Medical correlates of urinary incontinence in the elderly

Diabetes slows the recovery from urinary incontinence due to simulated childbirth in female rats

This study was done to test the hypothesis that simulated vaginal birth by vaginal distension (VD) causes more severe urinary incontinence and slower recovery in diabetic rats. After measuring baseline leak point pressure (LPP) in 16 diabetes mellitus (DM) and 16 age- and weight-matched control (Ct) female Sprague-Dawley rats, these animals underwent either VD or sham VD (sham). Four and ten days after the procedures, LPP and conscious cystometry were assessed. Tissues were then harvested and examined by light microscopy. LPP at baseline was equal among all four groups. Four days after VD, LPP in both VD groups dropped to significantly lower levels than in sham rats (P < 0.001). Moreover, LPP in the DM+VD group was significantly lower than in the Ct+VD group. At 10 days, LPP in the Ct+VD group had recovered to its baseline value, whereas the LPP in the DM+VD group remained significantly reduced. DM rats had larger bladder capacity and longer voiding intervals than Ct rats. Histological findings included more severe damage to the external sphincter striated musculature of the urethra in DM+VD group compared with Ct+VD. In conclusion, these findings suggest that DM causes increased severity and delayed functional recovery from the effects of simulated childbirth.

Urinary incontinence and diabetes: a review

Both urinary incontinence and diabetes are chronic and costly conditions affecting millions of Americans. Unfortunately, these chronic conditions often coexist in the same person, compounding the economic and social costs and diminishing quality of life. The connection between urinary incontinence and diabetes has been mentioned in subsets of articles under prevalence or risk factors. The relationship is strong enough that researchers and clinicians should be aware of this link when formulating protocols or providing clinical care. This article summarizes knowledge of diabetes mellitus and urinary incontinence and explores the nature of their relationship.

Effects of fidarestat, an aldose reductase inhibitor, on nerve conduction velocity and bladder function in streptozotocin-treated female rats

The effects of fidarestat, an aldose reductase inhibitor (ARI), were assessed on nerve conduction velocity (NCV) in somatic nerves and on multiple measures of bladder function in rats made hyperglycemic with streptozotocin (STZ) and in age-matched controls. Nerve conduction velocity was recorded at baseline and at 10, 20, 30, and 50 days after confirmation of the STZ-induced hyperglycemia in all rats (N=47); bladder function was assessed in a representative subset of rats (N=20) at Day 50. Caudal NCV was markedly slowed by STZ, and this effect was significantly reversed by fidarestat. The initial deficit and treatment-related improvement were especially evident for responses driven by high-frequency repetitive stimulation. Of the 11 parameters of bladder activity assessed, four measures-bladder capacity, micturition volume, micturition frequency, and bladder weight-were significantly different in the control and STZ-treated groups. These deficits were not affected by fidarestat. At Day 50, the induced deficits in bladder function were highly correlated with caudal NCV (r values ranging from 0.70 to 0.96; P values ranging from .02 to <.0001). These results suggested that fidarestat improved the slowing of somatic nerve NCV in hyperglycemic rats, but it was not effective in reversing associated bladder dysfunction, in spite of the highly significant correlation between these two diabetes-induced deficits. Possible explanations for this dissociation are discussed.

Predictors of urinary incontinence in a prospective cohort of postmenopausal women

OBJECTIVE

To prospectively assess risk factors associated with occurrence of urinary incontinence among postmenopausal women.

METHODS

We followed up 1,017 postmenopausal health maintenance organization enrollees, aged 55 to 75 years, for 2 years. The primary outcome measures were any urinary incontinence and severe incontinence reported at 12- or 24-month follow-up visits.

RESULTS

Baseline prevalence of any amount or frequency of urinary incontinence in the past year was 66%. Among the 345 women without incontinence at baseline, 65 (19%) at 1 year and 66 (19%) at 2 years reported any incontinence. Ninety-two of 672 (14%) and 96 of 672 (14%) women with incontinence at baseline reported no incontinence at years 1 and 2. In an adjusted multiple logistic regression model, independent predictors of any incontinence included white race (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6), vaginal estrogen cream (OR 2.0, CI 1.1-3.7), vaginal dryness (OR 1.6, CI 1.2-2.2), vaginal discharge (OR 1.5, CI 1.0-2.2), 6 or more lifetime urinary tract infections (OR 1.8, CI 1.2-2.6), and diabetic peripheral neuropathy (OR 1.7, CI 1.0-3.1). In adjusted models, predictors of severe incontinence were history of hysterectomy (OR 1.8, CI 1.1-2.7) and any vaginal symptom (OR 1.7, CI 1.0-2.8).

CONCLUSION

A substantial proportion of incontinence-free postmenopausal women developed urinary incontinence during 2 years of follow-up. Because vaginal symptoms are associated with urinary incontinence, their relationship with other risk factors, including vaginal Escherichia coli colonization and vaginal estrogen cream use, warrant additional study. Similarly, diabetic peripheral neuropathy and hysterectomy associations suggest areas for future investigation.

LEVEL OF EVIDENCE

II-2.

Diabetic uropathy

Diabetes mellitus (DM) is becoming more common in the United States affecting an estimated 18.2 million Americans. Not only is the number of American's with DM staggering, but so are the medical and economic costs of DM. DM accounts for nearly 15% of all health care costs in the United States. The chronic hyperglycemia of DM is associated with long-term damage, dysfunction and failure of multiple organ systems, including the genitourinary system. Genitourinary complications are common among diabetics. Of individuals diagnosed with DM, 80% have lower urinary tract complications, while 50% develop nephropathy and 35-75% develop sexual dysfunction. In order to decrease the number and severity of diabetic urologic complications, early recognition and a more comprehensive understanding of how diabetes impacts the genitourinary tract is imperative.

Prevalence of anal incontinence according to age and gender: a systematic review and meta-regression analysis

CONTEXT

Anal incontinence is increasingly being recognised as a significant cause of physical and psychological morbidity with implications for healthcare provision within the community. There is controversy about which population groups are most disadvantaged by this chronic condition.

OBJECTIVES

The aim of this study was to evaluate the prevalence of this condition in the community according to age and gender, a systematic review was performed.

DATA SOURCES

Data were from Embase, Medline, bibliographies of known articles and contact with experts.

STUDY SELECTION

Studies were selected if data on anal incontinence could be extracted for participants over 15 years of age and living in the community.

DATA EXTRACTION

Data were extracted using a piloted form on participants' characteristics, study quality and incontinence rates.

DATA SYNTHESIS

Meta-analysis was used to combine data from multiple studies, and meta-regression evaluated the variation in rates according to age and gender in an analysis adjusted for study quality.

