Severity of Urinary Incontinence and Effect on Quality of Life in Women by Incontinence Type

Overview

Journal Obstet Gynecol

Specialty Gynecology & Obstetrics

Date 2013 May 3

PMID 23635747

Citations 38

Authors

Vatche A Minassian

Elizabeth Devore

Kaitlin Hagan

Francine Grodstein

Affiliations

Soon will be listed here.

Abstract

Objective: To estimate how symptom severity, extent of bother, and quality of life differ across urinary incontinence (UI) subtypes.

Methods: We evaluated prevalent UI cases from the Nurses' Health Studies, including women aged 41-83 years. Women with UI (leaking more than once per month) were subclassified according to reported symptoms such as stress UI (SUI, leakage with activity), urge UI (UUI, leakage with urgency), or mixed UI (SUI and UI co-occurring equally). The UI severity was assessed in 102,418 women based on the Sandvik severity index. In a subset of older women with weekly UI, we asked about bother (n=1,697) and quality of life (Incontinence Impact Questionnaire; n=1,748). The UI severity, bother, and quality of life were compared across subtypes using polytomous logistic regression, adjusting for other characteristics.

Results: The distributions of UI subtypes were 51% SUI, 27% UUI, and 22% mixed UI. Approximately half had slight UI, 26% had moderate UI, and 23% had severe UI. Severe UI was more common in women reporting mixed UI (37%) than UUI (27%) or SUI symptoms (15%) (P<.001). More women with severe mixed (21%; P=.02) and UUI symptoms (13%; P=.1) reported being "greatly" bothered by their UI compared with SUI (10%). Women with severe mixed (mean 18.0; P<.001) and UUI symptoms (mean 13.4; P=.004) had higher mean incontinence effect scores compared with SUI (mean 9.8).

Conclusion: Women reporting mixed UI symptoms describe more severe and bothersome incontinence, with higher effect on quality of life.

Level Of Evidence: II.

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References

Minassian V, Stewart W, Hirsch A . Why do stress and urge incontinence co-occur much more often than expected?. Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19(10):1429-40. DOI: 10.1007/s00192-008-0647-2. View

Uebersax J, Wyman J, Shumaker S, McClish D, Fantl J . Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995; 14(2):131-9. DOI: 10.1002/nau.1930140206. View

Frick A, Huang A, Van Den Eeden S, Knight S, Creasman J, Yang J . Mixed urinary incontinence: greater impact on quality of life. J Urol. 2009; 182(2):596-600. PMC: 2746250. DOI: 10.1016/j.juro.2009.04.005. View

Brubaker L, Moalli P, Richter H, Albo M, Sirls L, Chai T . Challenges in designing a pragmatic clinical trial: the mixed incontinence -- medical or surgical approach (MIMOSA) trial experience. Clin Trials. 2009; 6(4):355-64. PMC: 2875993. DOI: 10.1177/1740774509339239. View

Herzog A, Fultz N . Prevalence and incidence of urinary incontinence in community-dwelling populations. J Am Geriatr Soc. 1990; 38(3):273-81. DOI: 10.1111/j.1532-5415.1990.tb03504.x. View

Minassian V, Stewart W, Wood G . Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol. 2008; 111(2 Pt 1):324-31. DOI: 10.1097/01.AOG.0000267220.48987.17. View

Hannestad Y, Rortveit G, Sandvik H, Hunskaar S . A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag. J Clin Epidemiol. 2000; 53(11):1150-7. DOI: 10.1016/s0895-4356(00)00232-8. View

Grodstein F, Fretts R, Lifford K, Resnick N, Curhan G . Association of age, race, and obstetric history with urinary symptoms among women in the Nurses' Health Study. Am J Obstet Gynecol. 2003; 189(2):428-34. DOI: 10.1067/s0002-9378(03)00361-2. View

Cundiff G, Harris R, Coates K, Bump R . Clinical predictors of urinary incontinence in women. Am J Obstet Gynecol. 1997; 177(2):262-6; discussion 266-7. DOI: 10.1016/s0002-9378(97)70185-6. View

10.

Dooley Y, Lowenstein L, Kenton K, Fitzgerald M, Brubaker L . Mixed incontinence is more bothersome than pure incontinence subtypes. Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19(10):1359-62. DOI: 10.1007/s00192-008-0637-4. View

11.

Bump R, Norton P, Zinner N, Yalcin I . Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol. 2003; 102(1):76-83. DOI: 10.1016/s0029-7844(03)00376-4. View

12.

Thomas T, Plymat K, Blannin J, Meade T . Prevalence of urinary incontinence. Br Med J. 1980; 281(6250):1243-5. PMC: 1714689. DOI: 10.1136/bmj.281.6250.1243. View

13.

Moller L, Lose G, Jorgensen T . The prevalence and bothersomeness of lower urinary tract symptoms in women 40-60 years of age. Acta Obstet Gynecol Scand. 2000; 79(4):298-305. DOI: 10.1080/j.1600-0412.2000.079004298.x. View

14.

Coyne K, Kvasz M, Ireland A, Milsom I, Kopp Z, Chapple C . Urinary incontinence and its relationship to mental health and health-related quality of life in men and women in Sweden, the United Kingdom, and the United States. Eur Urol. 2011; 61(1):88-95. DOI: 10.1016/j.eururo.2011.07.049. View

15.

Milsom I . The prevalence of urinary incontinence. Acta Obstet Gynecol Scand. 2000; 79(12):1056-9. View

16.

Thom D . Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc. 1998; 46(4):473-80. DOI: 10.1111/j.1532-5415.1998.tb02469.x. View

17.

Melville J, Katon W, Delaney K, Newton K . Urinary incontinence in US women: a population-based study. Arch Intern Med. 2005; 165(5):537-42. DOI: 10.1001/archinte.165.5.537. View

18.

Currie C, McEwan P, Poole C, O Odeyemi I, Datta S, Morgan C . The impact of the overactive bladder on health-related utility and quality of life. BJU Int. 2006; 97(6):1267-72. DOI: 10.1111/j.1464-410X.2006.06141.x. View

19.

Brubaker L, Stoddard A, Richter H, Zimmern P, Moalli P, Kraus S . Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn. 2009; 28(4):268-73. PMC: 2702259. DOI: 10.1002/nau.20698. View

20.

Minassian V, Yan X, Lichtenfeld M, Sun H, Stewart W . The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012; 23(8):1087-93. PMC: 3905313. DOI: 10.1007/s00192-012-1743-x. View