Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly

Abstract

Background: Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. Objective:To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging. Method:Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. Results:The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628), 10.6% (R2=0.106; F=3.03; p=0.057), and 10.1% (R2=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343) was observed only between UI and IO recruitment. Conclusion:These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly.

Is there a link between back pain and urinary symptoms?

“…21 These studies are contrasted by studies that did not show there was a significant difference between pelvic floor strength or ability to activate the abdominals among women with LBP who did or did not have urinary incontinence. 24,26 Among these four studies, the quality was rated as good for 3/4 and poor for 1/4. Overall the quality of these studies in this section was judged as good (3/8), fair (2/8), and poor (3/8), ( Table 2, with further details in the online appendix).…”

“…21,22 Low back pain with urinary incontinence does not seem to represent a more severe form of pelvic floor dysfunction. 24,26 There are several potential hypotheses that may explain the relationship between back pain and urinary dysfunction. Kinesiology and muscle physiology studies have demonstrated that low back pain may develop due to changes in control of the traditional trunk muscles (transversus abdominis, rectus abdominis, and multifidus); more recent studies have recognized the role of the pelvic floor muscles in spinal stability.…”

“…We identified eight studies that included an assessment of pelvic floor function, low back pain and/or urinary incontinence ( Table 2). [20][21][22][23][24][25][26][27] Three were RCTs that examined whether the addition of pelvic floor therapy (with some behavior modifications) improved LBP; two demonstrated no improvement in low back pain or functional disability, 23,25 and another with a longer course of treatment did show a significant improvement in low back pain and functional disability. 20 In all three studies, urinary incontinence did improve.…”

“…Four studies examined the correlation between pelvic floor function among women with low back pain, 21,22 or among women with low back pain with or without incontinence. 24,26 There was a high proportion of pelvic floor dysfunction on physical exam among women with low back pain (however no comparison group was included) 22 and women with low back pain tended to have less pelvic floor strength and control compared to controls. 21 These studies are contrasted by studies that did not show there was a significant difference between pelvic floor strength or ability to activate the abdominals among women with LBP who did or did not have urinary incontinence.…”

The Effects of Chiropractic Spinal Manipulation on Urinary Incontinence in Patients with Low Back Pain and Radiculopathy: A Retrospective Case Series Report

“…Low Back Pain (LBP) and Urinary Incontinence (UI) are prevalent among elderly individuals especially in women. LBP and UI are conditions that strongly affect functioning in the elderly and hinder the performance of everyday activities, thus causing physical and emotional distress, incurring high socioeconomic costs, restricting social participation, and decreasing the quality of life [3]. There are large variations in the severity and impact of incontinence.…”