Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old

Does the climacteric influence the prevalence, incidence and type of urinary incontinence?

Divergent opinions have been reported in the literature regarding the influence of the climacteric on the prevalence, incidence and types of urinary incontinence. In addition, the influence of hormonal therapy in the climacteric (HRT) on the occurrence of urinary incontinence in the perimenopausal period has been the subject of much discussion. This review evaluates the current literature regarding any possible association between the climacteric and the prevalence, incidence and types of urinary incontinence as well as illustrating the possible influence of HRT on urinary incontinence. Urinary incontinence is more common in women than in men and there is evidence to suggest that the prevalence of urinary incontinence in women increases in a linear fashion with age. There is no conclusive evidence to support a specific increase in the prevalence of urinary incontinence at the time of the menopause. Stress urinary incontinence is more common in premenopausal women and urgency urinary incontinence and mixed incontinence are more common in postmenopausal women. Women receiving systemic estrogen, with or without progestogen, are more likely to develop or experience worsening of incontinence.

App-based Yoga of Immortals: A Novel, Easy-to-use Intervention in the Management of Urinary Incontinence

OBJECTIVE

To study the effectiveness Yoga of Immortals (YOI) intervention in participants with urinary incontinence (UI) of all types. YOI uniquely combines specific yogic postures, breathing exercises, sound therapy & meditation and is practiced by many for general well-being.

MATERIALS AND METHODS

In this App-based cohort study, a survey was sent to the YOI app subscribers. Those who identified with UI and consented were sent the ICIQ-UI- SF (for mean symptom score & severity of UI), and the ICIQ-LUTS-QOL (for impact of UI on QOL) Questionnaires at baseline, 4, and 8 weeks. Global impression of improvement was assessed by PGI-I scale.

RESULTS

258/422 participants (18-74 years) were included and showed significant decrease in mean scores on the ICIQ-UI-SF (4.06 ± 0.24 at baseline; 2.90 ± 0.22 at 4-weeks [p ≤ 0.001] and 3.44 ± 0.23 at 8 weeks [p ≤ 0.001]) and ICIQ-LUTS-QOL (28.36± 0.74 at baseline; 24.46± 0.70 at 4-weeks [p ≤ 0.001] and 25.78± 0.70 at 8 weeks [p≤ 0.001]). Additionally, the 55-60 year subgroup also had significant decrease in mean scores on ICIQ-LUTS-QOL (25.06 ±1.20 at base line; 21.69 ± 1.07 at 4 weeks [p ≤ 0.01] and 22.28 ± 0.96 at 8 weeks [p ≤ 0.01]).

CONCLUSION

YOI intervention resulted in significant improvement in mean scores on ICIQ-LUTS-QOL; ICIQ-UI-SF; frequency and severity of urinary leak; and daily life activity. Majority of the participants felt 'very much better' on PGI-scale. Being app- based, it has the added advantage of the ability to be used anytime and anywhere.

The prevalence of urinary incontinence

The reported prevalence of urinary incontinence (UI) among women varies widely in different studies due to the use of different definitions, the heterogenicity of different study populations, and population sampling procedures. Population studies from numerous countries have reported that the prevalence of UI ranged from approximately 5% to 70%, with most studies reporting a prevalence of any UI in the range of 25-45%. Prevalence figures increase with increasing age, and in women aged ≥70 years more than 40% of the female population is affected. Prevalence rates are even higher in the elderly-elderly and amongst nursing home patients. There are only a few studies describing progression as well as remission of UI in the general population as well as in selected groups of the population. The mean annual incidence of UI has been reported to range from 1% to 9%, while estimates of remission are more varying, from 4% to 30%. The prevalence of UI is strongly related to the age of the woman and thus, due to the increase in mean life expectancy, the overall prevalence of UI in women is expected to increase in the future.

Mechanical oscillations superimposed on the pelvic floor muscles during Kegel exercises reduce urine leakage in women suffering from stress urinary incontinence: A prospective cohort study with a 2-year follow up

INTRODUCTION

New methods of conservative treatment of female stress urinary incontinence are needed. We investigated whether superimposed vibration mechanosignals during Kegel exercises could reduce the amount of urinary leakage after 4 and 6 weeks of training.

MATERIAL AND METHODS

Sixty women with stress urinary incontinence were included in this prospective cohort study. Vibration mechanosignals were superimposed during Kegel exercises using an intravaginal device. Each training session consisted of 15 maximal contractions of pelvic floor muscles for 5 s. The women performed training (5 min/day) at home for 4 (n = 60) and 6 (n = 36) weeks. Urine leakage (g) during stress test with standardized bladder volume, and contraction force without and with superimposed mechanical stimulations were measured at inclusion (T₀ ), and after 4 (T₂ ) and 6 (T₃ ) weeks of training using an intravaginal device. Incontinence Questionnaire-Short Form was recorded at T₀ , and in a sub-cohort of women (n = 36) at 2 years follow up.

RESULTS

Mean urine leakage reduced significantly from 20.5 (± 12.2) g at T₀ to 4.8 (± 6.7) g at T₂ and 1.5 (± 6.7) g at T₃ . After 4 and 6 weeks of training, urinary leakage was ≤ 4 g on stress test in 44 and 49 of the 60 women, respectively. At T₀ , the mean Incontinence Questionnaire-Short Form score was 13 (± 2.4), and at 2 years follow up, the score was 6.3 (± 3.75).

CONCLUSIONS

Superimposed mechanical stimulation with Kegel exercises significantly reduced urinary leakage in women with stress urinary incontinence.

Assessing health, quality of life and urogenital function in a sample of the Swedish general population: a cross-sectional study

OBJECTIVE

Evaluate the urinary, bowel and sexual function as well as stress symptoms and depression in a sample of the Swedish population.

DESIGN

A random sample of Swedish men and women in age groups from 30 to 89 years, a total of 3000 individuals, were contacted and after receiving informed consent, a questionnaire was sent.

MAIN OUTCOME MEASURES

Measures of urinary, bowel, sexual function and quality of life.

RESULTS

The questionnaire was sent to 2094 individuals who gave informed consent. The questionnaire was answered by 1078 individuals. Quality of life, stress symptoms and depressed mood were relatively constant across age groups for both men and women. Urinary function differed significantly across gender and age groups, but bowel function was relatively unaffected by age. Overall bowel dysfunction was slightly more prevalent among women compared with men. For both men and women, the frequency of intercourse or other sexual activities decreased with age, whereas sexually associated distress increased by age in men, but decreased among women.

CONCLUSIONS

In a general population, the urinary function varied across age and sex. Overall bowel dysfunction was slightly more prevalent among women compared with men. Sexually associated distress increased by age for men, but decreased for women.

TRIAL REGISTRATION NUMBER

NCT02392923; Results.

A prospective study of the natural history of urinary incontinence in women

BACKGROUND

Symptoms of urinary incontinence are commonly perceived to vary over time; yet, there is limited quantitative evidence regarding the natural history of urinary incontinence, especially over the long term.

