Leaking urine: prevalence and associated factors in Australian women

Limited evidence of a threshold effect for increasing adiposity on risk of symptoms at midlife

OBJECTIVE

To assess the nature of relationships between increasing body mass index (BMI) and the prevalence of midlife symptoms in a population with high adiposity.

METHODS

In the cross-sectional Study of Women's Health in Qatar, 841 participants aged 40 to 60 years were recruited from nine primary health centers in Doha. Face-to-face interviews collected demographic, menopause, and symptom information. BMI (kg/m 2 ) was categorized as healthy, overweight, or class I, II, or III obesity. Multivariate logistic regression models were used to examine aches/stiffness in joints, trouble sleeping, shortness of breath, urinary incontinence, and hot flashes with BMI categories. Restricted cubic splines (RCSs) were used to estimate relationships between continuous BMI and each symptom and to conduct formal tests of nonlinearity.

RESULTS

Mean BMI was 34.3 kg/m 2 (SD, 6.0 kg/m 2 ). Women with class II and III obesity had higher odds of reporting aches/stiffness than women with a healthy BMI, and the odds of reporting urinary incontinence were three times higher among women with class III obesity (odds ratio, 3.08; 95% confidence interval, 1.17-8.14). Using restricted cubic spline models, a significant nonlinear association ( P = 0.002) was observed between aches/stiffness and BMI with an apparent threshold of 38 kg/m 2 . Linear relationships were observed with BMI for urinary incontinence ( P < 0.001 for linear trend) and shortness of breath ( P = 0.005 for linear trend). Trouble sleeping and hot flashes were not associated with BMI.

CONCLUSIONS

Even at very high levels of BMI, likelihood of urinary incontinence and shortness of breath increases with BMI. In contrast, likelihood of aches/stiffness has a nonlinear relationship with BMI, increasing to a threshold level.

Is urethral pressure associated with parity and delivery mode?

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence is the most prevalent type of urinary incontinence and childbirth is a risk factor. The aim of this study is to evaluate the association between delivery mode and urethral sphincter function as measured by the maximum urethral pressure (MUP).

METHODS

A retrospective study on women seen in a tertiary urogynaecological center for urodynamic testing between January 2017 to December 2019. Women were classified into the following groups: (1) nulliparous; (2) caesarean section only; (3) at least one spontaneous vaginal delivery but no instrumental deliveries; (4) at least one vacuum delivery but no forceps; (5) at least one forceps delivery.

RESULTS

The complete data sets of 1238 women were analysed; 1112 (90%) were vaginally parous. Mean age was 58 (18-95) years. Mean parity was 2.6 (0-9); 57 (4.6%) were nulliparous, 69 (5.6%) had only been delivered by caesarean section, 762 (61.6%) had at least one spontaneous vaginal delivery but no instrumental deliveries, 41 (3.3%) had at least one vacuum but no forceps delivery, and 309 (25%) had at least one forceps delivery. Mean MUP was 41.8 cmH₂O. There was a significant association between vaginal parity and MUP (P < 0.001). On ANOVA test, delivery mode was significantly associated with MUP. This became nonsignificant on regression analysis, with only age significantly associated with MUP (P < 0.001).

CONCLUSIONS

The effect of childbirth on urethral sphincter function seems to be largely due to the first vaginal birth. We failed to show an effect of instrumental delivery.

Pilot study exploring the incidence of lower urinary tract symptoms during pregnancy in a district general hospital in Northern Ireland: a prospective survey

INTRODUCTION AND HYPOTHESIS

The objective of this study was to ascertain the prevalence of lower urinary tract symptoms (LUTS) during pregnancy with a prospective survey in the UK.

MATERIALS AND METHODS

Pregnant women over the age of 18 years booked for shared antenatal care at a district general hospital were asked to complete a validated 14-stem questionnaire enquiring about lower urinary tract symptoms. (ICIQ-FLUTS). Primary outcome measure was completion of the ICIQ-FLUTS questionnaire. Secondary analysis included the prevalence and odds ratios of individual symptoms that make up the ICIQ-FLUTS score.

RESULTS

In all, 383 women completed the questionnaire. The most common symptom reported was urgency with a prevalence of 80%. Urgency was over twice as likely to be reported in those with a BMI > 30. The next most common symptom reported was stress incontinence with 65% of participants reporting some leakage on exertion. The likelihood of reporting stress incontinence increased with parity, BMI > 30 and participants in the third trimester with odds ratios of 1.81, 2.07 and 2.09, respectively. Women were almost four times more likely to report any type of urinary incontinence if they had had a vaginal birth in their first pregnancy compared to those who had a caesarean section and women who had a forceps delivery were seven times more likely to report incontinence.

CONCLUSIONS

The antenatal period may represent an important opportunity for health promotion and intervention. The high prevalence of LUTS in our antenatal population highlights the need to educate women on bladder care.

Pilot study exploring the incidence of lower urinary tract symptoms during pregnancy in a district general hospital in Northern Ireland: a prospective survey

INTRODUCTION AND HYPOTHESIS

The objective of this study was to ascertain the prevalence of lower urinary tract symptoms (LUTS) during pregnancy with a prospective survey in the UK.

MATERIALS AND METHODS

Pregnant women over the age of 18 years booked for shared antenatal care at a district general hospital were asked to complete a validated 14-stem questionnaire enquiring about lower urinary tract symptoms. (ICIQ-FLUTS). Primary outcome measure was completion of the ICIQ-FLUTS questionnaire. Secondary analysis included the prevalence and odds ratios of individual symptoms that make up the ICIQ-FLUTS score.

RESULTS

In all, 383 women completed the questionnaire. The most common symptom reported was urgency with a prevalence of 80%. Urgency was over twice as likely to be reported in those with a BMI > 30. The next most common symptom reported was stress incontinence with 65% of participants reporting some leakage on exertion. The likelihood of reporting stress incontinence increased with parity, BMI > 30 and participants in the third trimester with odds ratios of 1.81, 2.07 and 2.09, respectively. Women were almost four times more likely to report any type of urinary incontinence if they had had a vaginal birth in their first pregnancy compared to those who had a caesarean section and women who had a forceps delivery were seven times more likely to report incontinence.

