Publications by authors named "Leslee L Subak"
Yoga has been recommended as a complementary management strategy for women with chronic pelvic pain (CPP), but many women lack access to specialized yoga instruction for this indication, and few data are available to evaluate changes in CPP with yoga. This feasibility trial evaluated the acceptability and tolerability of a remotely delivered yoga program for CPP in women and examined data quality and interpretability for measures of pelvic pain intensity and impact with yoga instruction. Ambulatory women with CPP were recruited from northern California in 2020-2022 and randomly assigned to a 2-month program involving twice weekly group classes delivered by videoconference supplemented by individual practice of pelvic yoga techniques versus a control program involving equivalent-time instruction and practice of nonspecific skeletal muscle stretching-strengthening exercises.
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- Pelvic floor yoga is being explored as a possible alternative treatment for urinary incontinence (UI) in women, but solid evidence supporting its effectiveness is still limited.
- This study compared a 12-week pelvic floor yoga program to a general physical conditioning program to see which was more effective in reducing UI.
- Results showed both groups experienced a decrease in UI frequency, with pelvic yoga showing slightly better outcomes, but the differences were minimal and not statistically significant for all types of UI.
Background: Urgency-type urinary incontinence affects one in four older community-dwelling women and overlaps with other common aging-associated health syndromes such as cognitive impairment, physical mobility impairment, and depression. Observational studies have raised concern about potentially higher rates of delirium and dementia in older adults taking anticholinergic bladder medications, but few prospective data are available to evaluate the effects of these and other pharmacologic treatments for urgency incontinence on cognition and other multisystem functional domains important to older women.
Methods: The TRIUMPH study is a randomized, double-blinded, 3-arm, parallel-group trial comparing the multisystem effects of anticholinergic versus beta-3-adrenergic agonist bladder therapy and versus no active bladder anti-spasmodic pharmacotherapy in older women with urgency incontinence.
Aims: To provide an overview of the barriers and facilitators to overactive bladder (OAB) therapy initiation and adherence.
Methods: A PubMed and Embase literature search was conducted to identify barriers to OAB therapy adherence.
Results: OAB therapy adherence is associated with improvements in urinary symptoms, and quality of life with reductions in annual costs for OAB-related expenditures.
This brief report describes the rapid conversion of a randomized trial of a Hatha-based yoga program for older women with urinary incontinence to a telehealth videoconference platform during the coronavirus disease 2019 (COVID-19) pandemic. Interim results demonstrate the feasibility of recruiting and retaining participants across a wide range of ages and ethnic backgrounds, but also point to potential obstacles and safety concerns arising from telehealth-based instruction. The investigators present lessons learned about the benefits and challenges of using telehealth platforms to deliver movement-based interventions and consider strategies to promote accessible and well-tolerated telehealth-based yoga programs for older and diverse populations.
View Article and Find Full Text PDFBackground: Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI).
Methods: We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food frequency questionnaire, with incident UI subtypes after 3 years among 19 741 postmenopausal women in the Women's Health Initiative Observational Study. Odds ratios (ORs) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression.
Background: Most clinical investigations involving yoga lack adequate description of the specific yoga elements, including physical postures. Few studies have measured self-efficacy regarding the performance of yoga postures or assessed observed success in performing postures.
Methods: We developed and piloted several tools to evaluate self-efficacy and observed success in practicing yoga in the context of a randomized feasibility trial of an Iyengar-based yoga intervention for urinary incontinence in ambulatory women ≥50 years.
Background: Nocturnal bladder symptoms and sleep disruption commonly coexist in middle-aged and older women. Although sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, nonbladder factors also may influence sleep in this population. Many women with overactive bladder are eager to identify nonpharmacologic strategies for both bladder symptoms and sleep disruption, given the potential adverse effects of sedative and anticholinergic bladder medications in this population.
View Article and Find Full Text PDFObjective: To examine relationships between interpersonal trauma exposures and urinary symptoms in community-dwelling midlife and older women.
Methods: We analyzed cross-sectional data from a multiethnic cohort of women aged 40-80 years enrolled in an integrated health care system in California. Lifetime history of intimate partner violence (IPV) and sexual assault, current posttraumatic stress disorder (PTSD) symptoms, and current urinary symptoms were assessed using structured-item questionnaires.
Purpose: We evaluated the effects of device guided, slow-paced respiration on urgency associated urinary symptoms, perceived stress and anxiety, and autonomic function in women with overactive bladder syndrome.
Materials And Methods: We performed a randomized, parallel group trial of slow-paced respiration to improve perceived stress and autonomic dysfunction as potential contributors to overactive bladder. Ambulatory women who reported at least 3 voiding or incontinence episodes per day associated with moderate to severe urgency were randomized to use a portable biofeedback device to practice daily, slow, guided breathing exercises or a control device which appeared identical and was reprogrammed to play music without guiding breathing.
Background: Little is known about sexual problems and genitourinary health of older sexual minority adults, who comprise up to 4% of the adult population but may differ in experiences of genitourinary aging, given known health disparities and behavior differences.
Aim: To examine and compare genitourinary and sexual complaints among older sexual minority and sexual majority adults.
Methods: We analyzed data from the 2010-2011 National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of older community-dwelling U.
Importance: Short-term improvements in sexual functioning are reported after bariatric surgery, but to our knowledge, little is known about the durability of these improvements.