OBJECTIVE

We sought to delineate the course of urinary incontinence symptoms over time, using 2 large cohorts of middle-aged and older women, with data collected over 10 years.

STUDY DESIGN

We studied 9376 women from the Nurses' Health Study, age 56-81 years at baseline, and 7491 women from the Nurses' Health Study II, age 39-56 years, with incident urinary incontinence in 2002 through 2003. Urinary incontinence severity was measured by the Sandvik severity index. We tracked persistence, progression, remission, and improvement of symptoms over 10 years. We also examined risk factors for urinary incontinence progression using logistic regression models.

RESULTS

Among women age 39-56 years, 39% had slight, 45% had moderate, and 17% had severe urinary incontinence at onset. Among women age 56-81 years, 34% had slight, 45% had moderate, and 21% had severe urinary incontinence at onset. Across ages, most women reported persistence or progression of symptoms over follow-up; few (3-11%) reported remission. However, younger women and women with less severe urinary incontinence at onset were more likely to report remission or improvement of symptoms. We found that increasing age was associated with higher odds of progression only among older women (age 75-81 vs 56-60 years; odds ratio, 1.84; 95% confidence interval, 1.51-2.25). Among all women, higher body mass index was strongly associated with progression (younger women: odds ratio, 2.37; 95% confidence interval, 2.00-2.81; body mass index ≥30 vs <25 kg/m²; older women: odds ratio, 1.93; 95% confidence interval, 1.62-2.22). Additionally, greater physical activity was associated with lower odds of progression to severe urinary incontinence (younger women: odds ratio, 0.86; 95% confidence interval, 0.71-1.03; highest vs lowest quartile of activity; older women: odds ratio, 0.68; 95% confidence interval, 0.59-0.80).

CONCLUSION

Most women with incident urinary incontinence continued to experience symptoms over 10 years; few had complete remission. Identification of risk factors for urinary incontinence progression, such as body mass index and physical activity, could be important for reducing symptoms over time.

Does transition of urinary incontinence from one subtype to another represent progression of the disease?

INTRODUCTION AND HYPOTHESIS

Mixed urinary incontinence (UI) is, on average, more severe than urgency UI or stress UI. We tested the hypothesis that mixed UI is a more advanced stage of UI by comparing transition probabilities among women with stress, urgency, and mixed UI.

METHODS

We used data from the General Longitudinal Overactive Bladder Evaluation Study-UI, which included community-dwelling women, aged 40+ years, with UI at baseline. Study participants completed two or more consecutive bladder health surveys every 6 months for up to 4 years. Using sequential 6-month surveys, transition probabilities among UI subtypes were estimated using the Cox-proportional hazards model, with the expectation that probabilities from stress or urgency UI to mixed UI would be substantially greater than probabilities in the reverse direction.

RESULTS

Among 6,993 women 40+ years of age at baseline, the number (prevalence) of women with stress, urgency, and mixed UI was 481 (6.9%), 557 (8.0%), and 1488 (21.3%) respectively. Over a 4-year period, the transition probabilities from stress UI (34%) and urgency UI (27%) to mixed UI was significantly higher than probabilities from mixed to stress UI (6%) or to urgency UI (rate = 9%). The adjusted transition hazard ratio for stress UI and urgency UI was 2.06 (95% CI: 1.73-2.92) and 1.85 (95% CI: 1.63-2.57) respectively compared with mixed UI.

CONCLUSION

The substantially higher transition from stress UI and urgency UI to mixed UI supports the hypothesis that mixed UI might represent a more advanced stage of UI that may have implications for understanding disease progression.

Changes in incontinence after hysterectomy

PURPOSE

Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy.

METHODS

108 patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively. Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively.

RESULTS

In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress incontinence correlated with BMI (r = 0.25, p < 0.01) and urge incontinence with age (r = 0.24, p < 0.02). Further, improvement after hysterectomy in stress incontinence was associated with younger age (r = 0.20, p < 0.04). Improvement in urge incontinence was positively associated with BMI (r = 0.22, p = 0.02). A slight but significant loss was seen in lean body mass 13 and 30 days postoperatively.

CONCLUSIONS

Hysterectomy was not significantly associated with the risk of incontinence; in particular, when no further vaginal surgery is performed. Hysterectomy may even have a slightly positive effect on incontinence and de-novo cure.

Hysterectomy is not associated with de-novo urinary incontinence: A ten-year cohort study

OBJECTIVE

To determine prevalence, incidence proportion, and changes of urinary incontinence (UI) 10-13 years after hysterectomy compared to two control groups.

STUDY DESIGN

A longitudinal cohort study of 661 women with follow-up for ten years. Originally, 866 women answered a questionnaire on continence status preoperatively. Ten years postoperatively the queries were repeated in 371 with a hysterectomy, 89 with laparoscopic cholecystectomy (LC), and 201 with transcervical endometrial resection (TCRE). Significant incontinence was UI at least once a week. The main outcome measures were prevalence and incidence proportions of UI.

RESULTS

The overall prevalence of stress UI ten years after surgery was 23% compared to 12% preoperatively. Urge UI was prevalent in 12% compared to 5% preoperatively. Incidence proportions of stress UI were in hysterectomies 21%, in LC 15%, and in TCRE 18%. Similarly, incidence proportions of urge UI were in hysterectomies 11%, in LC 11%, and in TCRE 8%. No significant differences between surgical procedures were found; however, we found substantial amount of changes in continence status from continent to incontinent and vice versa in all three groups.

CONCLUSIONS

No significant difference was found after hysterectomy compared to controls in the prevalence or incidence proportions of UI after 10 years follow-up. Hysterectomy is not a risk factor of UI.

Clinical epidemiological insights into urinary incontinence

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI) is very common and heterogeneous among women with limited knowledge of progression or prognosis. Evidence based on clinical epidemiology can help to better understand the natural history of UI.

METHODS

We examine the challenges of UI definition and its subtypes, its impact on quality of life and health-seeking behavior. We review the proposed pathophysiology of UI subtypes and known risk factors as they relate to our current knowledge of the disease state. Finally, we emphasize the role of epidemiology in the process of acquiring new insight, improving knowledge, and translating this information into clinical practice.

RESULTS

Stress UI is most common overall, but mixed UI is most prevalent in older women. The three UI subtypes have some common risk factors, and others that are unique, but there remains a significant gap in our understanding of how they develop. Although the pathophysiology of stress UI is somewhat understood, urgency UI remains mostly idiopathic, whereas mixed UI is the least studied and most complex subtype. Moreover, there exists limited information on the progression of symptoms over time, and disproportionate UI health-seeking behavior. We identify areas of exploration (e.g., epigenetics, urinary microbiome), and offer new insights into a better understanding of the relationship among the UI subtypes and to develop an integrated construct of UI natural history.

CONCLUSION

Future epidemiological strategies using longitudinal study designs could play a pivotal role in better elucidating the controversies in UI natural history and the pathophysiology of its subtypes leading to improved clinical care.