RESULTS

There were 29 studies (69,152 participants), of which 5 met over half of the high quality criteria. The rate of solid and liquid faecal incontinence among people aged 15-60 years was 0.8% [95% confidence interval (CI) 0.3-1.9] in men and 1.6% (95% CI 0.8-3.1) in women. In those aged over 60, this increased to 5.1% (95% CI 3.4-7.6) in men and 6.2% (95% CI 4.9-8.0) in women. Meta-regression showed that age had a significant influence on rates of solid and liquid faecal incontinence (p = 0.007), but not gender (p = 0.368) or study quality (p = 0.085).

CONCLUSIONS

The rate of solid and liquid faecal incontinence in older people is significantly higher than their younger counterparts. Gender differences in rates did not reach statistical significance.

Risk factors for urinary incontinence among middle-aged women

OBJECTIVE

The purpose of this study was to identify risk factors for urinary incontinence in middle-aged women.

STUDY DESIGN

We conducted a cross-sectional analysis of 83,355 Nurses' Health Study II participants. Since 1989, women have provided health information on mailed questionnaires; in 2001, at the ages 37 to 54 years, information on urinary incontinence was requested. We examined adjusted odds ratios of incontinence using logistic regression.

RESULTS

Forty-three percent of the women reported incontinence. After adjustment, black (odds ratio, 0.49; 95% CI, 0.40-0.60) and Asian-American women (odds ratio, 0.57; 95% CI, 0.46-0.72) were at reduced odds of severe incontinence compared with white women. Increased age, body mass index, parity, current smoking, type 2 diabetes mellitus, and hysterectomy all were associated positively with incontinence. Women who were aged 50 to 54 years had 1.81 times the odds of severe incontinence compared with women who were <40 years old (95% CI, 1.66-1.97); women with a body mass index of > or =30 kg/m2 had 3.10 times the odds of severe incontinence compared with a body mass index of 22 to 24 kg/m2 (95% CI, 2.91-3.30).

CONCLUSION

Urinary incontinence is highly prevalent among these middle-aged women. Potential risk factors include age, race/ethnicity, body mass index, parity, smoking, diabetes mellitus, and hysterectomy.

[Prevalence of urinary incontinence in hospitalized patients]

The aim of this study is to verify the prevalence of urinary incontinence in hospitalized patients and identify the statistical associations between the figures gathered and some of the patients' demographic and clinical variables. The data were obtained with 77 inpatients of three different units from the University of São Paulo's Hospital Universitário. The results showed a total prevalence of 35% and partial rates of 48%, 37% and 22% in the Surgical, Obstetric and Clinical Units respectively. Significant statistical correlation were observed between the prevalence and dysuria (r = 0.19 and p = 0.046), urinary infections (r = 0.24 and p = 0.019), length of inpatient stay (r = -0.32 and p = 0.002) and gender (males: r = -0.27 and p = 0.008).

Temporal differences in bladder dysfunction caused by diabetes, diuresis, and treated diabetes in mice

Diabetic bladder dysfunction is a common complication of diabetes mellitus (DM) with poorly understood natural history. This study examined the temporal changes in bladder function 3, 9, 12, and 20 wk after induction of DM by streptozotocin (STZ) in male C57BL/6 mice compared with that in age-matched diabetic mice treated with insulin, 5% sucrose-induced diuretic mice, and sham-treated control mice. Conscious cystometrograms of mice were examined in addition to the measurements of micturition cycle. Diabetes resulted in decreased body weight. Bladder weight, urine output, bladder capacity, and compliance increased in the DM and diuretic groups. Peak voiding pressure (PVP) increased initially in both DM and diuretic mice. However, in DM mice, PVP dropped dramatically at and after 12 wk. Similar changes in the capacity, compliance, and emptying ability of the bladder were seen during the first 9 wk of the diabetes or diuresis, whereas significant decline in the emptying ability of the bladder was only seen in diabetes after 12 wk of disease in mice. Long-term insulin replacement effectively reversed most changes in bladder function. These results suggest that the transition from a compensated to a decompensated bladder dysfunction occurs 9-12 wk after induction of DM in mice by STZ.

Type 2 diabetes mellitus and risk of developing urinary incontinence

OBJECTIVES

To evaluate the association between type 2 diabetes mellitus (DM) and development of urinary incontinence in women.

DESIGN

Prospective, observational study.

SETTING

The Nurses' Health Study cohort.

PARTICIPANTS

Eighty-one thousand eight hundred forty-five women who reported information on urinary function in 1996.

MEASUREMENTS

Self-reported, physician-diagnosed DM was ascertained using questionnaire from 1976 to 1996 and confirmed using standard criteria. Self-reported urinary incontinence, defined as leakage at least weekly, was ascertained in 1996 and 2000. Logistic regression models were used to calculate multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relationship between DM (as of 1996) and prevalent and incident incontinence.

RESULTS

The risk of prevalent incontinence (multivariate RR=1.28, 95% CI=1.18-1.39) and incident incontinence (multivariate RR=1.21, 95% CI=1.02-1.43) was significantly greater in women with DM than women without. Using a validated severity index, risk of developing severe incontinence was even more substantial in women with DM than in those without (multivariate RR=1.40, 95% CI=1.15-1.71 for leakage enough to wet the underwear; RR=1.97, 95% CI=1.24-3.12 for leakage enough to wet the outer clothing). In addition, risk of incontinence increased with duration of DM (P-trend=.03 for prevalent incontinence; P=.001 for incident incontinence).

CONCLUSION

DM independently increases risk of urinary incontinence in women. Because risk of incontinence appeared associated with longer duration of DM, even delaying the onset of DM could have important public health implications.

Diabetes and urinary incontinence in 50- to 90-year-old women: a cross-sectional population-based study

OBJECTIVE

The purpose of this study was to examine the association between urinary incontinence and diabetes in a large community-based population of women.

STUDY DESIGN

The Health and Retirement Study is a large multistage area probability sample of households in the United States. Data were collected from 10,678 women aged 50 to 90 years. Dependent variables were no, mild, and severe incontinence. Independent variables consisted of demographic and health data. Diabetes was dichotomized into insulin-requiring (IRDM) and non-insulin-requiring disease (NIRDM). Survey-based ordered logistic regression was used to simultaneously analyze associations between incontinence groups.

RESULTS

Urinary incontinence was reported by 22% (2319/10,678) of women. IRDM was associated with urinary incontinence (odds ratio [OR] 1.63; 95% CI 1.28-2.09), but NIRDM was not (OR 1.20; 95% CI 1.00-1.45).

CONCLUSION

IRDM is independently associated with urinary incontinence in women ages 50 to 90 years, independent of patient body mass index, comorbidities, or age.

