Effect of Vitamin D Supplementation on Severity of Stress Urinary Incontinence in Premenopausal Women With Vitamin D Insufficiency

The aging process is often associated with a gradual decline in muscle strength, including the weakening of pelvic floor muscles which are largely responsible for pelvic organ support and urinary retention. Weakness of these muscles is linked with urinary incontinence, the most frequently reported symptom of pelvic floor disorders. The most common type of urinary incontinence is stress urinary incontinence (SUI), which affects about 50% of women with increase in incidence with advancing age. The prevalence of stress urinary incontinence is approximately 23.58% in Pakistani middle aged women aged 40-50.

SUI occurs during times of elevated intraabdominal pressure (e.g., sneezing, coughing, and exercise). The levator muscles are responsible for supporting pelvic organs and maintaining the closure of the urethra. Strengthening the pelvic floor muscles through exercise and training is recommended as an effective treatment for SUI. The smooth and skeletal muscles throughout the body have vitamin D receptors. The pelvic floor muscles also express Vitamin D receptors, therefore Vitamin D insufficiency has shown asignificant association with pelvic floor dysfunction. Pelvic floor dysfunction includes symptoms of fecal incontinence, urinary incontinence and pelvic organ prolapse.

This study was conducted to see the association of vitamin D supplementation with improvement in stress incontinence symptoms.

Participants will be explained that their blood will be drawn twice in the study and they need to fill questionnaires with the help of principal investigator. They will be requested to sign a consent form and they will be assured that they can withdraw from the study at any time. SUI will be assessed by completing the standard ICIQ-SF (Incontinence Questionnaire - Urinary Incontinence Short) questionnaire at baseline and Serum concentrations of 25-hydroxy vitamin D will be tested by the ELISA immunoassay as per the protocol of the manufacturer.

The pateints will be divided into two groups by randomization. Group A ( intervention group) and group B (placebo group).All the patients in both groups will be advised pelvic floor exercises which is the standard first line management for stress urinary incontinence. Each study participant will be requested for 3ml of venous blood to determine their vitamin D3 levels. The treatment group will be asked to take vitamin D3 (cholecalciferol)(50,000IU) tablets, once a week, for 8 weeks and control group will be taking placebo ( isphagol husk capsules) weekly for 8 weeks. The research participants will be unaware of the type of preparation being given to them. The principal investigator will be aware of the preparation being given (single blind study).