What are the probable predictors of urinary incontinence during pregnancy?

Objectives. The frequency, predisposing factors and impact of urinary incontinence (UI) on quality of life (QoL) during pregnancy were investigated.

Materials and Method. A preliminary cross-sectional survey was studied among pregnant women between January and July of 2014. A total of 132 pregnant women were recruited using a questionnaire form for sociodemographic features, the Turkish version of the International Consultation on Incontinence-Short Form (ICIQ-SF), for the characteristics of UI and Wagner’s Quality of Life scale to assess impact on QoL. p < 0.05 was set significant.

Results.Urinary incontinence was present in 56 out of 132 pregnant women (42.4%, UI-present group): mean age, 26.7 ± 5.4y(p = 0.780); median height, 160 cm (min–max: 153–176, p = 0.037); median BMI, 28.7 kg/m²(min–max: 22.4–50.0, p = 0.881); urine leakage occurred per week once (n = 18, 32.1%), twice or thrice (n = 8, 14.3%); per day few times (n = 14, 25%), once (n = 5, 8.9%) and always (n = 8, 14.3%) with mainly a small amount of urine leakage (n = 33, 58.9%) or a moderate (n = 4, 7.1%). There were statistically significant relationships between QoL scores and frequency of UI (p = 0.002) or amount of leakage (p = 0.002). Impact on QoL scores ranged from mild (n = 33, 58.9%), moderate (n = 4, 7.1%) to severe (n = 4, 7.1%) levels in daily life. UI impacted the daily life activities of women by making them less likely to undertake activities outside their homes (23.2%), by affecting their working performance and friendships (8.9%), their daily home activities (7.1%), their general health status (12.5%), their sexual relations (12.5%), by making them more nervous or anxious (10.7%) and by the need to wear pads or protectors (25%). ANOVA, Tukey, and Tamhane tests as the minimal important difference model yielded significant relevance between statistical analyses and clinical outcomes by using standard deviations (p = 0.001, 0.001 and 0.005 respectively). The following features favored the occurence of UI: Age (OR = 0.845, 95% CI [0.268–2.669]), being a housewife (OR = 1.800, 95% CI [0.850–3.810]), anemia (OR = 0.939, 95% CI [0.464–1.901]), parity (OR = 0.519, 95% CI [0.325–0.829]), miscarriage (OR = 1.219, 95% CI [0.588–2.825]) and living in rural areas (OR = 1.800, 95% CI [0.887–3.653]). Height (p = 0, 037), educational status (0.016), miscarriage (0.002), parity (0.006) and place of living (0.020) were significant factors.

Conclusions.Many pregnant women are suffering from UI, which warrants a significant public health consideration in the region. Age, height, being a housewife or graduation level higher than primary school, living in rural, parity, miscarriage, and anemia were the factors in favor of the onset of UI. The authors plan a health promotion program in the region according to the results in order to provide information to health caregivers, especially family physicians, and to educate women about the predictors of UI and pelvic floor exercises for primary prevention and secondary relief of UI during and after pregnancy and provide some hygienic supplies to the poor in this aspect.

Urinary incontinence in gynaecological consultations. Do all women with symptoms wish to be treated?

OBJECTIVE

To determine the prevalence and symptom severity of urinary incontinence (UI) in women who attend primary care gynaecological consultations, as well as the proportion of women with UI symptoms who wish to be studied and treated.

MATERIALS AND METHODS

A multicentre, observational, descriptive cross-sectional study was conducted of women who visit the 8 specialised consultations for sexual and reproductive health (SRH) in the 4 Catalan provinces for any reason (except UI, pregnancy and postpartum). We employed the ICQ-UI-SF questionnaire to detect UI symptoms. Women with UI symptoms (ICI-Q-SF>0) were asked whether they wanted specific care for their UI problem. Those who answered "no" were asked why.

RESULTS

The study included 2840 women, 41.8% of whom reported urine losses, especially mild to moderate symptoms. Some 53.62% of the women with UI responded that they did not wish to be treated. Of these, 75% had mild symptoms, 45% had moderate symptoms, and only 16% and 5% had severe or very severe symptoms, respectively. Fifty-three percent of the women did not want treatment because the UI was not a significant problem for them.

CONCLUSIONS

Almost half of the women who attended a specialised consultation for SRH for any reason reported UI symptoms, especially mild and moderate. More than half of the patients with UI symptoms did not want to start a diagnostic and treatment process for their problem. Symptom severity is associated with the willingness to be treated.

Clinical validation of the Bladder Health Survey for urinary incontinence in a population sample of women

INTRODUCTION AND HYPOTHESIS

Our aim was to clinically validate the Bladder Health Survey (BHS) for detecting urinary incontinence (UI) in population-based surveys.

METHODS

A random sample of women ≥40 years was recruited from primary care practices. We assessed the BHS content validity with an expert advisory board. Test-retest reliability of UI questions was measured. BHS UI definitions included noncases, active (more than three symptoms in the prior 6 months), inactive (past but no current symptoms), and incident (new onset over the past 2 years) cases. To assess criterion validity, we compared BHS diagnosis to an expert clinical diagnosis using structured history, pelvic exam, voiding diary, and urodynamics (if needed). Construct validity was assessed comparing the BHS UI score and case status to Sandvik's score.

RESULTS

Among 322 patients, the BHS identified 17 % as noncases, 70 % as active, 10 % as inactive, and 3 % as incident cases. Using the clinical diagnosis as the gold standard, the percent of true-positive UI cases was 98 % (active), 84 % (inactive), and 80 % (incident). A total of 75 % of BHS noncases were true negatives. The receiver operating characteristic c-statistic was 0.86. Sensitivity and specificity of the BHS were 91 % and 84 %, respectively. The Sandvik score for active cases (median = 4) was significantly greater than it was for inactive (median = 1), incident (median = 1), and noncases (median = 0) (p < 0.001). The BHS UI score was significantly correlated with the Sandvik severity score (r = 0.68, p < 0.01).

CONCLUSION

The BHS is highly reliable, with robust content and construct validity for detecting UI for use in population samples.

Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence

AIMS

To perform a deterministic cost-utility analysis, from a 1-year societal perspective, of two treatment programs for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post. The treatments were compared with each other and with no treatment.

METHODS

We performed this economic evaluation alongside a randomized controlled trial. The study included 250 women aged 18-70, with SUI ≥ 1 time/week, who were randomized to 3 months of pelvic floor muscle training via either an Internet-based program including e-mail support from an urotherapist (n = 124) or a program sent by post (n = 126). Recruitment was web-based, and participants were self-assessed with validated questionnaires and 2-day bladder diaries, supplemented by a telephone interview with a urotherapist. Treatment costs were continuously registered. Data on participants' time for training, incontinence aids, and laundry were collected at baseline, 4 months, and 1 year. We also measured quality of life with the condition-specific questionnaire ICIQ-LUTSqol, and calculated the quality-adjusted life-years (QALYs) gained. Baseline data remained unchanged for the no treatment option. Sensitivity analysis was performed.