Characteristics of middle-aged and elderly women with urinary incontinence

OBJECTIVE

To describe the prevalence of urinary incontinence and to find characteristics useful in general practice for identifying middle-aged and elderly women with the problem.

DESIGN

Cross-sectional interview study.

SETTING

Population-based samples of Danes.

SUBJECTS

A total of 5795 women older than 45 years (46+ years).

MAIN OUTCOME MEASURES

Prevalence of incontinence and clinical characteristics assessed by standardized interview questions.

RESULTS

The overall prevalence of urinary incontinence was 20% among women less than 60 years of age and 44% among those older than 80 years. Increasing age was highly associated with both forms of incontinence (stress and urge). High body mass index (BMI), chronic lung disease, and stroke were also associated with both forms, while number of children was associated with stress incontinence only. Predictive models show that 56% of women characterized by high age (older than 80 years) and overweight (BMI higher than 30) will suffer from urinary incontinence. The low-risk group defined by these two parameters (aged 46-60 years and not overweight) still had a 19% prevalence in the last month.

CONCLUSION

The prevalence of urinary incontinence increased with age. Even in the low-risk groups the problem was very common in old age. Questions about incontinence should, therefore, be asked in relevant consultations with all elderly female patients.

Health problems associated with lower urinary tract symptoms in older women. A population-based survey

OBJECTIVE

To identify health problems associated with lower urinary tract symptoms (LUTS) in an older female population.

DESIGN

Population-based cross-sectional survey.

SETTING

Third wave for the Tampere Longitudinal Study on Ageing (TamELSA) in 1999-2000.

SUBJECTS

A total of 203 women aged 70 years and over.

MAIN OUTCOME MEASURES

LUTS categorized as urge symptoms only, voiding symptoms only, and urge and voiding symptoms combined. The health indicators were polypharmacy (> 3 medications), use of sleeping medication, constipation, treated urinary tract infections (UTIs), and neurological, cardiovascular, and musculoskeletal diseases.

RESULTS

Of the respondents 16% reported urge symptoms, 22% voiding symptoms, and 26% combined symptoms. In the multinomial logistic regression models, constipation and musculoskeletal diseases were significantly associated with voiding symptoms (OR 4.33; 95% CI 1.62-11.57 and OR 5.25; 95% CI 1.94-14.18, respectively) and with combined symptoms (OR 4.33; 95% CI 1.67-11.21 and OR 2.84; 95% CI 1.17-6.89, respectively). UTIs (OR 2.78; 95% CI 1.09-7.08) were associated with combined symptoms.

CONCLUSIONS

Voiding symptoms comprise a significant part of lower urinary tract symptomalogy in older women. Although constipation, musculoskeletal diseases, and UTIs are the main health problems associated with LUTS, other concomitant diseases and medications also need to be assessed in older female patients with LUTS.

Fatores associados com a incontinência urinária na mulher

Trata-se de um estudo para avaliar a prevalência da incontinência urinária (IU) e fatores associados entre mulheres profissionais de enfermagem de um hospital-escola. De 378 formulários distribuídos, 291 (77%) foram respondidos e 80 funcionárias (27,5%) relataram queixa de IU. A análise multivariada indicou maior probabilidade das mulheres desenvolverem IU após os 41 anos e quando referiam alteração de peso, constipação intestinal ou hipertensão arterial. Concluiu-se que medidas educativas de prevenção e tratamento fazem-se necessárias para melhorar e prevenir a IU entre mulheres trabalhadoras da enfermagem.

Evaluating Potentially Modifiable Risk Factors for Prevalent and Incident Nocturia in Older Adults

OBJECTIVES

To examine associations between nocturia and potentially modifiable risk factors in older adults.

DESIGN

Secondary analysis of cross-sectional and longitudinal data.

SETTING

Respondents were selected using population-based sampling, drawing from a single Michigan county in 1983. They were followed through 1990.

PARTICIPANTS

Community-living adults aged 60 and older.

MEASUREMENTS

Episodes of nocturia, development of nocturia at 2 years after baseline survey, age, sex, hypertension, diabetes mellitus, drinking fluids before bedtime, amount of fluid intake before bedtime, diuretic use, and 24-hour coffee intake. All measures were self-reported.

RESULTS

Bivariate cross-sectional analysis revealed significant associations with two or more episodes of nocturia for hypertension (odds ratio (OR)=1.7, 95% confidence interval (CI)=1.37-2.1), diabetes mellitus (OR=1.51, 95% CI=1.1-2.0), diuretic use (OR=1.7, 95% CI=1.3-2.1), age (OR=1.05 per additional year over 60, 95% 1.03-1.06), and number of cups of coffee (OR=0.93 for each cup of coffee, 95% CI=0.89-0.97). In multivariate analysis, hypertension (OR=1.52, 95% CI=1.2-1.9), diuretic use (OR=1.3, 95% 95% CI=1.0-1.7), and age (OR=1.04 per additional year over 60, 95% 1.03-1.06) were independently associated with two or more nocturia episodes per night. No baseline factors predicted future development of nocturia (save for age, in one model).

CONCLUSION

Hypertension, older age, and diuretic use were independently associated with two or more episodes of nocturia in cross-sectional analysis. No baseline factor was related to the development of nocturia over a 2-year interval in this sample. Nighttime fluid intake and coffee intake, practices providers commonly target in patients with nocturia, were not associated with nocturia in this population-based sample of community-living older adults.

[Five-year follow-up of urinary incontinence in older people in a Spanish rural population]

OBJECTIVE

To determine prevalence, incidence and remission rates and change patterns of urinary incontinence (UI) over a 5-year time span.

DESIGN

Longitudinal study.

LOCATION

Basic Health Zone of Cabra (Cordoba).

PATIENTS

A random age-stratified sample of 827 subjects selected from a total of 5139 persons > or = 65 years of age and followed up between 1996 and 2001.

INTERVENTIONS

Home interview.

MEASUREMENTS

Questions about detection and level of severity of UI, sociodemographic data, and level of functioning. Two logistic regression models were created to identify risk factors for the probability to be alive and to develop UI, respectively.

RESULTS

UI prevalence reached 36% at baseline and 46% five years later. Mortality rates were similar in continent and incontinent subjects. 54.5% of continent subjects in 1996 remained so in 2001. Five-year incidence and remission rates were 29% and 15%, respectively. In both sexes, slight and moderate incontinence mainly progressed to moderate and severe degrees, whereas severe UI remained unchanged in 40.1%. The main risk factors for increased survival and for UI incidence were self-rated health and level of functioning.

CONCLUSIONS

Prevalence of UI is high, incidence is moderate and remission is low. Urinary incontinence is a dynamic problem and does not affect mortality. Impaired mobility has a strong influence on UI incidence.

