Correlates of urinary, fecal, and dual incontinence in older African-American and white men and women

OBJECTIVES: To determine prevalence and correlates of urinary (UI), fecal (FI), and dual (DI) incontinence in community‐dwelling older adults. DESIGN: Cross‐sectional, population‐based in‐home survey. SETTING: Three rural and two urban Alabama counties (1999–2001). PARTICIPANTS: Stratified random sample of 1,000 Medicare beneficiaries aged 65 and older: 25% African‐American men, 25% white men, 25% African‐American women, 25% white women. MEASUREMENTS: UI defined as involuntary urine loss at least monthly; FI defined as “In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?” Independent variables were sociodemographics, medical history, and activities of daily living (ADLs) excluding toileting. Multinomial logistic regression models were constructed using UI, FI, and DI as dependent variables. RESULTS: UI, FI, and DI prevalences were 27%, 6%, and 6%, respectively. White women had higher prevalence of UI (41.1% vs 24.6%, P<.001) and DI (18.5% vs 8.0%, P=.07) but not FI (4.4% vs 3.8%, P=.83) than African‐American women. Men had no racial differences in prevalence (UI 22.2%, FI 7.7%, DI 4.6%). In women, UI, FI, and DI correlates included higher Charlson comorbidity score and depressive symptoms and greater ADL difficulty for UI and DI. In men, UI was associated with prostate disease and depressive symptoms; FI with chronic diarrhea, history of transient ischemic attack (TIA), and poor self‐perceived health; and DI with history of TIA, foot and leg swelling, and depressive symptoms. CONCLUSION: Women had racial differences as well as similar correlates of incontinence subtypes, whereas men did not.     

Prevalence and correlates of fecal incontinence in community-dwelling older adults

Objectives: To determine prevalence and correlates of fecal incontinence in older community‐dwelling adults. Design: A cross‐sectional, population‐based survey. Setting: Participants interviewed at home in three rural and two urban counties in Alabama from 1999 to 2001. Participants: The University of Alabama at Birmingham Study of Aging enlisted 1,000 participants from the state Medicare beneficiary lists. The sample was selected to include 25% black men, 25% white men, 25% black women, and 25% white women. Measurements: The survey included sociodemographic information, medical conditions, health behaviors, life‐space assessment (mobility), and self‐reported health status. Fecal incontinence was defined as an affirmative response to the question “In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?” Severity was classified as mild if reported less than once a month and moderate to severe if reported once a month or greater. Results: The prevalence of fecal incontinence in the sample was 12.0% (12.4% in men, 11.6% in women; P=.33). Mean age±standard deviation was 75.3±6.7 and ranged from 65 to 106. In a forward stepwise logistic regression analysis, the following factors were significantly associated with the presence of fecal incontinence in women: chronic diarrhea (odds ratio (OR)=4.55, 95% confidence interval (CI)=2.03–10.20), urinary incontinence (OR=2.65, 95% CI=1.34–5.25), hysterectomy with ovary removal (OR=1.93, 95% CI=1.06–3.54), poor self‐perceived health status (OR=1.88, 95% CI=1.01–3.50), and higher Charlson comorbidity score (OR=1.29, 95% CI=1.07–1.55). The following factors were significantly associated with fecal incontinence in men: chronic diarrhea (OR=6.08, 95% CI=2.29–16.16), swelling in the feet and legs (OR=3.49, 95% CI=1.80–6.76), transient ischemic attack/ministroke (OR=3.11, 95% CI=1.30–7.41), Geriatric Depression Scale score greater than 5 (OR=2.83, 95% CI=1.27–6.28), living alone (OR=2.38, 95% CI=1.23–4.62), prostate disease (OR=2.29, 95% CI=1.04–5.02), and poor self‐perceived health (OR=2.18, 95% CI=1.13–4.20). The following were found to be associated with increased frequency of fecal incontinence in women: chronic diarrhea (OR=6.39, 95% CI=2.25–18.14), poor self‐perceived health (OR=5.37, 95% CI=1.75–16.55), and urinary incontinence (OR=4.96, 95% CI=1.41–17.43). In men, chronic diarrhea (OR=5.38, 95% CI=1.77–16.30), poor self‐perceived health (OR=3.91, 95% CI=1.39–11.02), lower extremity swelling (OR=2.86, 95% CI=1.20–6.81), and decreased assisted life‐space mobility (OR=0.73, 95% CI=0.49–0.80) were associated with more frequent fecal incontinence. Conclusion: In community‐dwelling older adults, fecal incontinence is a common condition associated with chronic diarrhea, multiple health problems, and poor self‐perceived health. Fecal incontinence should be included in the review of systems for older patients.     