CONCLUSIONS

The antenatal period may represent an important opportunity for health promotion and intervention. The high prevalence of LUTS in our antenatal population highlights the need to educate women on bladder care.

Urinary Incontinence Among Omani Women: Prevalence, risk factors and impact on quality of life

Objectives

Urinary incontinence (UI) in women is a common health problem which can have a negative impact on quality of life (QOL). This study aimed to determine the prevalence, risk factors and impact of UI on the QOL of Omani women attending primary healthcare centres in Muscat, Oman.

Methods

This cross-sectional study was conducted at three primary healthcare centres in Muscat from April to August 2018. Women who were 20–50 years of age, not pregnant, not in the six-month postnatal period, not seriously ill and not diagnosed with pelvic organ prolapse were included. A self-administered questionnaire using the International Consultation Incontinence Questionnaire-Short Form was used to evaluate the frequency, severity and impact of UI on QOL.

Results

A total of 1,070 women were included in this study (response rate = 92.5%). The mean age was 31.39 ± 7.64 years. UI was reported by 369 (34.5%) women, of whom 182 (49.3%) had stress UI, 97 (26.3%) had urgency UI, 88 (23.8%) had mixed UI and two (0.5%) had other UI. Age, body mass index (BMI), having been married or employed, hypertension, cough, constipation and vaginal or assisted vaginal delivery during the previous birth were significant risk factors for UI. Only 41 (11.1%) out of the 369 women with UI had ever sought medical advice despite the fact that more than two thirds of the women with UI reported negative effects on their QOL.

Conclusion

UI is a common medical problem in Oman. Several risk factors, including age and BMI, were identified. Despite its negative consequences for QOL, women were found to be reluctant to seek medical attention for the condition.

The effect of childbirth on urinary incontinence: a matched cohort study in women aged 40-64 years

BACKGROUND

The relative impact of age, pregnancy and vaginal delivery on urinary incontinence is still an unresolved issue that involves the controversial question about the protective effect of cesarean delivery.

OBJECTIVE

The purpose of this study was to estimate and compare the effect size of 1 pregnancy, 1 vaginal delivery, and the derived protective effect of cesarean delivery for different aspects of urinary incontinence in women 40-64 years old, all 20 years after birth.

STUDY DESIGN

This Swedish nationwide matched cohort study involved 14,335 women. Data from 3 restricted, randomly selected, source cohorts of (1) nulliparous women who were unexposed to childbirth (n=9136), (2) primiparous women who had experienced cesarean delivery and who had been exposed to 1 pregnancy (n=1412), and (3) primiparous women who had been exposed to 1 pregnancy followed by vaginal delivery (n=3787) were retrieved from The Swedish Medical Birth Register and Statistics Sweden and surveyed in 2008 and 2014, respectively. Parous women were all assessed 20 years postnatally. One-to-one matching with an interval for pairing of 3 years and 3 body mass index units was used in women 40-64 years old with information about body mass index (kilograms/square meters) and urinary incontinence. The procedure succeeded in 2630 of 2635 women (99.8%) and resulted in an adequate distribution of age and body mass index between groups. The surveys used a postal- and an internet-based questionnaire with validated questions for various aspects of urinary incontinence. Fisher's exact test and the Mann-Whitney U test were used for comparisons between matched groups; trend was analyzed with Mantel-Haenszel statistics. Predicted, age-related values of different aspects of urinary incontinence were obtained by logistic regression analysis.

RESULTS

Pregnancy increased the prevalence of urinary incontinence from 20.1-30.1% (odds ratio, 1.71; 95% confidence interval, 1.43-2.05; P<.0001]. Urinary incontinence increased further after vaginal delivery to 43.0% (odds ratio, 1.75; 95% confidence interval, 1.49-2.05; P<.0001); "moderate" and "severe" urinary incontinence increased from 12.7-19.5% (odds ratio, 1.67; 95% confidence interval, 1.35-2.07; P <.0001). There was a parallel increase in urinary incontinence from 40-65 years of age in nulliparous and vaginally and cesarean delivered women. Cesarean delivery, compared with vaginal delivery, was associated with a 30.0% reduction of urinary incontinence (P<.0001) and a 35-52% reduction of more severe grades of urinary incontinence (P<.0001) and was unaffected by age.

CONCLUSION

Both pregnancy and vaginal delivery incurred an increased risk of urinary incontinence in the long term. The age-related gap for urinary incontinence between nulliparous and primiparous women who were delivered by vaginal delivery or cesarean delivery was constant between parallel trajectories that spanned ages from 40-64 years. The calculated protective effect of cesarean delivery was unaltered and significant during the same age interval.

Will cesarean section increase the risk of interstitial cystitis/painful bladder syndrome?

AIMS

A high number of patients with interstitial cystitis/painful bladder syndrome (IC/PBS) have a history of pelvic surgeries, and cesarean section is one of the most common pelvic surgeries in women. This study aimed to investigate if cesarean section increases the risk of IC/PBS.

METHODS

Women who exclusively gave birth through cesarean section or vaginal delivery were identified from a nationwide database between 2002 and 2013. All were followed up during the study period to detect the event of IC/PBS. The IC/PBS hazard ratio (HR) in the cesarean cohort was compared with the vaginal delivery cohort with and without matching for confounding factors.

RESULTS

The unmatched group included 22 158 cesarean deliveries and 40 214 vaginal deliveries. The IC/PBS HR in the cesarean cohort compared with that in the vaginal delivery cohort was 1.370 (95% confidence interval [CI], 0.903-2.079; P = 0.139). In the matched group, 8368 women were matched in each cesarean and vaginal delivery cohort using propensity scores for age and comorbidities. The IC/PBS HR was 0.725 (95%CI, 0.358-1.471; P = 0.373). Both HRs in these two groups were not significantly different. The incidence density of IC/PBS in delivered women, non-delivery women, and the general female population were not significantly different either (0.310, 0.255, and 0.292 per 1000 person-years, respectively; P = 0.549).

CONCLUSIONS

The risk of IC/PBS was not different between cesarean and vaginal delivery after controlling the confounding factors in this cohort study. Cesarean section has no causal effect on IC/BPS. Furthermore, delivery was not a risk factor for IC/PBS.