Enuresis in childhood, and urinary and fecal incontinence in adult life: do they share a common cause?

OBJECTIVE

To investigate whether there is any association between urinary or fecal incontinence and childhood bedwetting, and given such a relationship, to detect which type of urinary incontinence (UI) is associated with childhood bedwetting.

PATIENTS AND METHODS

In all, 1021 patients who were admitted to the outpatient gynaecology clinics of the authors' institution for an annual gynaecological examination were included in this descriptive clinical study. A simple multi-choice screening questionnaire was used to collect data for analysis.

RESULTS

There was a history of bedwetting in childhood in 181 (21.1%) of women without and in 48 (29.6%) of those with UI; the difference was significant (chi-square, P < 0.05). Women with stress UI had significantly higher rates of enuresis in childhood (35.4%) than those without UI (21.1%; P = 0.003). Of women who had a history of bedwetting in childhood, 12.2% had stress UI, but only 6.4% of those with no such history had stress UI. Fecal incontinence was significantly more common in women with a history of bedwetting in childhood (P < 0.05).

CONCLUSION

A history of childhood bedwetting seems to increase the risk of having UI, stress UI and fecal incontinence. Being aware of this association may provide an opportunity to avoid exposing these women to additional risk factors for these condition.

Urinary incontinence as a predictor of death and institutionalization in a general aged population

The prognostic significance of urinary incontinence (UI) was evaluated using the Helsinki (Finland) Aging Study Database, in which a random sample of persons of three age cohorts (75, 80 and 85 years, n=649) was followed for 5 years. The prevalence rates of UI in the three age groups were 10.5%, 20.4% and 28.6%, respectively. UI was also frequent in healthy aged subjects (15.6%), but most common in hospitalized patients (35.3%), in those with severe depression (51.8%), previous stroke (37.6%) or dementia (48.8%). UI had age- and gender-adjusted risk ratios (95% C.I.) for mortality of 1.75 (1.33-2.30) and for long-term institutional care of 2.37 (1.30-3.84). However, after controlling for the presence of dementia, the risk ratios were no longer significant. Thus, UI predicts both death and long-term institutionalization in the general aged population. However, this observation is mainly explained by the close association of UI with dementia.

Functional impairment as a risk factor for urinary incontinence among older Americans

AIMS

Using a large nationally representative sample of older Americans we investigate four domains of functional impairment as possible risk factors for the subsequent development of urinary incontinence (UI) symptoms.

METHODS

Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics among the Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UI symptoms.

RESULTS

A greater number of serious chronic conditions and functional impairment in the lower body mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors that contributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, being represented by a proxy respondent, and functional impairment in the strength domain.

CONCLUSIONS

Understanding the possible relationship between functional impairment and UI is an important step toward developing appropriate interventions for the prevention, treatment, or management of urine loss.

Stress Urinary Incontinence in Active Elderly Women

Urinary incontinence in the elderly is a significant health problem fraught with isolation, depression, and an increased risk of institutionalization and medical complications. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most common type of urinary incontinence. SUI can seriously degrade the quality of life for many active seniors, and has become an economic challenge for society. With the rapid increase in the active elderly worldwide, SUI is becoming a significant global problem. However, since only a fraction of women with SUI have consulted a physician, the clinical extent and public health impact of SUI are probably underestimated. The mounting social, medical, and economic problem of SUI in active elderly women as a rapidly growing segment of the population worldwide is reviewed. We evaluate the age-related changes of the lower urinary tract, examine risk factors, and suggest different treatment options shown to be effective in reducing SUI in this population.

Urinary incontinence in the frail elder

Urinary incontinence (UI) is a complex disorder affecting a large segment of the frail older population. Physical factors such as medication use and disease comorbidity can affect continence control. Cognitive disorders and functional decline pose additional challenges in management of urinary symptoms. Those individuals who have adequate socioeconomic support and caregiver assistance may have a greater advantage in maintaining continence.Physical, cognitive, functional, and psychosocial factors each contribute to the risk profile for both the development of frailty and the likelihood of experiencing UI.

Genetic and environmental influences on urinary incontinence: a Danish population-based twin study of middle-aged and elderly women

BACKGROUND

Familial clustering has been reported for urinary incontinence (stress and urge), but different etiologies for the two types of incontinence have been suggested.

OBJECTIVE

The aim of this study was to estimate the relative influence of genetic and environmental factors on stress, urge, and mixed incontinence among elderly and middle-aged women.

METHODS

This is a population-based classical twin study of 1168 female twin pairs [548 monozygotic (MZ) and 620 dizygotic (DZ)] from a middle-aged (46-68 years) and an old (70-94 years) cohort identified in the Danish Twin Registry. Urinary incontinence was assessed with the help of two validated questions identifying stress and urge incontinence in interviews.

RESULTS

For urge incontinence, the tetrachoric correlation was significantly higher for MZ twins, compared to that for DZ twin pairs in both middle-aged [0.51 (95% CI: 0.26-0.71) versus -0.22 (95% CI: -0.59-0.18)] and elderly [0.50 (95% CI: 0.27-0.68) versus 0.28 (95% CI: 0.02-0.42)], indicating genetic effects. The heritability of urge incontinence was 42% (95% CI: 16-63%) among middle-aged women and 49% (95% CI: 29-65%) among the elderly. Moreover, mixed incontinence had a substantial genetic component. The role of genetic factors was less clear in stress incontinence.

CONCLUSIONS

Genetic factors play a substantial role in the development of urge and mixed incontinence, whereas the role of genetic factors in stress incontinence is less prominent.

Urinary incontinence in elderly women: findings from the Health, Aging, and Body Composition Study

OBJECTIVE

To estimate the prevalence of and risk factors for stress and urge incontinence in a biracial sample of well-functioning older women.

METHODS

We performed a cross-sectional analysis of 1,584 white and black women, aged 70-79 years, enrolled in a longitudinal cohort study. Participants were asked about incontinence, medical problems, and demographic and reproductive characteristics and underwent physical measurements. Using multivariable logistic regression, we compared women reporting at least weekly incontinence with those without incontinence.