Prevalence and Correlates of Nocturia in Community‐Dwelling Older Adults

OBJECTIVES: To determine the prevalence and correlates of nocturia in community‐dwelling older adults. DESIGN: Planned secondary analysis of cross‐sectional data from the University of Alabama at Birmingham Study of Aging population‐based survey. SETTING: Participants' homes. PARTICIPANTS: One thousand older adults (aged 65–106) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% each African‐American women, African‐American men, white women, and white men. MEASUREMENTS: In‐person interviews included sociodemographic information, medical history, Mini‐Mental State Examination (MMSE) score, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as rising two or more times per night to void. RESULTS: Nocturia was more common in men than women (63.2% vs 53.8%, odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15–1.91, P=.003) and more common in African Americans than whites (66.3% vs 50.9%, OR=1.89, 95% CI=1.46–2.45, P<.001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African‐American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m²). Higher MMSE score was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African‐American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). CONCLUSION: Nocturia in community‐dwelling older adults is a common symptom associated with male sex, African‐American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia.     

Prevalence and Risk Factors of Male Urinary Incontinence: Results of a Korean Population‐Based Study

Objectives: The purpose of this study was to identify the prevalence of and risk factors for urinary incontinence (UI) in Korean men. Methods: This epidemiologic survey adopted a two‐stage systematic sampling method. A total of 5831 men participated in this survey. Face‐to‐face interviews were used to collect data. Age, mobility, self‐care ability, comorbidities and smoking were included as potential risk factors. The type of UI was assessed with the Urogenital Distress Inventory‐6 questionnaire. To provide representative population prevalence estimates, the sample population was weighted by age. Results: The age‐adjusted prevalence of Korean male UI was 5.5%. Urgency urinary incontinence was the most prevalent incontinence type. Men aged 65 years and older had a rate of UI eight times that of men aged 19–44 years. Men with problems in mobility or self‐care had an OR of 2.3 and 1.7, respectively. Conclusion: The age‐adjusted prevalence of UI in community‐dwelling Korean men was 5.5%, which is lower than that of Korean women and higher than previously reported prevalence of Korean male incontinence. Age, immobility, and self‐care ability were risk factors for male UI.     

Urinary and Fecal Incontinence and Quality of Life in African Americans

OBJECTIVES: To investigate associations between quality of life (QoL) and incontinence in a population‐based African‐American sample. DESIGN: Cross‐sectional survey. SETTING: Metropolitan St. Louis, Missouri. PARTICIPANTS: Eight hundred fifty‐three non‐institutionalized African Americans aged 52 to 68 in the African American Health study. MEASUREMENTS: Respondents who reported having involuntarily lost urine over the previous month were classified as having urinary incontinence (UI), and respondents who reported having lost control of their bowels or stool over the past year were classified as having fecal incontinence (FI). QoL was measured using the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36) and the 11‐item Center for Epidemiologic Studies Depression Scale (CES‐D). RESULTS: Prevalences of UI and FI were 12.1% (weighted n=102/841) and 5.0% (weighted n=42/841). Participants with UI and those with FI had worse SF‐36 scores than their referent groups (physical function ?15.5 and ?38.1 points, respectively; role physical ?13.2 and ?26.5 points; bodily pain ?15.7 and ?24.5 points; general health perceptions ?15.5 and ?27.6 points; vitality ?15.0 and ?16.5 points; social functioning ?18.4 and ?25.6 points; role emotional ?13.2 and ?22.1 points; mental health ?12.2 and ?17.5 points; all Ps<.001), adjusting for age, sex, body mass index, and chronic conditions. Proportions with clinically relevant levels of depressive symptoms were also higher in both groups (UI+17.9%; P<.001) and FI (+37.2%; P<.001) than in their referent groups. CONCLUSION: UI and FI were strongly associated with worse health‐related QoL as well as symptoms of depression in this population‐based sample of African Americans.     