RESULTS

Compared to the postal program, the extra cost per QALY for the Internet-based program ranged from 200€ to 7,253€, indicating greater QALY-gains at similar or slightly higher costs. Compared to no treatment, the extra cost per QALY for the Internet-based program ranged from 10,022€ to 38,921€, indicating greater QALY-gains at higher, but probably acceptable costs.

CONCLUSION

An Internet-based treatment for SUI is a new, cost-effective treatment alternative.

Long-term prevalence and predictors of urinary incontinence among women in the Diabetes Prevention Program Outcomes Study

OBJECTIVES

To examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance.

METHODS

This analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008.

RESULTS

At the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence.

CONCLUSIONS

Intensive lifestyle intervention has a modest positive and enduring impact on urinary incontinence, and should be considered for the long-term prevention and treatment of urinary incontinence in overweight/obese women with glucose intolerance.

Incidence and remission of urinary incontinence at midlife: a cohort study

OBJECTIVE

Urinary incontinence (UI) is often considered to be an age-related disease that develops gradually as women grow older. Much remains to be learnt about factors that promote its incidence or its remission. Our objective was to assess its incidence and risk factors.

DESIGN

Longitudinal cohort study.

SETTING

French GAZEL cohort.

POPULATION

A cohort of 4127 middle-aged women (aged 47-52 years at baseline) over an 18-year period (1990-2008).

METHODS

UI was defined as 'difficulty retaining urine'. The question was asked at baseline and repeated every 3 years over an 18-year period. Two groups (UI incidence and remission) were analysed according to status at baseline (continent or incontinent). A multivariable analysis (Cox model) was used to estimate the risk factors for UI incidence and remission.

MAIN OUTCOME MEASURES

Annual incidence and remission rates and risk factors for UI incidence and remission.

RESULTS

The annual incidence and remission rates for UI were 3.3% and 6.2%, respectively. High educational level (hazard ratio [HR] = 1.28; 95% confidence interval [95% CI] = 1.05-1.55), parity, i.e. at least one baby versus no baby (HR = 1.64; 95% CI = 1.19-2.27), menopause (HR = 5.44; 95% CI = 4.47-6.63), weight gain, i.e. for each kilogram change in weight (HR = 1.00; 95% CI = 1.00-1.02), onset of depressive symptoms (HR = 1.31; 95% CI = 1.09-1.57) and impairment in health-related quality of life incidence (social isolation dimension [HR = 1.29; 95% CI = 1.04-1.60] and energy dimension [HR = 1.41; 95% CI = 1.17-1.70]) were associated with an increased probability of UI. The factors associated with persistent UI were age (HR = 0.58; 95% CI = 0.55-0.61), weight gain (HR = 0.99; 95% CI = 0.98-0.99) and transition to menopausal status (HR = 1.54; 95% CI = 1.19-1.99).

CONCLUSIONS

Our study suggests that, in our population of middle-aged women, age, menopause, weight gain, onset of depression and impaired health-related quality of life may promote UI.

Urinary incontinence incidence: quantitative meta-analysis of factors that explain variation

PURPOSE

We sought to explain variation in female age specific incidence rates for urinary incontinence using published, population based studies.

MATERIALS AND METHODS

We performed an extensive MEDLINE® review of published, population based studies of the female urinary incontinence incidence rate from 1966 to 2011 using a combination of symptom and epidemiological search terms. A total of 18 reports described 17 unique incidence studies. We abstracted the features of each study (eg sample size, followup, etc) along with detailed data on 109 age specific incidence rates (ie new cases per 1,000 person-years). Because the Nurses' Health Study had unique demographics and was dominant in sample size, analyses were completed with and without this study. Weighted (ie square root of sample size) linear regression was used to determine factors (ie age, source population, race, frequency score, etc) explaining variance among age specific incidence rates.

RESULTS

Age and case definition accounted for 60% of the variation in incidence rates among studies. The age specific incidence was less than 2/1,000 person-years before age 40 years and it increased thereafter. For a given age group incidence rates varied as much as sixfold across studies, a finding that was largely explained by variation in case definition.

CONCLUSIONS

The case definition accounts for substantial variation in urinary incontinence incidence estimates. Developing standards for reporting would provide a foundation for policy guidance and understanding etiology. We recommend that quantitative frequency criteria (eg 2 times or more per month) be reported vs vague thresholds (eg sometimes or often).

Prevalence, incidence and remission of urinary incontinence in women: longitudinal data from the Norwegian HUNT study (EPINCONT)

Background

To determine incidence and remission of UI as well as changes in UI prevalence in the Norwegian EPINCONT surveys.

Methods

The EPINCONT surveys were conducted in the county of Nord-Trøndelag, Norway, as part of two large cross-sectional health surveys (HUNT2 and HUNT3) in 1995 – 1997 (EPINCONT1 (E1)), and 2006 – 2008 (EPINCONT2 (E2)). EPINCONT collected information about prevalence of UI, as well as information about type and severity of UI.

Results

A 16% relative increase in UI prevalence was found in 11 years. The women who answered E2 were significantly older, had a higher BMI and higher prevalence of diseases such as asthma, diabetes and angina compared with the women who answered E1.

The incidence of UI was 18.7%. Increase in BMI (OR 1.03, 95% CI: 1.02 – 1.04), weight increase (OR 1.29 (95% CI: 1.14 – 1.45) for gaining 3 – 10 kilos and OR 1.71 (95% CI: 1.47 – 1.99) for gaining 10 kilos or more) and parity (OR 1.37 (95% CI: 1.04 – 1.79) for 1 childbirth, OR 1.28 (95% CI: 1.03 – 1.61) for 2 childbirths, and OR 1.56 (95% CI: 1.26 – 1.95) for 3 or more childbirths when participating in E2) were all found to be associated with increased odds of incident UI in adjusted regression analyses. Increasing age reduced the odds of incident UI. The 11 year remission of UI was 34.1%. Increasing age (OR 0.98, 95% CI: 0.98 – 0.99), increasing BMI (OR 0.96, 95% CI: 0.95 – 0.98) and large weight gains of 10 kilos or more (OR 0.69, 95% CI: 0.54 – 0.88) were all associated with reduced remission of UI.

Conclusion

Crude UI prevalence increased between the studies. Changes in known risk factors for UI such as age, BMI, weight and parity could explain some of the relative increase in prevalence, and were also found to be associated with either incidence of UI, remission of UI or both.

Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Stress urinary incontinence (SUI) affects 10-35% of women, and it is sometimes very distressful. Pelvic floor exercises are the first line of treatment, but access barriers or embarrassment may prevent women from seeking help. There is a need for new, simple, and effective ways to deliver treatment. Management of SUI without face-to-face contact is possible, and Internet-based treatment is a new, promising treatment alternative.

OBJECTIVE

To compare two treatment programmes for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post.