RESULTS

Overall, 21% reported incontinence at least weekly. Of these, 42% reported predominantly urge incontinence, and 40% reported stress. Nearly twice as many white women as black women reported weekly incontinence (27% versus 14%, P <.001). Factors associated with urge incontinence included white race (odds ratio [OR] 3.1, 95% confidence interval [CI] 2.0-4.8), diabetes treated with insulin (OR 3.5, 95% CI 1.6-7.9), depressive symptoms (OR 2.7, 95% CI 1.4-5.3), current oral estrogen use (OR 1.7, 95% CI 1.1-2.6), arthritis (OR 1.7, 95% CI 1.1-2.6), and decreased physical performance (OR 1.6 per point on 0-4 scale, 95% CI 1.1-2.3). Factors associated with stress incontinence were chronic obstructive pulmonary disease (OR 5.6, 95% CI 1.3-23.2), white race (OR 4.1, 95% CI 2.5-6.7), current oral estrogen use (OR 2.0, 95% CI 1.3-3.1), arthritis (OR 1.6, 95% CI 1.0-2.4), and high body mass index (OR 1.3 per 5 kg/m2, 95% CI 1.1-1.6).

CONCLUSION

Urinary incontinence is highly prevalent, even in well-functioning older women, whites in particular. Many risk factors differ for stress and urge incontinence, suggesting differing etiologies and prevention strategies.

Effect of chronic ischemia on bladder structure and function

Our studies with the animal model show that arterial stenosis and insufficiency--a common problem in the elderly--lead to marked changes in bladder structure and function. Moderate chronic ischemia leads to functional and structural changes quite different from those caused by severe chronic ischemia. The extent of histopathophysiologic changes in the chronically ischemic bladder depends on the degree of arterial stenotic disease and the severity of bladder ischemia. Histopathophysiologic changes in our animal model appear to be similar in many ways to those reported in clinical detrusor instability. This would suggest that vascular risk factors and ensuing arterial obstructive disease and bladder ischemia might play an important role in the development of bladder dysfunction. A better understanding of the involvement of vascular risk factors in voiding dysfunction may lead to more accurate assessment of LUTS, precise patient selection for prostatectomy, and the development of prophylactic strategies and newer treatment.

Urinary Incontinence and Its Association with Death, Nursing Home Admission, and Functional Decline

OBJECTIVES

To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs).

DESIGN

A population-based prospective cohort study from 1993 to 1995.

SETTING

Community-dwelling within the United States.

PARTICIPANTS

Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline.

MEASUREMENTS

The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status.

RESULTS

The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association.

CONCLUSION

Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.

Postmenopausal Hormone Therapy and Risk of Developing Urinary Incontinence

OBJECTIVE

To better understand associations between post-menopausal hormone therapy and the development of urinary incontinence.

METHODS

Postmenopausal hormone use was assessed via biennial mailed questionnaires beginning in 1976 among Nurses' Health Study participants. In 1996, 39,436 post-menopausal women aged 50-75 years reported no leaking of urine and were followed-up for 4 years to identify incident cases of incontinence. We used logistic regression to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relation of postmenopausal hormone use from 1976 to 1996 to the development of incontinence from 1996 to 2000.

RESULTS

We identified 5,060 incident cases of occasional (leaking urine 1-3 times/month) and 2,495 cases of frequent incontinence (leaking at least weekly) for average yearly incidence rates of 3.2% and 1.6%, respectively. The risk of incontinence was elevated among women taking postmenopausal hormones compared with women who had never taken hormones (oral estrogen: RR 1.54, 95% CI 1.44, 1.65; transdermal estrogen: RR 1.68, 95% CI 1.41, 2.00; oral estrogen with progestin: RR 1.34, 95% CI 1.24, 1.44; transdermal estrogen with progestin: RR 1.46, 95% CI 1.16, 1.84). There was little risk after the cessation of hormones (RR 1.14, 95% CI 1.06, 1.23) and a decreasing risk of incontinence with increasing time since last hormone use; 10 years after stopping hormones, the risk was identical in women who had and had never taken hormone therapy (RR 1.02, 95% CI 0.91, 1.14).

CONCLUSION

Postmenopausal hormone therapy appears to increase risk of developing urinary incontinence. This risk does not vary by route of administration, type of hormones, or dose taken, but is diminished upon cessation of use.

LEVEL OF EVIDENCE

II-2

Cost of stress urinary incontinence: a claims data analysis

OBJECTIVES

The primary objectives of this research were to: (i) identify and present methodologies for estimating three types of 'cost-of-illness' measures using healthcare and disability claims data -- specifically 'cost of treatment', 'incremental cost of patient', and 'incremental cost of illness'; and (ii) perform a case-study analysis of these cost measures for women treated for stress urinary incontinence (SUI).

STUDY DESIGN AND METHODS

In this paper, we discuss aspects of cost-of-illness methodologies in the context of SUI. We first distinguish between 'cost of treatment' (i.e. the costs of treating a specific condition), 'incremental cost of patient' (i.e. the additional costs associated with patients with a particular condition, irrespective of any comorbid conditions they may also have), and 'incremental cost of illness' (i.e. the additional costs resulting from a particular illness, as distinct from the costs of other conditions that the patient might have, including conditions which might have caused the illness in question). The latter case is in many ways the most complex to model, requiring controls for related causal conditions. We then applied these three methodologies by analysing the costs associated with SUI. Using data from a large employer claims database (n > 100 000), we estimated a series of regression models that reflected cost of treatment, incremental cost of patient, and incremental cost of illness for SUI.

RESULTS

The three approaches yielded substantially different results. For many purposes the incremental cost-of-illness model provides the most appropriate results, as it controls for comorbid conditions, as well as patient demographics. On a per capita basis using the incremental cost-of-illness model, patients with SUI had direct costs that were 134% more than those for their controls and indirect costs that were 163% more than those for controls. Estimating costs for the average (i.e. mean) person results in dollar-termed estimates of the costs of SUI. In particular, we found that in 1998, the average direct medical cost of SUI was $US5642 and the indirect workplace cost of SUI was $US4208.

CONCLUSIONS

Since the various methods yield substantially different results, it is important that the end user of cost-of-illness analyses of claims data have a clear purpose in mind when reporting the cost of the condition of concern. The incremental cost-of-illness measure for claims data has substantial advantages in terms of enhancing our understanding of the specific cost impact of SUI.

Symptoms of urinary and faecal incontinence among men and women 75+ in relations to health complaints and quality of life

AIMS

The aim was to investigate the prevalence of self-reported symptom of urinary, faecal, and double incontinence (UI, FI, and DI) in men and women 75+ and to identify how other health complaints and Quality of Life (QoL) relate to incontinence symptoms.

METHODS

A randomised sample, stratified for age, of eligible men and women from the population were included in the study and 4,277 out of 8,500 completed a postal questionnaire (61.6% women). The questions focused on difficulties in controlling urine and faeces, other health complaints, socio-economic background, and social relations.

