The Relationship between urinary bladder control and gait in women

Booth J, Paul L, Rafferty D, MacInnes C. Neurourology and Urodynamics 2012, Article first published online: 12 JUN 2012 | DOI: 10.1002/nau.22272

Pelvic Physiotherapy Distance Journal Club July 11, 2012

Beth Shelly PT, DPT, WCS, BCB PMD

What question did the study ask?

Is there a difference in temporal gait parameters during a strong desire to void?

Subjects

36 women ages 25 to 85 without UI or other bladder dysfunction symptoms (as measured by the IPSS)

Study design / method

Each woman walked 21 feet at a self selected pace three times under three different bladder conditions
·         First desire to void
·         Strong desire to void
·         After voiding
Multiple gait parameters were measured
·         Step length
·         Stride length
·         Swing time
·         Duration of single support
·         Duration of double support
·         Velocity
·         Cadence
The walkway for testing was positioned on the way to the bathroom. This is a measurement study

Results

Gait velocity and stride length for both sides was significantly decreased during string desire to void in comparison to after voiding.  In other words, women walk slower while they have urgency.  Authors point out it would make more sense that the women would walk faster toward the bathroom during urgency but that was not the case. 

Discussion

Authors listed several theories on the relationship of urgency to gait
1.       Strong desire to void interferes with cortical control of gait resulting in deterioration of rhythmical gait.
2.       Duel task or divided attention situation – during a duel task, quality of one or both tasks will decrease.  Prioritize bladder control over gait control resulting in continence with decreased gait quality.  Study sited – women with UUI had significantly less working memory.  Second study sited divided attention is known to impact gait parameters.  
3.       Increased abdominal muscle activity – it is known that abdominal muscle activity increases with bladder filling. Increased trunk muscle activity has been shown to decrease balance.  Thus the shorter steps may be an adaptive response to maintain stability. Group discussion – this does not seem to make sense
4.       Rise in intra-abdominal pressure – rise in intra-abdominal pressure due to bladder filling results in co-contraction of PFM and abdominal muscles and subsequently a change in gait pattern. 
5.       Group adds another theory – impact of hip muscle contraction during walking on the ability of the PFM to maintain continence.  Contraction of glut, adductors, OI may change PFM contraction

 Other studies

Effects of anxiety on running with and without an aiming task. Nibbeling N, Daanen HA, Gerritsma RM, Hofland RM, Oudejans RR. J Sports Sci. 2012;30(1):11-9. Epub 2011 Nov 23.

“Moreover, findings indicate that when combined, running, aiming, and anxiety all compete for attention leading to suboptimal attentional control and possibly a decrease in performance”

Understanding Risk of Falls in People With Cognitive Impairment Living in Residential Care.

Whitney J, Close JC, Jackson SH, Lord SR. J Am Med Dir Assoc. 2012 May 5. [Epub ahead of print]

“Fallers took more medications, were more likely to be taking antidepressants, had more functional impairment, poorer balance and gait, were more impulsive and anxious, exhibited more dementia-related behaviors, and performed worse on cognitive tests involving attention and orientation, memory, and fluency.”

 Thoughts

1.       UUI during walking is a common occurrence.  Is this related to anxiety of leaking or the actual contraction of certain muscle groups – abdominals versus adductors or obturator internus. 
2.       What treatments have you tried to address UUI during leaking
3.       What could be the next phase of this study, how could you clarify the mechanism further?

Strategies for clinical application from the group.

Core strengthening with and without PFM contraction in all positions
Decreasing force in heel strike by landing in mid-stance
Noticing differences in walking between treadmill and ground walking