Clinical study of effectiveness and safety of CELcomplex® containing Cucurbita Pepo Seed extract and Flax and Casuarina on stress urinary incontinence in women

Aim

The safety and effectiveness of a preparation containing a mix of Cucurbita Pepo Seed extract, Equisetum arvense and Linum usitatissimum - Flax A (CELcomplex^®) on stress urinary incontinence (SUI) was evaluated in female patients recruited from 20 urological and gynaecological outpatient clinics in Slovakia.

Methods

A total of 86 women aged from 32 to 88 with SUI (grade 1 = 44, grade 2 = 42) were enrolled in the study and followed-up for six weeks (point 1) and twelve weeks (point 2). The primary outcome of the study was evaluated by changes in day-time and nocturnal urinary frequency (bathroom visits) and urinary incontinence episodes (leaks). Also, adverse events were quantified as well as the self-perceived effectiveness of the treatment. Research Ethics Board approval was obtained for this study.

Results

After 12 weeks of treatment there was a 30% (grade 1 SUI, p < 0.01), and 35% (grade 2 SUI, p < 0.01) improvement in urinary incontinence episodes, a 40% (grade 1 SUI, p < 0.01) and 26% (grade 2 SUI, p < 0.01) improvement in day-time urination frequency and 64% (grade 1 SUI, p < 0.01) and 54% (grade 2 SUI, p < 0.01) improvement in nocturnal urinary frequency. Reported side effects were: headache (3.5%), flatulence (4.1%) and gastrointestinal discomfort (3%). A total of 89.4 % of women in the study reported no side effects from this therapy and 97% acknowledged improvement of symptoms.

Conclusion

This clinical study demonstrated that a 12 week treatment with a mix of Cucurbita Pepo Seed extract, Equisetum arvense and Linum usitatissimum - Flax A (CELcomplex^®) is highly effective on stress urinary incontinence (SUI) with minimum adverse events. Further studies may be needed in order to determine the effectiveness and efficacy of this phytotherapy in other populations.

Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study

INTRODUCTION

Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.

MATERIAL AND METHODS

This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and six months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses.

RESULTS

Birthweight was associated with significantly higher risk of urinary incontinence six months postpartum [3541-4180 g: odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.6; >4180 g: OR 1.6, 95% CI 1.2-2.0]. Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence six months postpartum; birthweight ≥3540 g and ≥36 cm head circumference; birthweight ≥3540 g and forceps, birthweight ≥3540 g and episiotomy; and ≥36 cm head circumference and episiotomy.

CONCLUSION

Some combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence six months postpartum in a synergetic way.

Is there an association between back pain and stress incontinence in adults with cystic fibrosis? A retrospective cross-sectional study

BACKGROUND

Back pain and stress urinary incontinence (SUI) are common in adults with cystic fibrosis (CF). This study aimed to establish whether there is an association between back pain, lung function and stress urinary incontinence and its relative risk.

METHOD

This was a cross-sectional, retrospective analysis of the Manchester Musculoskeletal Screening Tool (MMST) data. It includes pain, (Short Form McGill Pain Questionnaire (SF-MPQ and VAS)) and International Consultation on Incontinence Short Form (ICIQ-UI-SF) measures. Associations were tested using Spearman's rank correlation coefficient. Relative risk of developing symptoms was calculated the sig level was p=0.05.

RESULTS

ICIQ-UI-SF was associated with back pain (SF-MPQ) (Rho=0.32, p<0.001) and pain (VAS) (Rho=0.23, p<0.01). RR of developing SUI with back pain was 2; RR of developing back pain with SUI was 1.3.

CONCLUSIONS

An association is indicated between back pain (SF-MPQ and VAS), and SUI in adults with CF. This information is important when developing management strategies in the CF population.

Incidence and risk factors of urinary incontinence in women visiting Family Health Centers

Background

The objective of this study is to determine the incidence and the risk factors of the urinary incontinence in women visiting the Health Family Center.

Methods

430 women, who visited three Family Health Centers in the city center of Erzurum for any reason between 25 November and 20 January 2016, were included in this study without any sampling. The data were collected by using the face-to-face interview method. Percentage distribution, Chi square test, and logistic regression analysis were used in order to analyze the data.

Results

It was determined that 37.2 % of these women had urinary incontinence, but only 29.3 % of them visited a physician because of this complaint. Among a total of 160 women with urinary incontinence findings, stress type incontinence was observed at the highest rate (33.7 %), which was followed by mixed type (31.8 %), urge type (20.6 %) and other types (overflow, continuous urinary incontinence) (13.7 %). It was found that urinary incontinence had a significant correlation with the number of children, genital prolapse, duration of delivery longer than 24 h, diabetes and urogenital infection, but not with the age at the first and last childbirth, presence of the episiotomy, birth weight over 4 kg, and smoking.

Conclusions

It was determined that one-third of the women had urinary incontinence and certain medical and obstetric conditions were affecting the development of urinary incontinence. It is thought that it is important for the healthcare personnel to take the progression of the urinary incontinence under control by preventing the risk factors and to encourage the patients to seek treatment with the help of the proper information indicating that urinary incontinence is a treatable and preventable condition.

Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline

Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand.

Risk factors associated with urinary incontinence in Portugal and the quality of life of affected women

OBJECTIVE

To identify risk factors for urinary incontinence (UI) and assess the quality of life (QoL) of affected women.

METHODS

A cross-sectional study was conducted of all women with UI who attended the urology and gynecology services of four hospitals in central Portugal between March and December 2012. Information was obtained from participants using questionnaires assessing sociodemographic, obstetric, gynecologic, and lifestyle variables.

RESULTS

Among 505 participants, 351 (69.5%) had urgency UI, 107 (21.2%) stress UI, and 47 (9.3%) mixed UI. Stress UI was associated with smoking, alcohol consumption, constipation, gravidity, parity, and vaginal infections (P≤0.02 for all). Urgency UI was associated with age above 50 years, employment, smoking, and sitting for 2 hours or less per day (P≤0.02 for all). Mixed UI was associated with age 50 years or younger, smoking, sitting for 2 hours or less per day, and frequently carrying more than 3 kg in weight (P<0.001 for all). A negative impact on QoL was reported by 501 (99.2%) women. Compared with younger participants, women older than 50 years presented with more sleep/energy disturbances and performance limitations (P≤0.04 for both).