PATIENTS AND METHODS

Randomised, controlled trial conducted in Sweden 2009-2011. Computer-generated block-randomisation, allocation by independent administrator. No 'blinding'. The study included 250 community-dwelling women aged 18-70 years, with SUI ≥1 time/week. Consecutive online recruitment. The women had 3 months of either; (i) An Internet-based treatment programme (124 women), including e-mail support and cognitive behavioural therapy assignments or (ii) A treatment programme sent by post (126). Both programmes focused mainly on pelvic floor muscle training.

PRIMARY OUTCOMES

symptom-score (International Consultation on Incontinence Questionnaire Short Form, ICIQ-UI SF) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life, ICIQ-LUTSQoL).

SECONDARY OUTCOMES

(i) Patient Global Impression of Improvement, (ii) Incontinence aids, (iii) Patient satisfaction, (iv) Health-specific QoL (EQ5D-Visual Analogue Scale), and (v) Incontinence episode frequency. Follow-up after 4 months via self-assessed postal questionnaires.

RESULTS

In all, 12% (30 women) were lost to follow-up. Intention-to-treat analysis showed highly significant improvements (P < 0.001) with large effect sizes (>0.8) with both interventions, but there were no significant differences between groups in primary outcomes. The mean (sd) changes in symptom-score were: Internet 3.4 (3.4), Postal 2.9 (3.1) (P = 0.27). The mean (sd) changes in condition-specific QoL were: Internet 4.8 (6.1), Postal 4.6 (6.7) (P = 0.52). Compared with the postal-group, more participants in the Internet-group perceived they were much or very much improved (40.9% (43/105) vs 26.5% (30/113), P = 0.01), reported reduced usage of incontinence aids (59.5% (47/79) vs 41.4% (34/82), P = 0.02) and were satisfied with the treatment programme (84.8% (89/105) vs 62.9% (71/113), P < 0.001). Health-specific QoL improved in the Internet-group (mean change 3.7 (10.9), P = 0.001), but not in the postal-group (1.9 (13.0), P = 0.13). Overall, 69.8% (120/172) of participants reported complete lack of leakage or reduced number of leakage episodes by >50%.

CONCLUSIONS

Concerning primary outcomes, treatment effects were similar between groups whereas for secondary outcomes the Internet-based treatment was more effective. Internet-based treatment for SUI is a new, promising treatment alternative.

[Transobturatoric sling procedures for stress urinary incontinence in elderly women: indication and results]

Urinary incontinence is one of the great challenges in geriatrics. The prevalence is high in elderly women and increases continuously with increasing age. The consequences of incontinence can be severe and are often associated with social isolation. Placement of a transobturatoric sling is a frequently used option in the surgical treatment of stress incontinence. Continence rates are high and associated with low side effects but several sub-analyses have shown poorer success rates and an increase in perioperative morbidity in women over 70 years. Recent studies, however, point to similarly good success rates and thus provide an effective and safe treatment option.

Prevalence, incidence and obstetric factors' impact on female urinary incontinence in Europe: a systematic review

OBJECTIVES

A systematic review of the published data on the prevalence, incidence and risk factors of female urinary incontinence (UI) and obstetric treatment of UI in Europe.

DATA SOURCES

Epidemiologic studies were sought via PubMed to identify articles published in English, French, Spanish, German and Italian between 2000 and September 30, 2010, in Europe.

RESULTS

The prevalence of UI ranged from 14.1 to 68.8% and increased with increasing age. Significant risk factors for UI in pregnancy were maternal age ≥35 years and initial body mass index, a family history of UI and parity. UI in women who delivered 'at term' ranged from 26 to 40.2%, with a remission rate of 3 months after childbirth of up to 86.4%. Pelvic floor muscle training may help to prevent postpartum UI in primiparous women without UI during pregnancy.

CONCLUSION

UI definition, outcome measures, survey methods and validation criteria are still heterogeneous, and thus it is difficult to compare data and impossible to draw definite conclusions.

Original research: rates of remission, improvement, and progression of urinary incontinence in Asian, Black, and White women

BACKGROUND

Evidence suggests that race affects the prevalence and incidence of urinary incontinence (UI) in women. But little is known about racial differences in the rates of remission, improvement, and progression of UI in women.

OBJECTIVE

We sought to compare changes in UI frequency over two years among Asian, black, and white women with UI.

METHODS

Participants in the Nurses' Health Study and the Nurses' Health Study II responded to mailed questionnaires (in 2000 and 2002, and 2001 and 2003, respectively), giving information on race and the frequency of UI. Prospective analyses were conducted over two years from data gathered on 57,900 women, ages 37 to 79, who had at least monthly UI at baseline.

RESULTS

Over the two two-year study periods, black women were significantly more likely than white women to report remission of UI (14% versus 9%, respectively), and Asian women were significantly more likely than white women to report less frequent UI (40% versus 31%, respectively). Improvement was more common in older black women than in older white women, but rates of improvement were comparable between younger black and younger white women. Black women were less likely than white women to report more frequent UI at follow-up (30% versus 34%, respectively), and, after adjusting for health and lifestyle factors, the difference was borderline statistically significant.

CONCLUSIONS

Changes in the frequency of UI appear to vary by race, even after adjustment for risk factors. These findings may account for some of the previously observed differences in UI prevalence across racial groups. Although UI is a common condition in women of all races, nurses and other clinicians should be aware that its presentation may vary according to race. Such an understanding could increase clinicians' confidence in discussing UI with patients, reducing the possibility that the condition goes unrecognized.

KEYWORDS

epidemiology, progression, race, remission, urinary incontinence.

Urinary incontinence in pregnant women and their quality of life

AIMS AND OBJECTIVES

The aim was to investigate the prevalence of urinary incontinence during pregnancy and the related risk factors as well as to assess its influence on the quality of life.

BACKGROUND

Although urinary incontinence is common during pregnancy and can have a substantial impact on quality of life, women rarely seek help for this symptom.

DESIGN

This study was designed as a cross-sectional and descriptive survey.

METHODS

A total of 393 pregnant women participated in the study between March and June 2007. The data was collected using the International Consultation on Incontinence Questionnaire Short Form and Wagner's quality of life scale. Potential risk factors were investigated through logistic regression analysis.

RESULTS

The prevalence of urinary incontinence was 27% (106/393). Factors significantly associated with urinary incontinence included age group, parity, previous urinary incontinence, constipation, urinary incontinence in mother and sister, previous urinary incontinence during pregnancy and postpartum.

CONCLUSION

According to the results of our study, urinary incontinence is common in women during pregnancy. The quality of life of pregnant women was found to be either unaffected or affected very little by urinary incontinence.

RELEVANCE TO CLINICAL PRACTICE

This study reveals that the prevalence of urinary incontinence during pregnancy is very high. The findings will help increase the awareness of health care workers involved in the care of pregnant women about urinary incontinence and aid the design of more intensive education programmes directed towards the prevention of urinary incontinence during pregnancy.

Incidence of and risk factors for change in urinary incontinence status in a prospective cohort of middle-aged and older women: the reproductive risk of incontinence study in Kaiser

PURPOSE

Urinary incontinence is a dynamic condition that can progress and regress but few groups have examined risk factors for change in incontinence status.

