Urinary incontinence in women comes and goes, and reasons remain elusive

Efeito da incontinência urinária na autopercepção negativa da saúde e depressão em idosos: uma coorte de base populacional

Resumo Objetivou-se medir a prevalência de autopercepção negativa da saúde e sintomas depressivos em idosos segundo a presença de incontinência urinária, após nove anos de acompanhamento. Trata-se de um estudo de coorte prospectivo de base populacional intitulado Saúde do Idoso Gaúcho de Bagé, no Rio Grande do Sul. Foram entrevistados 1.593 idosos no estudo de linha de base (2008) e 735 entre setembro de 2016 e agosto de 2017. A exposição “incontinência urinária (IU)” foi avaliada no estudo de linha de base e os desfechos “autopercepção negativa da saúde” e “sintomas depressivos” em 2016/17. A razão de odds e o intervalo de confiança de 95% foram calculados com regressão logística bruta e ajustada para variáveis demográficas, sociais, comportamentais e de condições de saúde. A prevalência de IU foi 20,7% em 2008 e 24,5% em 2016/17; a incidência foi de 19,8%, sendo 23,8% entre as mulheres e 14,6% entre os homens (p = 0,009). Idosos com IU no estudo de linha de base apresentaram chances 4,0 (IC95%:1,8-8,8) e 3,4 (IC95%:1,8-6,2) vezes maior de desenvolver autopercepção negativa da saúde e sintomas depressivos, respectivamente, após nove anos de acompanhamento, comparados àqueles sem IU. Os resultados evidenciam maior chance de problemas mentais entre idosos com IU.

Prevalence and associated factors of urinary incontinence in women living in China: a literature review

Background

This review of studies on urinary incontinence (UI) was focused primarily on UI prevalence rates and associated factors across the adult lifecourse of Chinese women. UI is a urologic symptom that can have a significant impact on women's physical and mental health and quality of life. In addition, women with UI may experience socioeconomic burdens due to UI’s effect on their ability to work and function in society. Although researchers from many countries have reported prevalence rates and associated factors for UI, little is known about the prevalence of UI in China’s large female population. Language may act as a barrier to the inclusion of published studies in English-language journals. To overcome this barrier and to add to the global knowledge base about UI in women, the authors reviewed and discussed findings from epidemiological studies published in China and in Chinese language.

Methods

The authors retrieved research studies from the Wanfang database using the following search terms: "Subject: (Female) × Subject: (Urinary incontinence) × Subject: (Prevalence) × Date: 2013 to 2019". Searches employed the China National Knowledge Infrastructure Database, VIP Database for Chinese Technical Periodicals and China Biology Medicine Database. The authors also used PubMed to search English-language studies published in Chinese journals on UI in Chinese women.

Results

This literature review includes 48 articles published between January 2013 and December 2019. The overall UI prevalence rates reported in adult Chinese women ranged from 8.7 to 69.8%, representing 43–349 million women, respectively. For women aged 17–40 years, 41–59 years, and 60 years and older, prevalence rates ranged from 2.6–30.0, 8.7–47.7, to 16.9–61.6%, respectively. Significant associated factors for overall UI included age, body mass index, constipation, parity, and menopause. Despite the 17–40 age range being peak reproductive years, the literature revealed little focus on UI prevalence rates. For women aged 41–59 years, the main associated factors included those related to pregnancy and gynecologic diseases. For women 60 years and older, chronic diseases represented most of the associated factors.

Conclusions

About 43–349 million Chinese women may experience UI. Many of the identified associated factors could be mitigated to reduce UI incidence and prevalence rates. Little is known about the prevalence rates and associated factors for UI among young (aged 17–40) Chinese women. Future research should investigate UI in young women to improve bladder health across their lifecourse.

Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial

OBJECTIVE

Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, faecal, or flatal incontinence?

DESIGN

Women between 32^0/7 and 38^6/7 weeks of gestation with a twin pregnancy were randomised to planned caesarean or planned vaginal birth.

SETTING

The trial took place at 106 centres in 25 countries.

POPULATION

A total of 2305 of the 2804 women enrolled in the study completed questionnaires at 2 years (82.2% follow-up): 1155 in the planned caesarean group and 1150 in the planned vaginal birth group.

METHODS

A structured self-administered questionnaire completed at 2 years postpartum.

MAIN OUTCOME MEASURES

The primary maternal outcome of the Twin Birth Study was problematic urinary stress, or fecal, or flatal incontinence at 2 years RESULTS: Women in the planned caesarean group had lower problematic urinary stress incontinence rates compared with women in the planned vaginal birth group [93/1147 (8.11%) versus 140/1143 (12.25%); odds ratio, 0.63; 95% confidence interval, 0.47-0.83; P = 0.001]. Among those with problematic urinary stress incontinence, quality of life (measured using the Incontinence Impact Questionnaire, IIQ-7) was not different for planned caesarean versus planned vaginal birth groups [mean (SD): 18.4 (21.0) versus 19.1 (21.5); P = 0.82]. There were no differences in problematic faecal or flatal incontinence, or in other maternal outcomes.

CONCLUSIONS

Among women with a twin pregnancy and no prior history of urinary stress incontinence, a management strategy of planned caesarean compared with planned vaginal birth reduces the risk of problematic urinary stress incontinence at 2 years postpartum. Our findings show that the prevalence but not the severity of urinary stress incontinence was associated with mode of birth.

FUNDING

Canadian Institutes of Health Research (CIHR) (grant no. MCT-63164).

TWEETABLE ABSTRACT

For women with twins, planned caesarean compared with planned vaginal birth is associated with decreased prevalence but not severity of urinary stress incontinence at 2 years.