Correlates of 1‐Year Incidence of Urinary Incontinence in Older Latino Adults Enrolled in a Community‐Based Physical Activity Trial

The prevalence of urinary incontinence (UI) among older urban Latinos is high. Insight into etiologies of and contributing factors to the development of this condition is needed. This longitudinal cohort study identified correlates of 1‐year incidence of UI in older community‐dwelling Latino adults participating in a senior center–based physical activity trial in Los Angeles, California. Three hundred twenty‐eight Latinos aged 60 to 93 participating in Caminemos, a randomized trial to increase walking, were studied. Participants completed an in‐person survey and physical performance measures at baseline and 1 year. UI was measured using the International Consultation on Incontinence item: “How often do you leak urine?” Potential correlates of 1‐year incidence of UI included sociodemographic, behavioral, medical, physical, and psychosocial characteristics. The overall incidence of UI at 1 year was 17.4%. Incident UI was associated with age, baseline activity of daily living impairment, health‐related quality of life (HRQoL), mean steps per day, and depressive symptoms. Multivariate logistic regression models revealed that improvement in physical performance score (odds ratio (OR) = 0.69, 95% confidence interval (CI) = 0.50–0.95) and high baseline physical (OR = 0.60, 95% CI = 0.40–0.89) and mental (OR = 0.62, 95% CI = 0.43–0.91) HRQoL were independently associated with lower rates of 1‐year incident UI. An increase in depressive symptoms at 1 year (OR = 4.48, 95% CI = 1.02–19.68) was independently associated with a higher rate of incident UI. One‐year UI incidence in this population of older urban Latino adults participating in a walking trial was high but was lower in those who improved their physical performance. Interventions aimed at improving physical performance may help prevent UI in older Latino adults.     

Urinary incontinence (UI) and quality of life (QoL) of the elderly residing in residential homes in Turkey

The objective of this study was to evaluate urinary incontinence (UI) and its effect on the quality of life (QoL) of older people dwelling in residential homes in Turkey. A cross-sectional study was applied in residential homes. A total of 1110 people older than 60 years residing in five selected residential homes were studied. An interview was conducted with the residents who had sufficient cognitive function and agreed to participate. The QoL and the mental and the functional state of the residents were analyzed using the King's Health Questionnaire (KHQ), Mini Mental State Examination (MMSE), and the Rankin Scale, respectively: Of the total pool, 694 residents were included in the study of which 56.48% (n = 392) were female and 43.52% (n = 302) were male. UI was present in 170 women and 63 men. Pad usage was more common in women (88%) than that in men (29.1%). The QoL subdimensions showed that women had higher scores than men. Urge UI (UUI) had more impact on the QoL than that on functional, mixed or stress incontinence. We concluded that UI negatively affects the QoL of older people living in residential homes. In particular, women and patients suffering from UUI are more severely affected.     

Survey of Geriatricians on the Effect of Fecal Incontinence on Nursing Home Referral

OBJECTIVES: Determine the effect of fecal incontinence (FI) on healthcare providers' decisions to refer patients for nursing home (NH) placement. DESIGN: Survey. SETTING: Questionnaires were e‐mailed to participants' homes or offices. Participants could also volunteer at the 2008 American Geriatric Society annual meeting in Washington, DC. PARTICIPANTS: Two thousand randomly selected physician members and all 181 nurse practitioner members of the American Geriatrics Society were surveyed. MEASUREMENTS: The survey presented a clinical scenario of a 70‐year‐old woman ready for discharge from a hospital and asked about the likelihood of making a NH referral if the patient had no incontinence, urinary incontinence (UI) alone, or FI. Subsequent questions modified the clinical situation to include other conditions that might affect the decision to refer. A second survey of respondents to Survey 1 addressed possible moderators of the decision to refer (e.g., family caregiver presence, diarrhea or constipation, other physical or psychiatric limitations). Significance of differences in the relative risk (RR) for NH referral was tested using the chi‐square test. RESULTS: Seven hundred sixteen members (24.7% response rate) completed the first survey, and 686 of the 716 (96%) completed the second. FI increased the likelihood of NH referral (RR=4.71, P<.001) more than UI did (RR=1.90, P<.001). Mobility restrictions, cognitive decline, and multiple chronic illnesses increased the likelihood of NH referral more than FI alone (P<.001 for each), but in all scenarios, adding FI further increased the likelihood of referral (P<.001). Having family caregivers willing to help with toileting attenuated the likelihood of referral. CONCLUSION: FI increases the probability that geriatricians will refer to a NH. More‐aggressive outpatient treatment of FI might delay or prevent NH referral, improve quality of life, and reduce healthcare costs.     