CONCLUSION

UI is associated with several risk factors and has a negative impact on QoL. Appropriate investigation regarding the factors associated with the types of UI should be performed to diminish its impact on QoL.

Pelvic floor health: a concept analysis

AIM

To report an analysis of the concept 'pelvic floor health'.

BACKGROUND

'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well defined.

DESIGN

Rodger's evolutionary view was used to guide this analysis.

DATA SOURCES

Academic literature databases and public domain websites viewed via the Internet search engine Google.

REVIEW METHODS

Literature in English, published 1946-July 2014 was reviewed. Websites were accessed in May 2014, then analysed of presentation for relevance and content until data saturation. Thematic analysis identified attributes, antecedents and consequences of the concept.

RESULTS

Based on the defining attributes identified in the analysis, a contemporary definition is offered. 'Pelvic floor health' is the physical and functional integrity of the pelvic floor unit through the life stages of an individual (male or female), permitting an optimal quality of life through its multifunctional role, where the individual possesses or has access to knowledge, which empowers the ability to prevent or manage dysfunction.

CONCLUSION

This analysis provides a definition of 'pelvic floor health' that is based on a current shared meaning and distinguishes the term from medical and lay terms in a complex, multifaceted and often under-reported area of healthcare knowledge. This definition provides a basis for theory development in future research, by focusing on health rather than disorders or dysfunction. Further development of the meaning is required in an individual's social context, to ensure a contemporaneous understanding in a dynamic system of healthcare provision.

Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial

OBJECTIVE

To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence.

METHODS

In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program (n=30) and those who used vaginal cones (n=30). The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and followed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King's Health Questionnaire.

RESULTS

Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group (p=0.001 and p=0.008, respectively), but the severity of stress urinary incontinence was not significantly different between the two groups (p=0.2). The changes in strength of the pelvic floor, Incontinence Quality of Life, and King's Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention.

CONCLUSION

Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects.

Social impact and healthcare-seeking behavior among women with urinary incontinence in the United Arab Emirates

OBJECTIVE

To determine the prevalence and social impact of urinary incontinence (UI) and healthcare-seeking behaviors among women in the United Arab Emirates (UAE).

METHODS

A study was conducted of 429 women who attended family development foundation centers in Al Ain, UAE, between January 1, 2010, and January 31, 2011. Data on sociodemographics, obstetric and medical history, and factors related to UI were obtained using a questionnaire.

RESULTS

The prevalence of UI was 42.2% (mean age, 37.8years). Aspects of daily life (praying, social activities, physical activities, or sexual relationship) were disrupted by UI among 78.0% of the women, with severe effects reported by 8.8%. Independent risk factors for UI were education level, history of "dragging" genital lump, and constipation. In all, 50.5% of the affected women did not seek medical advice, stating the following reasons: hoped for spontaneous resolution of UI (61.9%); embarrassed to visit a male or female clinician (35.9%); believed that UI was a normal occurrence among women (31.5%); embarrassed to visit a male clinician (29.3%); and unaware that treatment was available (23.9%).

CONCLUSION

Although UI was prevalent in the UAE and affected quality of life, less than half of all women with this condition sought medical advice.

Prevalence and risk factors of urinary incontinence in Indian women: A hospital-based survey

Background and Objectives:

Urinary incontinence is a problem that creates both physical and psychological nuisance to a woman. This problem needs to be studied in detail in Indian population because of lack of precise data. The objectives of this study were to study the prevalence and risk factors of urinary incontinence in Indian women.

Materials and Methods:

This hospital-based cross-sectional study conducted from August 2005 to June 2007 included women attending gynecology OPD (consulters) and hospital employees (nonconsulters). Subjects who were incontinent were asked a standard set of questions. Incontinence was classified as urge, stress, or mixed based on symptoms. A univariate followed by multivariate analysis was done to look for risk factors.

Results:

Of 3000 women enrolled, 21.8% (656/3000) women were incontinent. There was no significant difference in incontinence rate between consulters and nonconsulters [618/2804 (22.1%) vs. 38/196 (19.4%); P value = 0.6). Of the total women having incontinence, highest numbers were found to have stress incontinence [73.8% (484/656)] followed by mixed [16.8% (110/656)] and urge incontinence [9.5% (62/656)]. Age more than 40 years; multiparity; postmenopausal status; body mass index more than 25; history of diabetes and asthma; and habit of taking tea, tobacco, pan, and betel are risk factors found to be associated with increased prevalence of urinary incontinence in univariate analysis. On multivariate analysis, age more than 40 years, multiparity, vaginal delivery, hysterectomy, menopause, tea and tobacco intake, and asthma were found to be significantly associated with overall incontinence. Stress incontinence was separately not associated with menopause. Urge incontinence was not associated with vaginal delivery.

Conclusion:

Urinary incontinence is a bothersome problem for women. Simple questionnaire can help to detect this problem and diagnose associated risk factors, so that necessary steps can be taken in its prevention and treatment.

Identifying the quality of life effects of urinary incontinence with depression in an Australian population

Background

To explore the additive effect of urinary incontinence, in people with comorbid depression, on health related quality of life.

Methods

Males and females, 15 to 95 years (n = 3010, response rate 70.2%) were interviewed face to face in the 1998 Autumn South Australian Health Omnibus Survey.

Results

Self-reported urinary incontinence was found in 20.3% (n=610), and depression as defined by the PRIME-MD in 15.2% (n=459) of the survey population. Urinary incontinence with comorbid depression was found in 4.3% of the overall population. Univariate analysis showed that respondents with urinary incontinence and comorbid depression were more likely to be aged between 15 and 34 years and never married when compared to those with incontinence only. Multivariate analysis demonstrated that in people with incontinence, the risk of having comorbid depression was increased by an overall health status of Fair or Poor, or the perception that their incontinence was moderately or very serious. Respondents reporting that they experienced incontinence with comorbid depression scored significantly lower than those experiencing incontinence without depression on all dimensions of the SF-36.