MATERIAL AND METHODS

We used stratified random sampling to construct a racially and ethnically diverse, population based cohort of 2,109 women 40 to 69 years old. Data were collected by questionnaires and medical record review. A second survey approximately 5 years later was completed by 1,413 women (67%) from the original cohort. The frequency of urinary incontinence was categorized as less than weekly, weekly and daily. Change in incontinence status was defined as new onset incontinence, incontinence progression or regression between frequency categories and resolution of incontinence. Predictor variables were demographics, body mass index and other medical conditions. We used logistic regression to estimate the adjusted OR and 95% CI.

RESULTS

Compared to white nonHispanic women, black women were less likely to have incontinence progression (OR 0.46, 95% CI 0.24-0.88). New onset incontinence was more common in women with a higher body mass index at baseline (p = 0.006) and those who experienced increased body mass index (p = 0.03) or decreased general health (p = 0.007) during the study. Participants with chronic obstructive pulmonary disorder at baseline were more likely to report incontinence progression (OR 2.64, 95% CI 1.22-5.70). Baseline incontinence type was not significantly associated with the risk of change in continence status independent of frequency.

CONCLUSIONS

Identifying risk factors for change in incontinence status may be important to develop interventions to decrease the burden of incontinence in the general population.

Changes in self-assessment of continence status between telephone survey and subsequent clinical visit

AIMS

To explore variance in reporting continence information obtained by telephone survey with face-to-face clinician interview in a clinical setting.

METHODS

As part of a cross-sectional, epidemiologic study of incontinence prevalence among Black and White women aged 35-64 years, randomly selected households were contacted from geographic areas of known racial composition. Of 2,814 women who completed a 20-min, 137-item telephone interview, 1,702 were invited for future components of the study. A subset of these women was recruited for a clinical evaluation that was conducted within a mean of 82 days (SD 38 days) following the interviews. Prior to urodynamics testing, a clinician interview was conducted inquiring about continence status. The criterion for incontinence for both the telephone interview and the clinician interview was constant: 12 or more episodes of incontinence per year. Women whose subjective reports of continence information differed between telephone and clinician interviews were designated as "switchers."

RESULTS

Of the 394 women (222 Black and 172 White) who completed the clinical portion, 24.6% (n = 97) were switchers. Switchers were four times more likely to change from continent to incontinent (80.4%, N = 78) than from incontinent to continent (19.4%, N = 19; P = 0.000) and nearly three times more likely to be Black (69%, N = 67) than White (31%, N = 30; P = 0.001). Telephone qualitative interviews were completed with 72 of the switchers. The primary reason for switching was changes in women's life circumstances such as variation in seasons, activities of daily living, and health status followed by increased awareness of leakage secondary to the phone interview.

CONCLUSION

One-time subjective telephone interviews assessing incontinence symptoms may underestimate the prevalence of incontinence especially among Black women.

The Hordaland Women's Cohort: prevalence, incidence, and remission of urinary incontinence in middle-aged women

INTRODUCTION AND HYPOTHESIS

The aim of study is to prospectively investigate the prevalence, incidence, and remission of urinary incontinence (UI) in a cohort of middle-aged women.

METHODS

In 1997-1999, 2,229 randomly selected women aged 41-45 agreed to participate in the Hordaland Women's Cohort, and six almost identical postal questionnaires were sent them during the following 10 years. Response rate was 95.7% at inclusion and has remained 87% to 93% in subsequent waves; 64.1% answered all six questionnaires. UI variables include type, amount, frequency, and severity.

RESULTS

Prevalence of UI increased by age until a peak in age group 51-52 years for any (50.3%) and significant (10.0%) UI. There was then a decrease in prevalence caused by a decrease in incidence and decrease in remission. Stress UI was the major type and most UI was of low severity.

CONCLUSION

Prevalence of any UI is high in middle-aged women but reaches a peak followed by a decrease.

Urinary incontinence, overactive bladder, and other lower urinary tract symptoms: a longitudinal population-based survey in men aged 45-103 years

BACKGROUND

Lower urinary tract symptoms (LUTS) such as urinary incontinence (UI) and overactive bladder (OAB) are highly prevalent conditions, but there are few studies describing progression and remission of LUTS in men, especially over the long term.

OBJECTIVE

To describe the prevalence of UI, OAB, and LUTS using current International Continence Society definitions in the same men studied longitudinally over time.

DESIGN

Prospective, population-based, longitudinal study.

SETTING AND PARTICIPANTS

In 1992, 10 458 men aged 45-99 yr, resident in the city of Gothenburg, were selected at random from the Population Register.

MEASUREMENTS

The men received a postal questionnaire about the presence of LUTS, as well as questions on social, medical, health-related quality of life (HRQoL), and demographic data. Responders in 1992 were reassessed 11 yr later in 2003 using a similar questionnaire.

RESULTS AND LIMITATIONS

In 2003, 4072 of the 7763 men who responded in 1992 were still available in the Population Register and 3257 men (80%) aged 56-103 yr, responded. Prevalence of UI and OAB had increased (p<0.01) in the same men assessed in 1992 (4.5% and 15.6%, respectively) and 2003 (10.5% and 44.4%, respectively). The prevalence of nocturia, urgency, slow stream, hesitancy, incomplete emptying, postmicturition dribble, and the number of daytime micturitions had also increased (p<0.01). Only a minority reported regression of symptoms. Men with UI or OAB reported a poorer (p<0.001) HRQoL compared with men without UI or OAB.

CONCLUSIONS

There was a marked increase in the prevalence of UI, OAB, and other LUTS in the same men assessed longitudinally over this 11-yr period. UI and OAB had a negative influence on HRQoL, and men who developed UI or OAB had a greater deterioration in HRQoL than men who had no change in their UI/OAB status over time.

Prevalence of urinary incontinence in a community sample from the city of São Paulo

PURPOSE

The aim of this study was to analyze the prevalence of urinary incontinence (UI) in a community sample from the city of São Paulo.

METHODS

This epidemiological survey was conducted at a family health program in São Paulo, Brazil, using randomized sampling. Data were collected by interviewing residents and were analyzed by Pearson's correlation coefficients, chi-square tests, and logistic regression analysis.

RESULTS

Seventy (10.7%) of the 657 subjects currently presented UI, including 50.7% with sporadic UI and 74.3% with UI upon moderate efforts. Ninety-three percent woke up during the night, 43.7% maintained continence until the bathroom, 63.4% had a sensation of wetness, and 77.5% reported no use of any continence aids. Female gender, advanced age, gynecologic or urologic surgery, dysuria, and urinary tract infection were correlated with UI (P < .001; r = 0.572).

CONCLUSION

The overall prevalence of UI was found to be high and was comparable to results from multiple countries.

Lower urinary tract symptoms in women

PURPOSE OF REVIEW

To summarize recent population-based literature on the prevalence and consequences of urinary incontinence and overactive bladder (OAB) symptoms in women and describe our present knowledge regarding known risk factors.

