Analysis of Collagen Status in Premenopausal Nulliparous Women With Genuine Stress Incontinence

Abstract

Objective To determine if differences exist in the collagen status of premenopausal nulliparous women with genuine stress incontinence compared with continent controls. Design Thirty-six premenopausal nulliparous women with urodynamically-proven genuine stress incontinence were compared with 25 controls. All the women studied had a periurethral vaginal biopsy taken of approximately 30-50 mg in wet weight. This biopsy was then analysed to determine the collagen content, the type 1:III collagen ratio and the collagen cross-link content. Setting A tertiary referral urodynamic unit. Results The nulliparous women with genuine stress incontinence had significantly less collagen in their tissues (P < 0.0001) compared with the continent controls. In addition, there was a decreased ratio of type I to type 111 collagen (P = 0.0008), and the cross-link content was also significantly reduced in the women with genuine stress incontinence (P < 0.0001). Conclusion Genuine stress incontinence is present in a significant number of women before childbirth. The aetiology of their incontinence appears to be due to a defect in their connective tissue, with both a quantitative and qualitative reduction in their collagen.

Avaliação da Incontinência Urinária na Gravidez e no Pós-Parto: Estudo Observacional

“…[13][14][15] Por outro lado, o balanço hormonal característico da gravidez (níveis aumentados de progesterona) tem também um efeito relaxante na musculatura lisa do assoalho pélvico e está associado a uma diminuição dos níveis de colagénio. 16,17 De acordo ainda com os achados do presente estudo, também vários investigadores identificaram uma associação significativa entre a multiparidade e a ocorrência de IU. 18,19 Segundo a literatura, estes achados suportam a hipótese de que a gravidez por si só pode exercer um efeito cumulativo negativo nos diferentes componentes da musculatura pélvica.…”

Diet as a risk factor for the development of stress urinary incontinence: a longitudinal study in women

“…Nevertheless, many epidemiological studies have not found an increase in prevalence of SUI around the time of the menopause, which would be expected to accompany the fall in oestrogen level that occurs, and a number of studies have reported a decrease in prevalence at this time (Thom & Brown, 1998). Recent work has suggested that constitutional differences in the laxity of connective tissue may play a role in the aetiology of SUI (Keane et al, 1997;Ulmsten & Falconer, 1999), and rates of collagen synthesis and degradation are controlled by the matrix metalloproteinase enzymes which are sensitive to oestrogens (Moalli et al, 2002).…”

The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence

“…However endopelvic fascia is inaccessible unless patients undergo abdominal or vaginal surgery. As previous work has shown that vaginal collagen closely resembles endopelvic fascia 6 , probably due to the common embryological origin of the vagina and lower urinary tract 23 , we used tissue from this source to investigate the effect of oestrogen supplementation. We report here the results of a trial designed to explore this hypothesis.…”

“…While it is possible that our findings are a statistical aberration, some of our results were highly significant. Recent research suggests that both stress incontinence and genitourinary prolapse may be connective tissue diseases 6,25 . It is possible that the loss of collagen observed after therapy with oestrogen may be occurring because of the diseased nature of the tissue; we already suspect that such tissue exhibits impaired collagen synthesis 25 .…”

“…The collagen of the endopelvic fascia is likely to be important in maintaining urinary continence and it has previously been reported that premenopausal urinary stress incontinence is due, at least in part, to an alteration in connective tissue metabolism 6 .…”