RESULTS

Among all respondents 39% reported symptom of UI (more so among women P < 0.001), symptom of FI in 16.9% (ns between sexes), DI, i.e., a combination of UI and FI, was reported among 14.5% (ns between sexes). Incontinence increased with age, and persons reporting incontinence also had significantly more of all other health complaints compared with persons without incontinence. Those reporting DI comprised an especially vulnerable group. Health complaints associated with UI were communicative and mobility problems, other urinary complaints, dizziness, cough, and fatigue. FI was associated with diarrhoea, stomach pain, fatigue, and other pain. Risk factors for DI were diarrhoea, communication, and mobility problems.

CONCLUSIONS

UI and FI were common among elderly men and women and increased with age. Furthermore, incontinence was associated with many other co-existing health complaints, and the most frail were those with DI.

Association of age, race, and obstetric history with urinary symptoms among women in the Nurses' Health Study

OBJECTIVE

The purpose of this study was to better understand associations among age, race, obstetric history, and urinary incontinence in women.

STUDY DESIGN

Race and obstetric history were assessed through the use of biennial mailed questionnaires from 1976 to 1996 among participants of the Nurses' Health Study. In 1996, 83,168 women aged 50 to 75 years reported their frequency of leaking urine and quantity leaked. We used logistic regression to calculate multivariate-adjusted odds ratios and 95% CIs for the relation of risk factors to leaking urine.

RESULTS

Overall, 34.1% of the women reported leaking urine at least once per month during the previous 12 months; this prevalence was lowest in the black women (21.2%). After potential confounders were controlled, there were strong trends of increasing prevalence of occasional and frequent leaking with increasing age (P trend <.0001). There was also increasing prevalence of leaking urine with increasing parity; for example, compared with nulliparous women, the odds ratio for frequent leaking was 1.72 (95% CI, 1.55-1.90) among those with >/=5 births. Odds ratios that were associated with parity were higher in women aged <60 years than in women aged >/=60 years. Age at first birth of >35 years was associated with a slight elevation in frequent leaking compared with women with age at first birth from 21 to 25 years but was stronger for women with age at first birth of <21 years (OR, 1.27; 95% CI, 1.13-1.42).

CONCLUSION

In these women, leaking urine is common; this condition is most prevalent in white women, in older women, in parous women, and in women with a younger age at first birth.

Long-term use of hormone therapy for urogenital complaints: is there a role?

In the past 20 years, menopause has become a household word, with much better understanding of its consequences. The growing numbers of menopausal women and clinical trials have coincided to draw increasing attention to the perimenopausal and menopausal years. Better studies of older therapies and the expanded number of new choices today, with more in development and evaluation, have complicated provider and patient choices, but greatly improved the potential for effective intervention.

Chronic ischemia increases prostatic smooth muscle contraction in the rabbit

PURPOSE

We studied the effect of chronic ischemia on prostatic smooth muscle contraction in the rabbit.

MATERIALS AND METHODS

New Zealand male rabbits weighing 3 to 3.5 kg were assigned to 2 groups. Group 1 (10 rabbits) underwent balloon endothelial injury of the iliac arteries and received a 0.5% cholesterol diet for 4 weeks and then a regular diet for 8 weeks. Control group 2 (10 rabbits) received a regular diet. After 12 weeks the animals were anesthetized. Iliac artery and prostate blood flow was recorded. Prostate tissues were prepared for isometric tension measurement, enzyme immunoassay to determine cyclic guanosine monophosphate (cGMP) release and histological examination.

RESULTS

In group 1 atherosclerosis as well as a significant decrease in iliac artery and prostate blood flow were observed. Ischemia significantly increased prostatic tissue contraction, decreased cGMP release and led to capsular and stromal thickening, and epithelial atrophy. The alpha1-adrenoceptor blocker doxazosin and the phosphodiesterase-5 inhibitor sildenafil citrate significantly decreased the contraction of control and ischemic tissues. Doxazosin was more effective in decreasing contractions when it was combined with sildenafil or the nitric oxide (NO) precursor L-arginine. In contrast, doxazosin was less effective when it was combined with the NO synthase inhibitor N omega-nitro-L-arginine or with the guanylate cyclase inhibitor methylene blue. Doxazosin significantly increased cGMP release in control tissues but not in ischemic tissues. Sildenafil significantly increased cGMP release in control and ischemic tissues.

CONCLUSIONS

Ischemia increased prostatic smooth muscle contraction and led to marked structural damage. Stimulators of NO synthesis and cGMP production enhanced the efficacy of doxazosin in decreasing prostatic tissue contraction. Sildenafil decreased contractility and increased cGMP release. Increased smooth muscle tone and structural changes in the ischemic prostate may suggest a role for prostate ischemia in resistance to urinary flow independent of prostate size.

Predictors of institutionalization in an older population during a 13-year period: the effect of urge incontinence

BACKGROUND

Longitudinal data on predictors of institutionalization in random older populations are limited. The aim here was to identify predictors of institutionalization in an unselected older population during a period of 13 years with a special focus on the prognostic value of urge incontinence.

METHODS

A population-based prospective survey was conducted involving 366 men and 409 women aged 60 years and older. Age-adjusted and multivariate Cox proportional hazards models were used to examine the predictive association of urge incontinence, living arrangements, neurological, cardiovascular, musculoskeletal, and other chronic diseases, activities of daily living (ADL) disability, and depressive symptoms with institutionalization separately in men and women.

RESULTS

Adjusted for age, ADL disability and other chronic diseases predicted institutionalization in both men and women. Urge incontinence and depressive symptoms in men and living alone and cardiovascular diseases in women were also significant predictors. In multivariate analyses where all potential predictors were included simultaneously, age (RR [relative risk] 1.15; 95% CI [confidence interval] 1.10-1.19), urge incontinence (RR 3.07; 95% CI 1.24-7.59), and depressive symptoms (RR 1.22; 95% CI 1.00-1.48) remained significant predictors of institutionalization in men. In women, age (RR 1.15; 95% CI 1.12-1.19) and living alone (RR 2.02; 95% CI 1.27-3.21) were independent predictors.

CONCLUSIONS

In addition to age, urge incontinence and depressive symptoms in men and living alone in women are significant prognostic indicators of institutionalization. The greater prognostic value of urge incontinence in men compared with women emphasizes the importance of interventions aimed at promoting continence and coping with the problem both at the individual and caregiver levels especially among older men.

Proceedings of the National Institute of Diabetes and Digestive and Kidney Diseases International Symposium on Epidemiologic Issues in Urinary Incontinence in Women

The Epidemiologic Issues in Urinary Incontinence: Current Databases and Future Collaborations Symposium included an international group of 29 investigators from 10 countries. The purpose of the symposium was to discuss the current understanding and knowledge gaps of prevalence, incidence, associated risk factors, and treatment outcomes for incontinence in women. During the symposium, investigators identified existing large databases and ongoing studies that provide substantive information on specific incontinence research questions. The investigators were able to form an international collaborative research working group and identify potential collaborative projects to further research on the epidemiology of urinary incontinence and bladder dysfunction.