RECENT FINDINGS

The prevalence of urinary incontinence in women ranged from 5 to 69%, with most studies reporting a prevalence of any urinary incontinence in the range of 25-45%. In a longitudinal population study in which women were followed for 16 years, the overall prevalence of urinary incontinence increased from 15 to 28%, and the incidence rate of urinary incontinence was 21%, whereas the corresponding remission rate was 34%. Increasing evidence is now available regarding a genetic component in the cause of stress urinary incontinence. The reported prevalence of OAB in women varied between 7.7 and 31.3%, and in general, prevalence rates increased with age. In a longitudinal study, the prevalence of OAB, nocturia and daytime micturition frequency of eight or more times per day increased by 9, 20 and 3%, respectively, in a cohort of women followed from 1991 to 2007. The incidence of OAB was 20%, and the corresponding remission rate was 43%.

SUMMARY

Urinary incontinence and OAB are highly prevalent conditions. The cost of illness for urinary incontinence and OAB is a substantial economic and human burden and is likely to increase further in the future, highlighting the need for effective forms of management.

Living with urinary incontinence: a longitudinal study of older women

BACKGROUND

urinary incontinence carries major social burden and considerable costs for health care systems.

OBJECTIVE

the aim of this study was to investigate changes in continence status among a large cohort of older women, and to identify factors associated with incidence of incontinence in later life.

SUBJECTS

participants of the Australian Longitudinal Study of Women's Health (ALSWH), aged 70-75 years in 1996 and who have completed four health surveys over the past 10 years.

METHODS

continence status across four survey periods, spanning 9 years, were defined according to women's reports of 'leaking urine' at each survey. Generalised estimating equation (GEE) models were used in longitudinal analyses of the factors associated with changing continence status over time.

RESULTS

this study presents longitudinal data on the prevalence and incidence of incontinence from a large cohort of older women, over 9 years of follow-up. Over this time, 14.6% (95% CI 13.9-15.3) of the women in the study who had previously reported leaking urine 'rarely' or 'never' developed incontinence, and 27.2% (95% CI 26.2%, 28.3%) of women participating in Survey 4 (S4) in 2005 reported leaking urine 'sometimes' or 'often' at that survey, with women being twice as likely to report incontinence at S4 as they were 6 years earlier. Longitudinal models demonstrated the association between incontinence and dementia (P < 0.001; OR = 2.34; 95% CI 1.64, 3.34), dissatisfaction with physical ability (P < 0.001; OR = 1.70; 95% CI 1.52, 1.89), falls to the ground (P <0.001; OR = 1.23; 95% CI 1.13, 1.33), BMI (P < 0.001; OR = 2.18; 95% CI 1.70, 2.80 for obese), constipation (P < 0.001; OR 1.46; 95% CI 1.34-1.58), urinary tract infection (P < 0.001; OR 2.07; 95% CI 1.89-2.28), history of prolapse (P </= 0.001; OR = 1.53; 95% CI 1.35, 1.74) and prolapse repair (P = 0.002; OR = 1.23; 95% CI 1.08, 1.40). Stroke (P = 0.01), parity (P = 0.017) and hysterectomy (P = 0.026) and number of visits to the general practitioner (P = 0.040) were less strongly associated with incontinence in the final longitudinal model. Incontinence was not significantly associated with area of residence (P = 0.344), education (P = 0.768), smoking (P = 0.055), diabetes (P = 0.072), attending support groups (P = 0.464) or attending social groups (P = 0.022).

CONCLUSION

strong associations between BMI, dysuria and constipation indicate key opportunities to prevent incontinence among older women.

Incidence and remission of urinary incontinence in a community-based population of women ≥ 50 years

INTRODUCTION AND HYPOTHESIS

The objective of the study was to determine incidence, remission, and predictors of change in urinary incontinence in women ≥ 50 in a racially diverse population.

METHODS

Subjects were women ≥ 50 with 4-year follow-up incontinence information in the Health and Retirement Study. Women with Any UI (AUI) and Severe UI (SVUI) were evaluated. Repeated measures logistic regression determined predictors of progression to and improvement of SVUI.

RESULTS

Women (11,591) were evaluated. AUI 4-year cumulative incidence was 12.7-33.8% (fifth vs. ninth decades). SVUI incidence was lower but also increased with age. Among the predictors of improvement in SVUI were age (ninth vs. fifth decade odds ratios (OR) = 6.06) and ethnicity (Black vs. White OR = 0.57). Improvement of SVUI (45.8% overall) decreased with age (ninth vs. fifth decade OR = 0.12).

CONCLUSIONS

SVUI incidence increased and remission decreased with age. Ethnicity and age predicted SVUI progression while age predicted improvement. Rates of the latter were high, particularly in younger patients.

The Hordaland Women's Cohort: a prospective cohort study of incontinence, other urinary tract symptoms and related health issues in middle-aged women

Background

Urinary incontinence (UI) is a prevalent symptom in middle-aged women, but data on incidence is limited and rarely reported. In order to analyze incidence, remission, or development patterns of severity and types of UI, we have established a 15-year prospective cohort (1997–2012).

Methods

The Cohort is based on the national collection of health data gathered from county studies (CONOR). Hordaland Health Study (HUSK) is one of them from Hordaland County. Each of the county studies may have local sub-studies and our Cohort is one of them. The Cohort included women aged 40–45 in order to have a broad approach to women's health including UI and other lower urinary tract symptoms (LUTS). A onefifth random sampling from HUSK was used to create the Cohort in 1997–1999. For the necessary sample size a preliminary power calculation, based on a 70% response rate at inclusion and 5% annual attrition rates was used. The Cohort is planned to collect data through questionnaires every second year for the 15-year period from 1997–2012.

Discussion

The Cohort represents a relatively large random sample (N = 2,230) of about 15% of the total population of women born between 1953–57 in the county of Hordaland. Our data shows that the cohort population is very similar to the source population. The baseline demographic, social and medical characteristics of the Cohort are compared with the rest of women in HUSK (N = 7,746) and there were no significant differences between them except for the level of education (P = 0.001) and yearly income (P = 0.018), which were higher in the Cohort population. Urological characteristics of participants from the Cohort (N = 1,920) were also compared with the other participants (N = 3,400). There were no significant statistical differences except for somewhat more urinary continence (P = 0.04), more stress incontinence (P = 0.048) and smaller amount of leakage (P = 0.015) in the Cohort. In conclusion, the Cohort ispopulation-based, with little selection bias, and thus is a rather unique study forinvestigating UI and LUTS in comparison with many other projects with similar purposes.

Urinary incontinence in women: variation in prevalence estimates and risk factors

OBJECTIVE

To understand variation in prevalence of urinary incontinence (UI) and risk factors, given different definitions.

