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

Pelvic Floor Disorders in Black Women: Prevalence, Clinical Care, and a Strategic Agenda to Prioritize Care

Pelvic floor disorders are a group of common conditions affecting women of all racial and ethnic groups. These disorders are undertreated in all women, but this is especially magnified in Black people who have been historically marginalized in the United States. This article seeks to highlight the prevalence of pelvic floor disorders in Black women, evaluate the clinical care they receive, examine barriers they face to equitable care, and present a strategic agenda to prioritize the care of Black women with pelvic floor disorders.

Community-based Versus Traditional Research Among Older Minority Women With Urinary Incontinence

OBJECTIVE

The aim of this study was to evaluate research retention of older minority women with urinary incontinence (UI) using a community-based participatory research (CBPR) versus a traditional research approach.

METHODS

An ancillary prospective study was conducted within an ongoing pilot randomized clinical trial to treat UI. Participants were recruited using CBPR in collaboration with a local community versus a traditional research approach at an academic center. Inclusion criteria were women 65 years and older and symptomatic UI. The primary outcome was the randomization rate defined as the proportion of women randomized into the randomized clinical trial out of screened participants. Screening and consent rates were also evaluated. Pearson χ2, Fisher exact, and t tests were used. The effect of CBPR on research retention rates was expressed as odds ratio (OR) with 95% confidence intervals (CI).

RESULTS

There were 10 and 88 women screened in the CBPR and traditional research groups, respectively. The CBPR participants were Hispanic (n = 10, 100%) and older (78.4 ± 8.3 years; P < 0.01). Most of the traditional research participants were non-Hispanic Black (n = 55, 62.5%) and younger (71.0 ± 4.9 years). The CBPR group had higher rates of screening (76.9% vs 40.6%; P = 0.01), consent (80% vs 44.3%; P = 0.045), and randomization (50.0% vs 14.8%; P < 0.01) compared with the traditional research group. Community-based participatory research increased the odds of research retention during screening (OR, 4.9; 95% CI, 1.3-18.2), consent (OR, 5.0; 95% CI, 1.0-25.0), and randomization (OR, 5.8; 95% CI, 1.5-22.7).

CONCLUSION

Compared with traditional research, CBPR yielded higher research retention among older minority women with UI in a clinical study.

PERFIL DE PACIENTES COM INCONTINÊNCIA URINÁRIA EM UM AMBULATÓRIO DE HOSPITAL UNIVERSITÁRIO

Objetivo:conhecer o perfil sociodemográfico e clínico das pessoas com incontinência urinária em ambulatório de Hospital Universitário. Métodos: estudo transversal, em que se utilizou formulário semiestruturado com 63 mulheres que aguardavam atendimento nos ambulatórios de ginecologia e urologia, entre os meses de julho e agosto de 2019. Os dados foram processados no software Statistical Package for the Social Sciences – SPSS 20.0. Resultados: foram realizadas entrevistas com mulheres com idade entre 19 e 77 anos. Dessas, 55,6% mantinha vida sexual ativa; 85,7% apresentava doença preexistente; 69,8% presentou perda urinária ao tossir, espirrar, sorrir, colocar peso e/ou fazer esforços; 12,7% precisa urinar assim que sentem vontade; e 17,5% apresenta perda de urina nas duas situações. Cerca de 35% procurou consulta devido à bexiga baixa e/ou perda de urina; 27% teve de 4 a 5 gestações. Dentre os fatores de risco associado à incontinência urinária, 28,6% tinha diabetes mellitus, 61,9% hipertensão arterial, 82,5% fazia uso de medicação contínua, 11,1% era obesa, 34,9% relatou problemas de constipação e 74,6% fez cirurgias pélvicas. Conclusão: concluiu-se que todas as mulheres do estudo apresentaram mais de um fator de risco para desenvolver incontinência urinária, reforçando sua multifatorialidade, bem como a importância de um tratamento holístico e multiprofissional.