Increased leukotriene and prostaglandin release, and overactivity in the chronically ischemic bladder

PURPOSE

Chronic ischemia has been shown to alter bladder contractility. We studied the roles of cyclooxygenase (COX) and lipoxygenase products in ischemia induced bladder overactivity in the rabbit.

MATERIALS AND METHODS

A total of 28 male New Zealand White rabbits were divided into 2 groups. In group 1 atherosclerotic occlusion of the iliac arteries was induced by balloon endothelial injury, followed by a short period of a high cholesterol diet. Group 2 received a regular diet alone. After 12 weeks blood flow measurements and cystometry were performed. Bladder tissues were processed for enzyme immunoassay of leukotrienes and prostaglandins (PGs), Western blotting of COX and lipoxygenase, isometric tension measurement and histology.

RESULTS

Atherosclerotic occlusion of the iliac arteries significantly decreased bladder blood flow. Moderate ischemia caused bladder overactivity, while severe ischemia inhibited bladder contractions. Ischemia increased leukotriene B4, E4 and C4 release by 141%, 132% and 254%, and increased PG F2alpha and thromboxane A2 release by 95% and 93%, respectively, although it did not alter PG E2 release. Western blotting showed increased 5-lipoxygenase, COX-1 and COX-2 protein levels in ischemic bladder tissues. Moderate ischemia increased bladder smooth muscle contraction in response to carbachol and electrical field stimulation. Tissue treatment with the COX inhibitor indomethacin significantly increased control tissue contraction but had no effect on ischemic tissues. Treatment with the 5-lipoxygenase inhibitor REV5901 abolished this effect of indomethacin in control tissues. Treatment with REV5901 significantly decreased the contraction of ischemic tissues but had no significant effect on control tissues. The effect of indomethacin plus REV5901 was similar to the effect of REV5901 alone. Histology showed urothelial thickening and mild fibrosis in the moderately ischemic bladder.

CONCLUSIONS

Chronic ischemia increased bladder 5-lipoxygenase, and COX-1 and COX-2 protein expression, and altered leukotriene and PG production. Treatment with COX and lipoxygenase inhibitors produced completely different effects in the ischemic bladder compared with the control bladder. Functional changes in the ischemic bladder were concurrent with structural changes in the urothelium. PGs modulate smooth muscle contractility in the healthy bladder. However, under ischemic conditions leukotrienes dominate bladder tone and appear to have a leading role in increased smooth muscle contraction and bladder overactivity.

Dynamic MRI after surgical repair for pelvic organ prolapse

PURPOSE

The purpose of this work was to compare dynamic MRI measurement results from patients with pelvic organ prolapse before and after surgical repair and to correlate postoperative MRI findings with the results of physical examination and patients' complaints.

MATERIALS AND METHODS

Thirty women were included in this prospective study. Fifteen patients with uterovaginal or vaginal vault descent and 15 asymptomatic female volunteers underwent dynamic MRI using a single-shot, fast spin-echo sequence with half-Fourier data acquisition. Single-slice midsagittal images of pelvic organs were obtained at maximal pelvic strain and at perineal contraction. Dynamic MRI was repeated on all patients 2-4 months after surgical repair. Postoperative and preoperative dynamic MRIs were compared with the normal values of the volunteer group. Postoperative MRIs were correlated with the clinical findings after surgical repair.

RESULTS

Seven patients reported symptoms after surgical repair, although only two had pathologic findings on physical examination (residual urine associated with third-degree stress urinary incontinence, and bladder neck descent). MRI showed pathologic changes in five of these patients. Two patients with persistent first-degree stress incontinence had no pathologic findings on MRI.

CONCLUSION

Dynamic MRI is helpful in the evaluation of persistent patient complaints after surgery for pelvic organ prolapse and detects more defects than physical examination does.

Urinary incontinence in female adolescents with cystic fibrosis

OBJECTIVES

Urinary incontinence is common in healthy women and occurs with increased frequency in adult women with chronic lung disease, including cystic fibrosis (CF). This study aimed to determine the prevalence, severity, and impact on daily life of urinary incontinence in female adolescents with CF.

METHODS

An interviewer-administered questionnaire was conducted with females who were aged 12 years and older and attend the CF Clinic at the Royal Children's Hospital in Melbourne, Australia.

RESULTS

Fifty-five (96%) of 57 eligible adolescents (age: 12-19 years) participated. Twenty-six (47%) reported ever having been incontinent of urine; 12 (22%) reported daytime incontinence twice a month or more. Median age of onset of incontinence was 13 years (range: 7-16 years). No relationship was seen with age, lung function, body mass index, or menarchal status. Coughing and laughing were the most commonly reported precipitants (affecting 84% and 68%, respectively). Of those with incontinence once a year or more, 42% reported that it sometimes prevented them from doing effective physiotherapy. Social life was affected by incontinence in approximately one third of respondents. Nearly half (42%) of affected adolescents had told no one, and only 2 had discussed the problem with their physician.

CONCLUSIONS

Urinary incontinence is common in female adolescents with CF and is not related to illness severity. Urinary incontinence has a negative impact on the performance of chest physiotherapy. Given the lack of adolescent report and knowledge of treatment availability, inquiry about symptoms of urinary incontinence should be part of the routine assessment of female adolescents with CF.

Urinary incontinence in Belgium; prevalence, correlates and psychosocial consequences

This article describes the prevalence of urinary incontinence in the Belgian population and assesses factors associated with urinary incontinence. The significance of urinary incontinence as a public health problem is evaluated through its psychosocial consequences. The data comes from the participants of the 1997 national health survey in Belgium, 15 years and older, (n = 7266). The presence and frequency of the urinary incontinence was estimated through self-reporting using a standard questionnaire. The prevalence of urinary incontinence in the population was 1.4% in men and 4.6% in women ranging from less than 1% under the age of 25 years to 13% in males and 21% in females aged 75 years and older. The prevalence in women was higher in all age groups. The prevalence of frequent incontinence (at least once a week) was 0.8% in males and 2.4% in females. Over the age of 75 years 9.8% of the males and 7.9% of the females reported weekly incontinence. Factors associated with the incontinence were physical limitations, comorbidity, having a prostate problem or uterine prolapse, being obese. Further, the prevalence of urinary incontinence was higher in women reporting chronic urinary infection and with a sedentary lifestyle. The prevalence of subjective ill-health, of mental ill-health, of a low appreciation of social contacts and of a low functional content of social contacts was higher in subjects with urinary incontinence. Urinary incontinence is common in both men and women, especially in older ages. Urinary incontinence is associated with other health problems. The substantial psychosocial consequences of urinary incontinence stress the need for more public health and medical attention.

