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研究生：	蔡凱婷 Tsai, Kai-Ting
論文名稱：	65歲以下停經後社區婦女的尿失禁預測因子：一項橫斷面研究 Predictors of urinary incontinence in community-dwelling postmenopausal women younger than 65 years: A cross-sectional study
指導教授：	洪菁霞 Hung, Ching-Hsia
學位類別：	碩士 Master
系所名稱：	醫學院 - 物理治療學系 Department of Physical Therapy
論文出版年：	2024
畢業學年度：	112
語文別：	英文
論文頁數：	83
中文關鍵詞：	停經後婦女、身體活動程度、尿失禁、身體組成
外文關鍵詞：	Postmenopausal women, urinary incontinence, physical activity levels, body composition
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背景
隨著年紀增長，女性的子宮機能與雌激素水平下降，逐漸由生殖期進入停經期。部分女性在更年期會出現如熱潮紅、失眠、情緒波動、體重增加等症狀，以及泌尿生殖系統相關的症狀。與停經前女性相比，停經後女性可能會因能代謝下降，導致體脂增加、肌肉量減少等等生理機能變化，進而養成靜態生活習慣。此外，停經後女性的尿失禁症狀可能會更進一步導致身體活動水平下降。在任何年齡階層，尿失禁在女性的發生率高於男性，影響女性的尿失禁相關因子包含年齡、身體組成、孕產次數和停經等許多因素。而女性在停經後發生的尿失禁症狀，與激素變化及老化共同影響的生理機制相關，然而，受更年期的混雜因子影響，較少研究討論剛進入停經期不久的婦女。若在剛進入停經期的婦女中觀察到與尿失禁相關的風險因素，可能助於女性在往後的停經期階段對於尿失禁症狀有更有效的預防策略。因此，需要了解停經後婦女的尿失禁預測因子是否與一般尿失禁的預測因素相同。本研究主要目的為探討停經後婦女的尿失禁預測因子，以及分析停經後時間長短與尿失禁和其他預測因子間的相關性。
方法
此篇研究為橫斷式研究，從2022年12月執行至2024年4月。招募無或患有尿失禁的停經後婦女，符合條件的受試者參加一次性的評估。評估內容包含問卷填寫(國際尿失禁諮詢委員會問卷、尿失禁症狀調查問卷、停經後時間長短以及身體活動量調查短版問卷)、身體組成測量、握力以及功能性活動能力評估。所有資料使用SPSS第20版進行統計分析，使用邏輯回歸分析，檢測尿失禁的預測因素，使用點二列相關係數評估停經後早晚期與各變數間的相關性，所有分析中p值小於0.05表示具有顯著統計差異。
結果
本研究共招募97位有無尿失禁的停經後婦女。受試者的平均年齡為58.1±4.4歲，平均身體質量指數為23.5±3.6公斤/公尺2；46.4%的受試者是停經後早期，53.6%的受試者為停經後晚期，61.9%的受試者有尿失禁症狀，其中45%的受試者症狀是介於輕度至重度的尿失禁。研究結果顯示患有輕度至重度尿失禁的停經後婦女的身體活動程度顯著高於無尿失禁的婦女。此外，步行多寡可能是輕度至重度尿失禁的風險因素。停經後時間長短與握力和身體組成中的骨骼肌肉量呈顯著負相關，但與尿失禁無顯著相關。
結論
對於45到65歲之間的停經後婦女，步行活動程度多寡可能是影響輕度到嚴重程度的尿失禁因子之一，然而尿失禁症狀會受到多重因素共同干擾，所以在未來研究中應進一步確認步行習慣對尿失禁症狀的影響，探討更多停經後婦女尿失禁的潛在風險因素，並制定有效的預防和治療策略，以改善停經後婦女的尿失禁管理。