PROFILE OF PATIENTS WITH URINARY INCONTINENCE IN A UNIVERSITY HOSPITAL OUTPATIENT CLINIC

Objective: to know the sociodemographic and clinical profile of people with urinary incontinence in an outpatient clinic of a University Hospital. Methods: cross-sectional study, using a semi-structured form with 63 women whowere awaiting care at the gynecology and urology outpatient clinics, between the months of July and August 2019. The data were processed in the software Statistical Package for the Social Sciences – SPSS 20.0. Results: interviews were carried out with women aged between 19 and 77 years. Of these, 55.6% maintained an active sex life; 85.7% had pre-existing disease; 69.8% presented urinary loss when coughing, sneezing, smiling, putting on weight and/or making efforts; 12.7% need to urinate as soon as they feel like it; and 17.5% had loss of urine in both situations. About 35% sought consultation due to low bladder and/or loss of urine; 27% had 4 to 5 pregnancies. Among the risk factors associated with urinary incontinence, 28.6% had diabetes mellitus, 61.9% had arterial hypertension, 82.5% used continuous medication, 11.1% was obese, 34.9% reported constipation problems and 74.6% underwent pelvic surgery. Conclusion: it was concluded that all women in the study had more than one risk factor for developing urinary incontinence, reinforcing their multifactoriality, as well as the importance of a holistic and multiprofessional treatment.

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.

Factors associated with persistent urinary incontinence

OBJECTIVE

Many women with urinary incontinence (UI) have symptoms that continue over many years; however, virtually nothing is known about factors that are associated with persistent UI.

STUDY DESIGN

We studied 36,843 participants of the Nurses' Health Study, aged 54-79 years at baseline for the UI study, who provided UI information on biennial questionnaires from 2000 through 2008; follow-up in the Nurses' Health Study is 90%. In total, 18,347 women had "persistent UI," defined as urine leakage ≥1/mo reported on all 5 biennial questionnaires during this 8-year period; 18,496 women had no UI during this period. Using multivariable-adjusted logistic regression, we estimated odds ratios (ORs) of persistent UI vs no UI across various demographic, lifestyle, and health-related factors, which were derived from reports in 2000.

RESULTS

Increasing age group, white race, greater parity, greater body mass index (BMI), and lower physical activity levels were each associated with greater odds of persistent UI, as were several health-related factors (ie, stroke, type 2 diabetes, and hysterectomy). Associations with persistent UI were particularly strong for increasing age group (P trend < .0001; OR, 2.75; 95% confidence interval [CI], 2.54-2.98 comparing women aged ≥75 vs <60 years) and greater BMI (P trend < .0001; OR, 3.14; 95% CI, 2.95-3.33 comparing women with BMI ≥30 vs <25 kg/m(2)); moreover, black women had much lower odds of persistent UI compared to white women (OR, 0.27; 95% CI, 0.21-0.34).

CONCLUSION

Factors associated with persistent UI were generally consistent with those identified in previous studies of UI over shorter time periods; however, older age, white race, and obesity were particularly strongly related to persistent UI.

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.

Caffeine intake and risk of urinary incontinence progression among women

OBJECTIVE

To estimate the association between long-term caffeine intake and risk of urinary incontinence (UI) progression over 2 years among women with moderate UI.

METHODS

We conducted a prospective cohort study in 21,564 women with moderate UI enrolled in the Nurses' Health Study and Nurses' Health Study II. Incontinence progression was identified from questionnaires during 2 years of follow-up. Baseline caffeine intake (ie, average intake during the previous year) and change in caffeine intake during the 4 years before baseline were measured using food frequency questionnaires. Odds ratios (ORs) for incontinence progression according to caffeine intake were calculated for each cohort separately, and then for both cohorts combined.

RESULTS

The percentage of women with UI progression was similar across categories of baseline level of caffeine intake and change in caffeine intake before baseline. For example, percentages were 21% compared with 22% comparing 450 mg or more to less than 150 mg of caffeine per day (adjusted OR 0.87, 95% confidence interval 0.70-1.08). Comparing women with increased caffeine intake to those with stable caffeine intake, percentages with progression were 22% compared with 20% (OR 1.08, 95% confidence interval 0.95-1.22). Results were similar in separate analyses of urge and stress UI.

CONCLUSION

Long-term caffeine intake over 1 year was not associated with risk of UI progression over 2 years among women with moderate incontinence, although we could not examine acute effects of caffeine. Improved understanding of the effect of caffeine on the bladder is needed to better-advise women with incontinence about caffeine intake.

LEVEL OF EVIDENCE

II.