Objective: To determine the percentage of adults with impairment in sexual functioning who experience durable improvements in sexual functioning after bariatric surgery and to identify factors associated with improvements.
Design, Setting, And Participants: The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study conducted at 10 hospitals in 6 US clinical centers.
Importance: Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues.
Objective: To examine the associations of intimate partner violence (IPV), sexual assault, and posttraumatic stress with menopause symptoms among midlife and older women.
Design, Setting, And Participants: A cross-sectional analysis of data from a multiethnic cohort of 2016 women 40 to 80 years of age in the Kaiser Permanente Northern California health care system was conducted from November 15, 2008, to March 30, 2012.
Importance: Urinary incontinence (UI) guidelines recommend behavioral interventions as first-line treatment using individualized approaches. A one-time, group-administered behavioral treatment (GBT) could enhance access to behavioral treatment.
Objective: To compare the effectiveness, cost, and cost-effectiveness of GBT with no treatment for UI in older women.
Objective: To evaluate the association between pharmacologic therapy for urgency urinary incontinence (UUI) and sleep quality.
Methods: We conducted a planned secondary data analysis of sleep outcomes in a previously conducted multicenter, double-blind, 12-week randomized trial of pharmacologic therapy for urgency-predominant incontinence among community-dwelling women self-diagnosed using the 3-Incontinence Questions questionnaire. Participants (N=645) were assigned randomly to 4-8 mg antimuscarinic therapy daily or placebo.
Sleep Quality and Daytime Sleepiness Among Women With Urgency Predominant Urinary Incontinence.
Female Pelvic Med Reconstr Surg
January 2019
Objective: The objective of this study was to examine the strength and direction of the association between urinary symptoms and both poor quality sleep and daytime sleepiness among women with urgency urinary incontinence.
Methods: A planned secondary analysis of baseline characteristics of participants in a multicenter, double-blinded, 12-week randomized controlled trial of pharmacologic therapy for urgency-predominant urinary incontinence in ambulatory women self-diagnosed by the 3 Incontinence Questions was performed. Urinary symptoms were assessed by 3-day voiding diaries.
Purpose: We sought to determine whether a behavioral weight reduction intervention would improve nonurinary incontinence lower urinary tract storage symptoms at 6 months, including urinary frequency, nocturia and urgency, compared to a structured education program serving as the control group among overweight and obese women with urinary incontinence.
Materials And Methods: PRIDE (Program to Reduce Incontinence by Diet and Exercise) was a randomized clinical trial performed in 338 overweight or obese women with urinary incontinence. Participants were randomized, including 226 to 6-month behavioral weight loss intervention and 112 to the control group.
Background: Urinary incontinence is associated with decreased female sexual function, but little is known about the prevalence, predictors, and impact of urine leakage during sexual activity among women in the community.
Objective: The purpose of this study was to evaluate the prevalence and impact of urine leakage during sex in ethnically diverse, community-dwelling midlife and older women.
Study Design: Urinary incontinence and sexual function were assessed by structured questionnaire in a multiethnic, community-based cohort of women enrolled in Kaiser Permanente Northern California, an integrated healthcare delivery system in California.
Objective: To develop a group-based therapeutic yoga program for women with chronic pelvic pain (CPP) and explore the effects of this program on pain severity, sexual function, and well-being.
Methods: A yoga therapy program for CPP was developed by a multidisciplinary panel of clinicians, researchers, and yoga consultants. Women reporting moderate to severe pelvic pain for at least six months were recruited into a single-arm trial.
Objective: The aim of this study was to identify clinical and demographic characteristics that moderate response to treatment with fesoterodine among women with a diagnosis of urgency-predominant urinary incontinence.
Methods: A multicenter, double-blinded, 12-week randomized controlled trial of pharmacologic therapy for urgency-predominant urinary incontinence in community-dwelling women diagnosed by the 3-item Incontinence Questionnaire (3IQ) was previously performed. Participants (N = 645) were randomized to fesoterodine therapy (4-8 mg daily; n = 322) or placebo (n = 323).
Background: Obesity may impair sexual function through multiple mechanisms, but little is known about sexual dysfunction among adults with severe obesity seeking bariatric procedures.
Objectives: To describe sexual function and associated factors before bariatric surgery.
Setting: Ten U.
Objectives: To evaluate prospective relationships between body composition and muscle strength with predominantly stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in older women.
Design: Prospective community-dwelling observational cohort study (Health, Aging, and Body Composition study).
Participants: Women initially aged 70 to 79 recruited from Pittsburgh, Pennsylvania, and Memphis, Tennessee (N = 1,475).
Pelvic Floor Disorders Registry: Study Design and Outcome Measures.
Female Pelvic Med Reconstr Surg
December 2016
Pelvic floor disorders affect up to 24% of adult women in the United States, and many patients with pelvic organ prolapse (POP) choose to undergo surgical repair to improve their quality of life. While a variety of surgical repair approaches and techniques are utilized, including mesh augmentation, there is limited comparative effectiveness and safety outcome data guiding best practice. In conjunction with device manufacturers, federal regulatory organizations, and professional societies, the American Urogynecologic Society developed the Pelvic Floor Disorders Registry (PFDR) designed to improve the quality of POP surgery by facilitating quality improvement and research on POP treatments.
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