end-stage renal disease and in their spouses. Am J Kidney Dis. 2001 Oct;38(4):839-46. — View Citation

Herzog AR, Diokno AC, Brown MB, Normolle DP, Brock BM. Two-year incidence, remission, and change patterns of urinary incontinence in noninstitutionalized older adults. J Gerontol. 1990 Mar;45(2):M67-74. — View Citation

Hilton P. Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom. Br J Obstet Gynaecol. 1988 Apr;95(4):377-81. — View Citation

Jacobson NS, Follette WC, McDonald DW. Reactivity to positive and negative behavior in distressed and nondistressed married couples. J Consult Clin Psychol. 1982 Oct;50(5):706-14. — View Citation

Jacobson NS. A component analysis of behavioral marital therapy: the relative effectiveness of behavior exchange and communication/problem-solving training. J Consult Clin Psychol. 1984 Apr;52(2):295-305. — View Citation

Johnson SM, Greenberg LS. Differential effects of experiential and problem-solving interventions in resolving marital conflict. J Consult Clin Psychol. 1985 Apr;53(2):175-84. — View Citation

Litman HJ, Steers WD, Wei JT, Kupelian V, Link CL, McKinlay JB; Boston Area Community Health Survey Investigators. Relationship of lifestyle and clinical factors to lower urinary tract symptoms: results from Boston Area Community Health survey. Urology. 2007 Nov;70(5):916-21. Epub 2007 Oct 24. — View Citation

Nathan EP, Joanning HH. Enhancing marital sexuality: an evaluation of a program for the sexual enrichment of normal couples. J Sex Marital Ther. 1985 Fall;11(3):157-64. — View Citation

Nilsson M, Lalos A, Lalos O. The impact of female urinary incontinence and urgency on quality of life and partner relationship. Neurourol Urodyn. 2009;28(8):976-81. doi: 10.1002/nau.20709. Erratum in: Neurourol Urodyn. 2012 Apr;31(4):607. Margareta, Nilsson [corrected to Nilsson, Margareta]; Ann, Lalos [corrected to Lalos, Ann]; Othon, Lalos [corrected to Lalos, Othon]. — View Citation

Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003 Aug;14(3):164-8; discussion 168. Epub 2003 Jul 25. Erratum in: Int Urogynecol J Pelvic Floor Dysfunct. 2004 May-Jun;15(3):219. — View Citation

Rust J, Golombok S. The Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Br J Clin Psychol. 1985 Feb;24 ( Pt 1):63-4. — View Citation

Salonia A, Zanni G, Nappi RE, Briganti A, Dehò F, Fabbri F, Colombo R, Guazzoni G, Di Girolamo V, Rigatti P, Montorsi F. Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross-sectional study. Eur Urol. 2004 May;45(5):642-8; discussion 648. — View Citation

Shaw C. A systematic review of the literature on the prevalence of sexual impairment in women with urinary incontinence and the prevalence of urinary leakage during sexual activity. Eur Urol. 2002 Nov;42(5):432-40. Review. — View Citation

Spanier GB. The measurement of marital quality. J Sex Marital Ther. 1979 Fall;5(3):288-300. — View Citation

Yip SK, Chan A, Pang S, Leung P, Tang C, Shek D, Chung T. The impact of urodynamic stress incontinence and detrusor overactivity on marital relationship and sexual function. Am J Obstet Gynecol. 2003 May;188(5):1244-8. — View Citation

* Note: There are 19 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Baseline Sexual Satisfaction Between Matched Female and Male Partners	Prior to beginning treatment with solifenacin, females presenting with UUI complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Their male partners also complete the GRISS at the baseline visit. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.	0 Weeks
Secondary	Change in Overall Sexual Satisfaction Among Females	Females presenting with UUI complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS) at baseline (0 weeks) and after 12-16 weeks of treatment with solifenacin. For this outcome, the baseline score is subtracted from the follow-up score and this change score is compared between those who respond and do not respond to treatment with solifenacin. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.	Baseline and 12-16 weeks
Secondary	Change in Overall Sexual Satisfaction Among Healthy Male Partners	Healthy male partners of female participants complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS) survey. For this outcome, their baseline score is subtracted from their follow-up score which is collected after their female partner completes approximately 12-16 weeks of solifenacin treatment for UUI symptoms. This change score is compared between male partners of female participants who respond to solifenacin versus male partners of female participants who do not respond to solifenacin. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.	Baseline and 12-16 weeks