The interaction of the presence of incontinence and the presence of depression was significantly associated with the dimensions of physical functioning.

Conclusions

Depression and incontinence both reduce QOL. When they occur together there appears to be an additive effect which affects both physical and mental health, perhaps by increasing a person’s negative perceptions of their illness. Clinicians should identify and manage comorbid depression when treating patients who have incontinence to improve their overall QOL.

The epidemiology of urinary incontinence in women with type 2 diabetes

PURPOSE

Little research has been conducted on the epidemiology of urinary incontinence in individuals with type 2 diabetes. We examined prevalence, incidence and risk factors for urinary incontinence among women with type 2 diabetes in the NHS (Nurses' Health Study) and NHS II.

MATERIALS AND METHODS

We obtained urinary incontinence information at study baseline (2000 in NHS and 2001 in NHS II) and 2 followup periods (2002 and 2004 in the NHS, and 2003 and 2005 in the NHS II). Among women with type 2 diabetes we calculated the prevalence of urinary incontinence for 9,994 women with baseline urinary incontinence information, and urinary incontinence incidence rates for 4,331 women with no urinary incontinence at baseline and urinary incontinence information during followup. Multivariable adjusted odds ratios and relative risks were estimated for associations between possible risk factors and urinary incontinence.

RESULTS

The prevalence of at least monthly urinary incontinence was 48% and at least weekly urinary incontinence was 29% among women with type 2 diabetes, and the corresponding incidence rates were 9.1 and 3.4 per 100 person-years, respectively. White race, higher body mass index, higher parity, lower physical activity, current postmenopausal hormone use and diuretic use were risk factors for prevalent and incident urinary incontinence in this study, and hysterectomy, vascular disease and longer duration of diabetes were associated with increased odds of prevalent urinary incontinence only. Increasing age and microvascular complications were associated with a greater risk of frequent urinary incontinence.

CONCLUSIONS

Urinary incontinence was common in this study of women with type 2 diabetes. We identified multiple risk factors for urinary incontinence in these women, several of which suggest ways to reduce urinary incontinence.

[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.

The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery

OBJECTIVE

To investigate the prevalence and risk factors for urinary incontinence (UI) 20 years after one vaginal delivery or one caesarean section.

DESIGN

Registry-based national cohort study.

SETTING

Women who returned postal questionnaires (response rate 65.2%) in 2008.

POPULATION

Singleton primiparae who delivered in the period 1985-1988 with no further births (n = 5236).

METHODS

The Swedish Pregnancy, Obesity and Pelvic Floor (SWEPOP) study linked Medical Birth Register (MBR) data to a questionnaire about UI.

MAIN OUTCOME MEASURES

Prevalence of UI and UI for more than 10 years (UI > 10 years) were assessed 20 years after childbirth.

RESULTS

The prevalence of UI (40.3 versus 28.8%; OR 1.67; 95% CI 1.45-1.92) and UI > 10 years (10.1 versus 3.9%; OR 2.75; 95% CI 2.02-3.75) was higher in women after vaginal delivery than after caesarean section. There was no difference in the prevalence of UI or UI > 10 years after an acute caesarean section or an elective caesarean section. We found an 8% increased risk of UI per current body mass index (BMI) unit, and age at delivery increased the UI risk by 3% annually.

CONCLUSIONS

Two decades after one birth, vaginal delivery was associated with a 67% increased risk of UI, and UI > 10 years increased by 275% compared with caesarean section. Our data indicate that it is necessary to perform eight or nine caesarean sections to avoid one case of UI. Weight control is an important prophylactic measure to reduce UI. Current BMI was the most important BMI-determinant for UI, which is important, as BMI is modifiable.

Urinary incontinence: prevalence, risk factors, and impact on health related quality of life in Saudi women

AIMS

The aims of this study were to determine the prevalence, risk factors, and impact upon health related quality of life (HRQL) of urinary incontinence in Saudi women.

METHODS

We performed a clinic-based cross-sectional survey. 6,600 women aged 20 years and older were selected. The bother of urinary incontinence symptoms was assessed using the Arabic version of the short form of Urogenital Distress Inventory (UDI-6) questionnaire. We measured the impact of urinary incontinence on HRQL using the Incontinence Impact Questionnaire (IIQ-7).

RESULTS

The overall prevalence of urinary incontinence in our study was 29%. The prevalence of urinary incontinence according to its type was 50% stress urinary incontinence, 28% urgency urinary incontinence, and 22% mixed urinary incontinence. Older age, obesity, large baby birth weight, high parity, caesarean delivery, vaginal delivery, and diabetes were significant risk factors. Less than 10% of the women in this study reported a significant effect of urinary incontinence on their HRQL. In our study population, 9% sought medical care.

CONCLUSIONS

Twenty-nine percent of the women in Riyadh suffered from urinary incontinence. Diabetes is the most significant factor. Urinary incontinence affects women's HRQL. Most of the women did not seek medical care. We consider our study as an important step to start the plans for early detection, and treating urinary incontinence in Saudi Arabia.

The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up

Introduction and hypothesis

The objective of this study was the assessment of the efficiency of the MiniArc for curing stress urinary incontinence.

Methods

Seventy-seven patients, operated on from March 2008 to November 2009, were evaluated in this study. One-year post-operative data are presented. All patients suffered from predominant stress urinary incontinence. After 1 year, response was 74%. Evaluation was performed using a questionnaire consisting of the EuroQol-5 Dimensions, the Patient Global Impression of Improvement, the Incontinence Impact Questionnaire, the Urinary Distress Inventory, the Prolapse/Urinary Incontinence Sexual Questionnaire, short form, and the Defecation Distress Inventory.

Results

One year after surgery, 68% of the patients stated an improvement in their incontinence status, while only 44% stated to be completely dry.

Conclusion

The 1-year follow-up suggests that the MiniArc is less effective in the treatment of stress urinary incontinence than the TVT.

Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study

OBJECTIVE

To investigate the contribution of prolonged labour, method of birth, timing of caesarean section and other obstetric risk factors to postpartum urinary incontinence.

DESIGN

Prospective pregnancy cohort.

SETTING

Six metropolitan public hospitals in Victoria, Australia.