Once-daily, extended-release formulations of antimuscarinic agents in the treatment of overactive bladder: a review

Overactive bladder (OAB) is a chronic condition that often requires long-term treatment to maintain control of symptoms. A range of therapeutic options are available; however, antimuscarinic agents form the mainstay of treatment. Of these agents, tolterodine and oxybutynin are the most widely used. It is well documented that the immediate-release (IR) formulations of these agents have equivalent efficacy in relieving OAB symptoms. However, tolterodine demonstrates a more favorable tolerability profile, particularly in terms of the frequency and severity of dry mouth. Due to the development of novel drug delivery systems, extended-release (ER) formulations of both oxybutynin and tolterodine are now available, permitting once-daily dosing. The convenience of once-daily dosing of antimuscarinic agents would be expected to improve patient compliance and further relieve the symptoms of OAB. Clinical studies with the ER formulations of tolterodine and oxybutynin demonstrate potential clinical advantages over their respective IR forms in terms of either efficacy or tolerability or both, although the therapeutic index of tolterodine ER appears to show a greater advantage over its IR counterpart compared with oxybutynin ER and its IR form. Importantly, the two ER agents have not been compared directly in a head-to-head clinical study. Overall, available clinical data suggest that the newly developed ER formulation of tolterodine represents a significant therapeutic advancement in the treatment of OAB.

Urinary incontinence in pregnancy and the puerperium

OBJECTIVE

To describe the incidence of urinary incontinence (UI) during pregnancy and the puerperium and to identify potential contributing factors.

DESIGN

A descriptive correlational design, using participant interviews and reviews of the existing medical records to determine the incidence of UI in pregnancy and the puerperium and to examine relationships between and among several variables. The variables included parity, episiotomy, use of forceps/vacuum extractor, type of anesthesia, prolonged Stage II labor, and race. Data were collected via two personal interviews and review of medical records. The first interview was conducted during the recruitment of each participant; the second was a telephone interview conducted 4 to 6 weeks postpartum. Data collected from the medical records included obstetric history, weeks of gestation, and estimated date of delivery. Data were entered into data files for analysis with SPSS 8.0 and summarized with descriptive statistics.

SETTING

A secluded area of a university teaching hospital prenatal clinic.

PARTICIPANTS

A convenience sample of 50 pregnant women, at least 18 years old, who received their care at a large university hospital prenatal clinic in the southeastern part of the United States.

RESULTS

First Interview (N = 50). More than half (62%; n = 31) of the sample reported some degree of involuntary urine loss during their pregnancy. The racial distribution of those reporting UI was the following: white (70%; 21 out of 30); African American (44%; 8 out of 18); Hispanic/Asian (100%; n = 2). Among the participants who experienced UI (n = 31), 76% (n = 23) reported that their health care provider never asked if they were experiencing any UI symptoms. Second Interview (n = 24). Only 48% of the initial participants could be contacted for the second interview because of changes in residence or telephones being disconnected with no forwarding number. Of the women in this sample who reported UI during the first interview (59%; n = 14), 7 (50%) continued to experience UI 4 to 6 weeks postpartum. The 2 remaining participants who reported UI 4 to 6 weeks postpartum (22%) had not experienced UI during pregnancy. Of the participants experiencing postpartum UI, 77% (n = 7) were white. Almost half of the participants with postpartum UI were ages 35 or older (44%; n = 4). Among the participants reporting episiotomy (n = 4), 3 (75%) reported having UI 4 to 6 weeks postpartum.

CONCLUSIONS

Study results support the conclusion that childbirth, specifically vaginal birth, is a major factor in developing UI in the early postpartum period. Age, race, and use of episiotomy appear to be contributing risk factors.

Health-related quality of life among adults with symptoms of overactive bladder: results from a U.S. community-based survey

OBJECTIVES

To assess, by means of a survey, the impact of the symptoms of overactive bladder (urinary frequency, urgency, and urge incontinence) on the quality of life in a community-based sample of the U.S. population.

METHODS

A telephone survey was conducted in the United States among an age and sex-stratified sample of 4896 noninstitutionalized adults 18 years of age and older. From the responses to the telephone survey, a total of 483 individuals with symptoms of overactive bladder and 191 controls completed a mailed follow-up questionnaire to assess their quality of life using the Medical Outcomes Study Short-Form 20.

RESULTS

After adjustment for age, sex, and the use of medical care, the greatest differences in the quality-of-life scores between the patients with incontinent overactive bladders and the controls were in the health perception (17.6 points; P <0.001) and role functioning (13.0 points; P <0.001) scales. Those with an overactive bladder with the symptoms of frequency or urgency, or both, but without incontinence, also had significantly lower scores than did the controls in mental health (P = 0.026), health perception (P = 0.01), and bodily pain (P = 0.016).

CONCLUSIONS

These data indicate that individuals with an overactive bladder experience decrements in their quality of life relative to community controls. An important new finding from this study is that individuals with an overactive bladder, even without demonstrable urine loss, also have a poorer quality of life than that of controls.

Urinary symptoms and incontinence in an urban community: prevalence and associated factors in older men and women

BACKGROUND

There is increasing recognition of the importance of a wide range of urinary symptoms in both men and women and that these symptoms are undertreated.

AIMS

To determine the prevalence of and factors associated with urinary symptoms, including nocturia, urgency, urge and stress incontinence and, in men, urinary stream difficulties; and the prevalence of being bothered by the symptoms and ever seeking treatment for them.

METHOD

Household survey by computer-assisted telephone interviews of people aged 41 years and over and living in inner metropolitan Sydney.

RESULTS

Fifty-three per cent (95% confidence interval (CI) 46-60) of men and 61% (95% CI 55-67) of women reported one or more symptoms in the previous month. In men, the most frequently reported symptoms were urgency (30%, 95% CI 24-36) and nocturia (25%, 95% CI 19-31). In women, stress incontinence (35%, 95% CI 29-41) and urgency (33%, 95% CI 27-39) were the most common symptoms reported. In men, the significant factors associated with reporting one or more symptoms, after adjustment for other variables, were age 60 years or more, no private medical insurance, obesity and fair or poor self-rated health. For women, the significant associations were age 50-59 years, age 70 years or more, no private health insurance, high psychological distress and fair or poor self-rated health.

CONCLUSIONS

Urinary symptoms are experienced by more than half of men and women aged over 40 in the central Sydney community, but many do not seek treatment. Such symptoms should be considered more broadly than the traditional focus on male 'prostatism' and female incontinence.