Background
As women age, their uterine function and estrogen levels decline, transitioning from the reproductive phase to menopause. Some women experience symptoms during menopause such as hot flashes, insomnia, mood swings, weight gain, and genitourinary symptoms. Compared to premenopausal women, postmenopausal women may experience physiological changes such as increased body fat and decreased muscle mass due to reduced metabolism, leading to a sedentary lifestyle. Additionally, postmenopausal women may experience urinary incontinence (UI), which can further decrease their physical activity levels. UI is more prevalent in women than men at any age, with various factors influencing UI in women, including age, body composition, parity, and menopause. The menopause-related UI symptoms are connected to physiological mechanisms influenced by hormonal changes and aging. However, due to the confounding factors of menopause, there has been less research focusing on women who have just entered the postmenopausal period. If risk factors related to UI can be observed in women who have just entered menopause, it could lead to the development of more effective preventive strategies for UI symptoms in the later stages of postmenopausal. Therefore, it is essential to understand whether the predictive factors for UI in postmenopausal women are the same as those for general UI. The primary aim of this study is to investigate the predictive factors of UI in postmenopausal women and analyze the correlation between years since menopause and UI as well as other predictive factors.
Methods
This cross-sectional study was conducted from December 2022 to April 2024, recruiting postmenopausal women with and without UI. Eligible participants underwent a one-time assessment, which included filling out questionnaires (International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, Questionnaire for Urinary Incontinence Diagnosis, years since menopause, and International Physical Activity Questionnaire-Short Form), body composition measurements, handgrip strength, and functional activity capacity assessments. All data were statistically analyzed using SPSS version 20, using logistic regression analysis to identify predictive factors of UI and point-biserial correlation to evaluate the relationship between early and late postmenopausal stages and various variables. A p-value of less than 0.05 in all analyses indicated statistical significance.
Results
The study recruited 97 postmenopausal women with and without UI. The average age of the participants was 58.1±4.4 years, and the average body mass index (BMI) was 23.5±3.6 kg/m². Among the subjects, 46.4% were in the early postmenopausal stage, and 53.6% were in the late postmenopausal stage. Additionally, 61.9% of the subjects had symptoms of UI, with 45% experiencing mild to severe UI. The results showed that postmenopausal women with mild to severe UI had higher levels of physical activity than those without UI. Additionally, walking levels could be a risk factor for mild to severe UI. The year since menopause was negatively correlated with handgrip strength and skeletal muscle mass in body composition, while no significant correlation with UI symptoms.
Conclusion
For postmenopausal women aged 45 to 65, the level of walking activity may be one of the factors influencing mild to severe UI. However, UI symptoms are influenced by multiple factors. Therefore, future research should further investigate the impact of walking habits on UI symptoms, explore more potential risk factors for UI in postmenopausal women, and develop effective prevention and treatment strategies to improve UI management for postmenopausal women.

摘要	III
ABSTRACT	V
致謝	VIII
ABBREVIATION	IX
TABLE OF CONTENTS	XI
CHAPTER 1 INTRODUCTION	1
1.1	Background and purpose	1
CHAPTER 2 LITERATURE REVIEW	3
2.1	Definition of menopause	3
2.2	Classification of postmenopausal stages	3
2.2.1	Early postmenopausal stage	4
2.2.2	Late postmenopausal stage	4
2.3	Changes in postmenopausal phase	4
2.3.1	Body composition	5
2.3.2	Muscle strength	5
2.3.3	Physical activity levels	6
2.4	Urinary incontinence	7
2.4.1	Prevalence of urinary incontinence	7
2.4.2	Mechanism of urinary incontinence	8
2.4.3	Predictors of urinary incontinence in women	9
2.5	Post-menopause and urinary incontinence	10
2.5.1	Physical activity and urinary incontinence	11
CHAPTER 3 MATERIALS AND METHODS	12
3.1	Research design	12
3.2	Participants	12
3.3.1	Year since menopausal	14
3.3.2	Urinary incontinence assessment	14
3.3.3	Physical activity levels	15
3.3.4	Body composition	16
3.3.5	Hand grip strength	17
3.4	Sample size	18
3.5	Statistical analysis	19
CHAPTER 4 RESULTS	21
4.1	Demographic characteristics	21
4.2	Comparison of participants with and without urinary incontinence	21
4.3	Factors associated with the presence of mild to severe urinary incontinence	22
4.4	Correlation with year since menopause	22
CHAPTER 5 DISCUSSION	23
5.1	Physical activity levels	23
5.2	Body composition	24
5.3	Hand grip strength	25
5.4	Predictor of mild to severe urinary incontinence	26
5.5	Years since menopause	27
5.6	Strengths and limitations	27
CHAPTER 6 CONCLUSIONS	29
REFERENCES	31
TABLES	42
Table 1. Demographic data of study participants	42
Table 2. Comparison between associated factors in study participants with and without urinary incontinence	44
Table 3. Comparison between associated factors in study participants with mild to severe urinary incontinence and without urinary incontinence	47
Table 4. Comparison between associated factors in study participants with mild to severe urinary incontinence and without urinary incontinence after matching for age and BMI	49
Table 5. Comparison of age, body composition, hand grip strength, exercise capacity, and physical activity level among different urinary incontinence severity groups.	51
Table 6. Factors associated with mild to severe urinary incontinence (n=64a)	53
Table 7. Comparison of age, occurrence of urinary incontinence, urinary incontinence severity, body composition, hand grip strength, exercise capacity, and physical activity level between early and late postmenopausal stage of study participants	54
Table 8. Correlation between year since menopause with age, urinary incontinence severity, body composition, hand grip strength, exercise capacity, and physical activity	56
FIGURES	57
Figure 1. Bioelectrical Impedance Analysis (BIA) (OMROM HBT-702T)	57
Figure 2. The Camry digital hand dynamometer (Model EH101)	57
Figure 3. Calf circumference measurement	58
APPENDICES	59
Appendices 1. Human study approval	59
Appendices 2. Approval of ethics midterm report	60
Appendices 3. Questionnaires for baseline characteristics	61
Appendices 4. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form	65
Appendices 5. The Questionnaire for Urinary Incontinence Diagnosis	67
Appendices 6. International Physical Activity Questionnaire short form	68
Appendices 7. Physical Activity Readiness Questionnaire	70
                                    

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