SAMPLE

A total of 1507 nulliparous women recruited to the maternal health study in early pregnancy (≤24 weeks).

METHOD

Data from hospital medical records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and 3 months postpartum analysed using univariable and multivariable logistic regression.

MAIN OUTCOME MEASURE

Urinary incontinence 3 months postpartum in women continent before the index pregnancy.

RESULTS

Of the women continent before pregnancy, 26% reported new incontinence at 3 months postpartum. Compared with women who had a spontaneous vaginal birth, women who had a caesarean section before labour (adjusted odds ratio [OR] 0.2, 95% CI 0.1-0.5) or in the first stage of labour (adjusted OR 0.2, 95% CI 0.1-0.4) were less likely to be incontinent 3 months postpartum. Adjusted OR for incontinence after caesarean section in the second stage of labour compared with spontaneous vaginal birth was 0.5 (95% CI 0.2-1.0). Prolonged second stage labour was associated with increased likelihood of postpartum incontinence in women who had a spontaneous vaginal birth (adjusted OR 1.9, 95% CI 1.1-3.4) or operative vaginal birth (adjusted OR 1.7, 95% CI 1.0-2.8).

CONCLUSIONS

In addition to pregnancy itself, physiological changes associated with the second stage of labour appear to play a role in postpartum urinary incontinence.

Incontinence improves in older women after intensive pelvic floor muscle training: an assessor-blinded randomized controlled trial

AIMS

To test the hypotheses that high intensity pelvic floor muscle training (PFMT) is effective in relief of stress urinary incontinence in community dwelling older women, and that intense PFMT improves stress urinary incontinence more than bladder training (BT) in this population.

METHODS

A two-center, assessor-blinded randomized controlled trial of 20 weeks duration with two active intervention arms: PFMT and BT. Assessments and interventions were undertaken at two metropolitan tertiary hospitals. Participants were community dwelling women over 65 years of age with urodynamic stress incontinence. Primary outcome measure was urinary leakage during a cough stress test. Secondary outcome measures included symptoms and bother (ICIQ-UI SF), participant global perception of change, leakage episodes (7-day accident diary), degree of "bother" (VAS) and health related quality of life (AQoL).

RESULTS

Eighty-three Caucasian women, 71.8 (SD 5.3) years participated in the study. Both groups improved over the intervention period; however, the PFMT group reported significantly lower amounts of leakage on the stress test [PFMT median 0.0 g, 95% CI: 0.2-0.9; BT median 0.3 g, 95% CI: 0.2-1.7, P=0.006], improved symptoms and bother [PFMT mean 5.9, 95% CI: 4.8-7.1; BT group mean 8.5, 95% CI: 7.1-9.9 and greater perception of change [PFMT 28 (73.6%); BT 12 (36.4%) (P=0.002)] after 5 months than the BT group.

CONCLUSIONS

High intensity PFMT is effective in managing stress urinary incontinence and is more effective than BT in healthy older women.

Urinary incontinence in adolescent females with cystic fibrosis

Urinary incontinence has been found to be common in girls and women with cystic fibrosis (CF). This often can have a marked impact on daily activities and quality of life. It may also lead to potential deterioration of respiratory status due to reduced adherence to forced expiratory manoeuvres (cough, lung function tests and exercise) by the girls trying to avoid occurrence of urinary incontinence (UI). Analysis of the literature is limited by the fact that different definitions and a variety of questionnaires have been used. There is little literature regarding UI in men and boys which is thought to be less common than in females. National guideline recommendations in the management of CF in Australia and the United Kingdom have in recent years changed to incorporate screening and management of UI. No studies to date have looked at outcomes of interventions in children and adolescents with CF or other respiratory conditions; however those working with this population need to be aware of the problem of UI as it is a treatable condition and could potentially be prevented.

Urinary incontinence after vaginal delivery or cesarean section

ABSTRACT Objective: To assess the prevalence of stress urinary incontinence, urge incontinence and mixed urinary incontinence among women residing in the city of Jundiaí (São Paulo, Brazil), and the relation between the type of incontinence and the obstetric history of these women. Methods: A cross-sectional community-based study was conducted. A total of 332 women were interviewed; they were seen for whatever reason at the public primary healthcare units of the city of Jundiaí, from March 2005 to April 2006. A pre-tested questionnaire was administered and consisted of questions used in the EPINCONT Study (Epidemiology of Incontinence in the County of Nord-Trondelag). Statistical analysis was carried out using the χ2 test and odds ratio (95%CI). Results: Urinary incontinence was a complaint for 23.5% of the women interviewed. Stress urinary incontinence prevailed (50%), followed by mixed urinary incontinence (35%) and urge incontinence (15%). Being in the age group of 35-64 years, having a body mass index of 30 or greater and having had only vaginal delivery or cesarean section, with uterine contraction, regardless of the number of pregnancies, were factors associated with stress urinary incontinence. However, being in the age group of 55 or older, having a body mass index of 30 or greater and having had three or more pregnancies, only with vaginal deliveries, were factors associated with mixed urinary incontinence. Conclusions: One third of the interviewees complained of some type of urinary incontinence, and half of them presented stress urinary incontinence. Cesarean section, only when not preceded by contractions, was not associated with stress urinary incontinence. The body mass index is only relevant when the stress factor is present.

Urinary incontinence is associated with lower psychological general well-being in community-dwelling women

OBJECTIVE

There are few studies documenting the impact of urinary incontinence (UI) on well-being in women. The aim of this study was to evaluate the relationships between different types of UI and general well-being in women in the community.

METHODS

A cross-sectional survey of 542 community-dwelling women, aged 24 to 80 years, was conducted in July 2006. A detailed self-administered questionnaire was mailed to the study participants. UI was assessed using the Questionnaire for Urinary Incontinence Diagnosis, and well-being was assessed using the Psychological General Well-being Index (PGWBI). The relationships between types of UI and PGWBI scores were assessed using multiple regression analyses while adjusting for potential confounders.