METHODS

The National Health and Nutrition Examination Survey 2001-2002 data on UI were used. Prevalence, severity, and associated risk factors of stress, urge, mixed, and any UI were estimated in 2,875 adult women. Severe UI was defined as incontinence a few times or more per week. Moderate UI was defined as an incontinence frequency of a few times per month only, and mild UI was defined as incontinence frequency of a few times per year only. Odds ratios for the association of potential risk factors were examined in a logistic regression model.

RESULTS

The overall prevalence of stress, urge, mixed, and any UI was 23.7%, 9.9%, 14.5%, and 49.2%, respectively. Prevalence of stress UI peaked at the fifth decade. Prevalence of urge and mixed UI increased with age. The largest number of risk factors and the strongest associations were found with severe UI. Age, ethnic background, and weight were significant risk factors common to all UI severity levels. Although parity and hysterectomy were risk factors for moderate and severe UI, they were not for mild UI.

CONCLUSION

Prevalence of UI varies substantially by type and case definition. The stronger associations of known risk factors with severe UI and the lack of risk factors with lesser UI severity types suggest that severe UI includes primarily clinically significant cases, whereas mild UI represents transient or nonpathologic states that may not be clinically significant.

LEVEL OF EVIDENCE

III.

Bacteriuria is associated with urge urinary incontinence in older women

OBJECTIVE

To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men.

DESIGN

Cross-sectional study.

SETTING

The catchment area of a primary healthcare centre in a Swedish middle-sized town.

SUBJECTS

Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537).

MAIN OUTCOME MEASURES

Urinary cultures and questionnaire data on urinary incontinence.

RESULTS

In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35-5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49-7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence.

CONCLUSION

Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.

The Natural History of Lower Urinary Tract Symptoms in Females: Analysis of a Health Screening Project

OBJECTIVE

To analyse over 6.5 yr the natural history of lower urinary tract symptoms (LUTS) of continent women participating in a health investigation.

METHODS

Women participating in a health screening survey in the area of Vienna in 1998-1999 underwent a detailed health investigation and completed the Bristol Female LUTS questionnaire. In 2005, all women still living in the area of Vienna were contacted by mail to complete the Bristol LUTS questionnaire again. For the current study, only women without urinary incontinence at baseline and follow-up were eligible.

RESULTS

A total of 223 women (mean age, 50.3 yr; range, 21-79) were included in this 6.5-yr longitudinal study. At baseline, 80 women (35.9%) reported LUTS; this number increased to 105 (47.1%) 6.5 yr later. The calculated mean annual incidence of LUTS was 5.3% and revealed no clear dependency on age: 20-39 yr, 5.6%; 40-59 yr, 5.9%; > or =60 yr, 3.7%. The mean annual remission rate of LUTS was 4.6% without clear age dependency. Symptoms most likely to improve were "urgency"; "frequency"; "nocturia" and "feeling of incomplete bladder emptying" had the highest tendency of worsening.

CONCLUSIONS

This longitudinal study on the natural history of LUTS in women without urinary incontinence provides estimates for incidence and remission rates over 6.5 yr. Compared with men, LUTS in women are a dynamic rather than a necessarily progressive disorder.

Incidence and remission of urinary incontinence in middle-aged women

OBJECTIVE

The objective of the study was to describe changes in urinary incontinence in middle-aged women.

STUDY DESIGN

A prospective analysis of 64,650 women aged 36-55 years in the Nurses' Health Study II. Participants reported urine leaking in 2001 and 2003. Two-year incidence and remission proportions were estimated.

RESULTS

The 2-year incidence of incontinence was 13.7%. Incidence generally increased through age 50 years and then declined slightly in older women. Among women with incident incontinence at least weekly, the incidence of stress incontinence increased through age 50 years (2-year incidence 1.7%), and the incidence of urge incontinence was stable across age groups (2-year incidence 0.4%). Also, a minority (38%) mentioned leaking to their physician. Complete remission of symptoms occurred in 13.9% of women with incontinence at baseline.

CONCLUSION

We found that incontinence occurs frequently in middle-aged women. Yet few women mentioned incontinence to their physicians; thus, it may be important to initiate conversations about urinary symptoms even among younger patients.

Long-term results of the pelvic floor muscle training for female urinary incontinence: An 8-year transition tree and predictive parameters

AIMS

The pelvic floor muscle (PFM) training is effective in alleviating the symptoms of urinary incontinence, but there are very few reports available on its long-term effectiveness. Therefore, 8-year follow-up data have been prospectively analyzed.

MATERIALS AND METHODS

Originally 123 women with stress or mixed urinary incontinence participated in an 8-week intensive PFM training program. The training comprised repeated muscle contractions of the pelvic floor and the timely locking of the perineum. An average of 8 years (6-10) had elapsed between the time of present assessment and the completion of the original training. Seventy-nine women were subjected to the present analysis. Self-reported responses of "completely cured" and "more than 50% improved" were regarded as treatment success (TS). An 8-year transition tree and predictive parameters were analyzed.

RESULTS

The success rate of the training was 39% at the 8-year follow-up. The transition tree demonstrated that the continence/incontinence status has been varying in 42% of the women, while it was stable in 58% throughout the follow-up period. The 6-year incidence and remission rates of incontinence were 34% and 18%, respectively. The higher pressure difference in the vaginal contraction strength between the baseline and strength at the end of the training is a predictive parameter of the long-term TS.

CONCLUSIONS

The results suggest that the 8-year TS rate was 39% and that the altered patterns of the continence status and incidence and remission rates of incontinence were similar to those observed in the general population.

Transobturator tape procedure outcome: a clinical and quality of life analysis of a 1-year follow-up

To report the results obtained with the transobturator sub-urethral tape (TOT) for the surgical treatment of stress urinary incontinence (SUI) after 1 year follow-up. Ninety-three patients diagnosed with SUI or mixed urinary incontinence (MUI) underwent a TOT procedure associated to prolapse surgery, if necessary. Pre-operative quality of life (QoL) was assessed with the Urogenital Distress Inventory Short Form (UDI-6)/Incontinence Impact Questionnaire Short Form (IIQ-7) questionnaires. Surgical and early complications were monitored. A stress test and an urodynamic test if urge incontinence de novo appeared were performed at 1 year follow-up. UDI-6/IIQ-7 questionnaires and SUI symptoms were recorded. Patients' characteristics, pre-operative quality of life and urodynamic evaluation were similar in the TOT and in the pelvic floor surgery group. From the sample, 15% had post-operative retention and 10% had vaginal erosion. The global rate of objective cure was 97% in both groups. The scores of the QoL questionnaires were worse by 9% and 10% with the procedure, respectively. Patients with urodynamic (MUI) or persistence of SUI symptoms (10%) did not reach a significant improvement, although patients with urge incontinence de novo (10%) did. The TOT procedure is safe and effective. Results showed that the association to pelvic floor surgical techniques did not diminish 1 year later. The stress test outcome assessment can overestimate the results, compared to the QoL assessment. In our report, the MUI did not improve with this surgical approach. Our results highlight the necessary employment of both the objective testing and the patient's opinion of her symptoms during daily life.

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.