RESULTS

A total of 506 (94%) women provided data for analysis. Women with incontinence had a lower total PGWBI score (76.9 +/- 16.5) than did women with no UI (81.6 +/- 15.3; P = 0.001). The total PGWBI mean score was significantly lower in women with stress-only UI (77.8 +/- 16.2; P = 0.05) and mixed UI (74.2 +/- 17.8; P < 0.001) compared with women with no UI. There was no significant difference in the mean total scores between women with urge UI and women without UI. Stress-only UI was negatively associated with the PGWBI subdomains of self-control, general health, and vitality, whereas those with mixed UI had lower scores for all the PGWBI subdomains. The associations for UI remained significant after adjustment for age, systemic hormone therapy use, menopause status, smoking status, and regular exercise.

CONCLUSIONS

Not only is UI associated with a significant reduction in well-being in community-dwelling women, but also, the relationship between different types of UI and well-being seems to differ.

The urethral motion profile before and after suburethral sling placement

PURPOSE

We examined the effect of the Monarc suburethral sling on urethral mobility.

MATERIALS AND METHODS

We retrospectively studied the records of 54 consecutive women who received a Monarc suburethral sling between July 2005 and November 2008. All patients were examined by volume ultrasound preoperatively and at followup (average 0.7 years). Volume data sets were analyzed using post-processing software. Urethral mobility was described by vectors of movement from rest to a maximum Valsalva maneuver of 6 equidistant points marked evenly along the urethra from bladder neck (point 1) to external urethral meatus (point 6), as identified in the mid sagittal view. Measurements were made of point coordinates relative to the pubic symphysis dorsocaudal margin at rest and during maximal Valsalva maneuver. To determine the urethral motion profile we calculated mobility vectors of the 6 points using the formula, square root [(x(val) - x(rest))(2) + (y(val) - y(rest))(2)], where val represents the value during the Valsalva maneuver and rest represents the value at rest. We compared values before and after sling placement.

RESULTS

The subjective cure rate for stress urinary incontinence was 78% (42 cases). There was a statistically significantly decreased mobility at points 2 to 4, corresponding to the urethral central aspect (p = 0.002 to 0.018). No significant change in mobility was noted at the bladder neck and distal urethra (p = 0.39 to 0.89).

CONCLUSIONS

Monarc suburethral sling placement decreases mid urethral mobility but does not seem to affect the bladder neck.

Urinary incontinence in obese adolescent girls

OBJECTIVE

Urinary incontinence is an established complication of obesity in adult women. We examined the prevalence, severity, and impact of incontinence in obese compared to non-obese girls.

METHODS

Subjects aged 12-17 years each completed a 29-item questionnaire assessing urinary symptoms and their impact. Clinically significant urinary incontinence was defined as involuntary urine leakage at least once weekly.

RESULTS

40 obese adolescent girls and 20 non-obese control girls were recruited. Among the obese girls, five (12.5%, 95% confidence interval: 4-28%) reported incontinence, and two of these five reported daily leakage. None of the 20 non-obese subjects reported leakage meeting the definition of incontinence. Incontinence severity scores (leakage frequency multiplied by leakage volume) averaged 1.3 in the obese group and 0.3 in the non-obese group (P=0.009) and were associated with symptom impact (P<0.001). Eleven (55%) of non-obese and 17 (43%) of obese subjects reported no urinary leakage, while infrequent, low-volume urine leakage was reported by 45% of both obese and non-obese subjects.

CONCLUSIONS

Urinary incontinence affects more than 10% of obese adolescent girls. Frequency and volume of urine loss are directly related to the impact that incontinence has on the sufferer. Results highlight the importance of screening for symptoms of urinary incontinence in obese girls.

Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors

INTRODUCTION

Few studies have examined associations of prepregnancy urinary incontinence (UI).

METHODS

Multicentre prospective pregnancy cohort study (n = 1,507) using standardised measures to assess frequency and severity of UI.

RESULTS

Prevalence of UI increased from 10.8% in the 12 months before the index pregnancy to 55.9% in the third trimester. Stress incontinence (36.9%) and mixed incontinence (13.1%) were more common during pregnancy than urge incontinence alone (5.9%). UI before pregnancy was associated with childhood enuresis (adjusted odds ratio (AdjOR) = 2.4, 95% confidence interval (CI) 1.6-3.4), higher maternal body mass index (AdjOR = 2.3, 95% CI 1.4-3.8), and previous miscarriages or terminations (AdjOR = 1.6, 95% CI 1.1-2.3). The strongest predictor of incident UI in pregnancy was occasional leakage (less than once a month) before pregnancy (AdjOR = 3.6, 95% CI 2.8-4.7).

CONCLUSIONS

Further research is needed to elucidate the complex interplay of prepregnancy and pregnancy-related factors in the aetiology of UI in nulliparous women.

Influence of maternal weight on the new onset of stress urinary incontinence in pregnant women

INTRODUCTION AND HYPOTHESIS

The aim of the study was to investigate the incidence and severity of stress urinary incontinence (SUI) in primigravid women at term and its association with maternal body weight.

METHODS

This was an observational study of 458 primigravid women who came to give birth at Donostia Hospital during 2007. Urinary symptoms were investigated (2002 ICS definitions), and a physical examination including height, weight, pelvic floor muscle strength, and fetal presentation was performed. We calculated the incontinence severity index (ISI) and the women answered the International Consultation on Incontinence short form questionnaire.

RESULTS

SUI affected 139 (30.3%) primigravid women. The ISI distribution was 40.3% slight, 54.7% moderate, 4.3% severe, and 0.7% very severe. Pregnant women at term with body weight >or=75 kg appear to have more than doubled the risk of presenting SUI.

CONCLUSIONS

The incidence of SUI is high in pregnancy. Increased maternal body weight at term is an independent risk factor for incontinence.

A review of the literature on gender and age differences in the prevalence and characteristics of constipation in North America

Constipation is a common problem and affects between 2% and 28% of the general population. It is thought to affect more women than men. The severity of constipation is variable and it can be an acute or chronic condition. Often, it requires frequent interventions that may produce mixed or even unsatisfactory results. Knowledge of potentially gender- and age-related differences in constipation would be useful to clinicians to help them identify high-risk patients. In addition, researchers might use this information to design both descriptive and intervention studies. This article reviews the evidence from the studies on gender and age differences in prevalence of constipation, gender differences in the prevalence and characteristics of constipation, and age differences in the prevalence and characteristics of constipation. The available literature suggests that the prevalence of constipation is consistently higher in women than in men. However, evidence of gender differences in the characteristics of constipation is inconsistent. Prevalence rates appear to increase gradually after the age of 50 years, with the largest increase after the age of 70 years. The literature is both sparse and inconsistent in its description of age differences in the characteristics of constipation. This lack of research is a significant issue given the magnitude of this problem in the older adult population. Research is needed on gender and age differences in the symptoms of constipation, and how covariates impact the prevalence and severity of constipation in the elderly.

Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction

INTRODUCTION AND HYPOTHESIS

The prevalence and clinical associations of recurrent (two or more symptomatic and medically documented in the previous 12 months) urinary tract infections (UTIs) have not been subjected to comprehensive analysis in a large group of women with symptoms of pelvic floor dysfunction.

METHODS

A prospective study was conducted involving 1,140 women presenting for their initial urogynecological assessment.

RESULTS

The overall prevalence of recurrent UTI was 19%. Significant positive associations of recurrent UTI were: (1) nulliparity with a 3.7 x (up to 50 years) increase over the prevalence for parous women and 1.8 x (over 50 years); and (2) women with an immediate postvoid residual (PVR) over 30 ml, which is significant in women over 50 years.

CONCLUSIONS

The early age decline (18-45 years) in the prevalence of recurrent UTI might be related to increasing parity. The later increase (over 55 years) was probably due to the increasing PVR effect superimposed on the nulliparity effect.

Body weight through adult life and risk of urinary incontinence in middle-aged women: results from a British prospective cohort

OBJECTIVES

To determine whether the onset and duration of being overweight or obese are associated with symptoms of urinary incontinence.

DESIGN

Nationally representative cohort study.

SUBJECTS

A total of 1201 women followed-up since their birth in 1946 and annually from 48 to 54 years.

MEASUREMENTS

The body mass index (BMI) at the age of 20, 26, 36 and 43, and symptoms of stress, urge and severe incontinence at seven consecutive years from age 48 to 54.

RESULTS

In each year from age 48 to 54, almost half (46-49%) reported symptoms of stress incontinence, urge incontinence rose from 22 to 25% and severe incontinence from 8 to 11%. At the age of 20, 26, 36 and 43, BMI was positively associated with stress symptoms and severe incontinence in midlife. BMI transition was found to have accumulation effects on symptoms of severe incontinence; women who were overweight/obese since age 20 years were more likely to report severe incontinence than women whose BMI remained below 25 kg/m(2) (odds ratio (95% confidence interval): 2.30 (1.36-3.93)) or who became overweight or obese at 43 years (1.85 (0.97-3.51)). These relationships existed beyond the effects of aging, childhood enuresis, kidney infection, childbirth characteristics, menopause, educational attainment, general practitioner consultations and smoking status. BMI was not associated with symptoms of urge incontinence.

CONCLUSIONS

Across adult life, higher BMI for women was linked with subsequent symptoms of stress and severe incontinence in midlife; those who were overweight or obese since early in adult life more than doubled their risk of severe incontinence. Women, and especially young women, should be encouraged to keep their weight in a normal range throughout adult life.

Psycho-relational aspects of urinary incontinence in female sexuality

Urinary incontinence (UI) is a very common disorder in women, involving severe consequences on the patients’ perception of quality of life and sexuality. The aim of this contribution is to analyze the psycho-relational aspects linked to UI, focusing on sexual activity, self-perception of sexual competence and self-esteem.

Urinary incontinence causes feelings of shame and inadequacy as well as low self-esteem; it may affect sexual activity, reducing sexual intercourse frequency. Many authors highlight a strong comorbidity between urinary incontinence and sexual dysfunctions, such as dyspareunia, vaginismus, hypo-active sexual desire, arousal and orgasm disorders. Literature analysis shows that changes in sexual activity are influenced not only by urinary incontinence symptoms but also by the disorder self-perception, by previous sexuality, menopause, social status and the partner's attitude.

The etiological study of urinary incontinence shows that several different factors play a role in this disorder. Therefore, an integrated therapeutic approach is suggested, considering, besides the organic issues, the experience and feelings of patients as well as the consequences on their sexual and social life.

Prevalence of Urinary Incontinence and Lower Urinary Tract Symptoms for Community-Dwelling Elderly 85 Years of Age and Older

OBJECTIVE

We sought to identify the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) and to evaluate the risk factors of community-dwelling South Korean elders for developing UI.

DESIGN

We undertook a cross-sectional study based on interviews using a structured questionnaire.

SETTING AND SUBJECTS

One hundred thirty-five community-dwelling elders, aged 85 years and older residing in 9 villages of Jeju Island, South Korea, were interviewed. Of 218 persons registered by the provincial government, interviews with 135 (62%) persons were completed.

METHODS

Between April 5, 2004 and May 31, 2004, a researcher or 1 of 3 research assistants visited each subject's home. The interview took approximately 40 minutes to complete. Data were recorded by a research assistant and interviews were performed by the primary investigator or research assistant.

INSTRUMENTS

LUTS severity was assessed by the Korean version of the International Prostate Symptom Score (IPSS) (7 items), and 3 additional items that specifically queried Urinary Incontinence (UI). Cognitive function and depression were assessed using the Korean version of the Mini Mental State Examination (MMSE-K) (13 items) and Geriatric Depression Scale Short Form Korean Version (GDSSF-K) (15 items).

RESULTS

Forty-seven elderly (34.8%) reported UI more than once a week during the prior 12 months. Mixed UI symptoms were reported by 29 subjects (61.7%), pure urge UI symptoms by 16 (34.0%), and pure stress UI symptoms by 2 respondents (4.3%). The mean IPSS score of the subjects was 6.0 +/- 6.3 (range: 0-35). Risk factors for developing UI were moderate (odds ratio (OR) 17.6; 95% confidence interval (CI) 6.87-45.30) and severe LUTS (OR 36.5; 95% CI 3.86-345.07) measured by the IPSS.

CONCLUSIONS

UI was found to affect 34.8% (47) of the community-dwelling elders 85 years or older in this study and mixed UI symptoms were predominant. LUTS was associated with an increased risk of UI.