Fecal incontinence among morbid obese women seeking for weight loss surgery: an underappreciated association with adverse impact on quality of life

Purpose Morbid obesity is associated with urinary incontinence (UI). The study purpose was to determine the prevalence of fecal incontinence (FI), its associated risk factors, and its impact on quality of life (QOL) in morbidly obese women. Materials and methods A questionnaire-based study on morbidly obese women [body mass index (BMI) ≥ 35 m/kg²], attending a bariatric surgery seminar, was conducted. Data included demographics, past medical, surgical and obstetric history, and obesity-related co-morbidities. Patients who reported of FI, completed the Cleveland Clinic Foundation Fecal Incontinence scale (CCF-FI) and the Fecal Incontinence Quality of Life scale (FIQL). Results Participants included 256 women [median age 45 years (19–70)] and mean BMI of 49.3 ± 9.4 m/kg². FI was reported in 63%. History of obstetric injury (OR: 2.4, 95% CI: 1.33–4.3; p < 0.001) and UI (OR: 1.2, 95% CI: 1.1–1.4; p < 0.001) were significantly associated with FI. There was no association with age, BMI, parity, and presence of diabetes or hypertension. Median CCF-FI score was 7 (1–20); 34.5% scored ≥10. Incontinence for gas was the most frequent type (87%) of FI, followed by incontinence for liquids (80%), which also had the highest impact on QOL (p < 0.01). Mean FIQL scores were >3 for all four domains studied. CCF-FI scores were significantly correlated with FIQL scores in all domains (p = 0.02). Comment The prevalence of FI among morbidly obese women may be much higher than the rates reported in the general population. FI has adverse effects on QOL. Its correlation with UI suggests that morbid obesity may pose a risk of global pelvic floor dysfunction.     

Prevalence of silent fecal and urinary incontinence in women from the town of Teruel.

OBJECTIVES: To study the prevalence of fecal (FI) and urinary incontinence (UI) in women from Teruel (Spain), as well as the clinical conditions associated with these disorders. METHODS: We studied prospectively women with an age range of 20-64 years who were randomly selected from the population seen in a primary care center because of medical disorders not related to incontinence. Patients with functional or cognitive impairment were excluded. Medical and obstetric antecedents, as well as the type and frequency of incontinence symptoms were collected in a questionnaire. RESULTS: Out of 115 women, 103 completed the study (mean age: 41+/-12 years range 20-64). UI was present in 34.9% (stress 33%, urge 14%, mixed 47%), FI in 14 (13.6%) (flatus 57%, liquid stools 43%), and 10 (9.7%) displayed both disorders. Age > 42 years and body mass index more or equal of 25 were associated with FI and UI; pregnancy was only associated with UI, but the group of women with more or equal of 2 vaginal deliveries showed a higher frequency of FI (p < 0.05, Chi squared test). In the multivariate analysis, only the presence of UI was associated with FI (OR 6.0; CI 95% 1.7-21). Association of FI and UI was more frequent in women older than 42 years (OR 16.7, CI 95% 1.9-141). No statistical differences were found when smoking, exercise, and type of childbirth were compared between the presence/absence of FI or UI. CONCLUSIONS: Urinary and fecal incontinence are frequent in women, and the coexistence of both disorders is not uncommon. Age, overweight and parity are associated with the presence of fecal and/or urinary incontinence.     

Vitamin B(12) deficiency and incontinence: is there an association?

BACKGROUND: This study investigated the relationship between B(12) (cobalamin) levels and incontinence in older outpatients using secondary data analysis. METHODS: Between 1991 and 1999, there were 929 patients (258 men and 671 women) for whom urinary incontinence (UI), fecal incontinence (FI), and B(12) were prospectively recorded. Covariates included race, gender, age, medications, Mini-Mental State Examination, modified illness rating, and instrumental activities of daily living (IADLs). RESULTS: Some form of incontinence (UI or FI or both) was found in 41% of subjects, isolated UI in 34%, double incontinence (DI) in 12%, and isolated FI in 4%. Having UI increased the risk of also having FI (p <.0001). Serum B(12) levels of 300 pg/ml or less were not predictive of isolated UI or isolated FI. However, in logistic regression, DI was predicted by B(12) (odds ratio [OR] = 2.113, p =.0094), IADLs (OR = 0.810, p <.0001), cathartics/laxative use (OR = 1.902, p =.126), and diuretic use (OR = 2.226, p =.006). Considering isolated UI in women, higher IADLs reduced risk of UI (OR = 0.956, p =.002), while diuretics (OR = 1.481, p =.041) and antihistamines (OR = 1.909, p =.046) both increased risk of UI. In men, only use of anticonvulsant medications (OR = 4.529, p =.023) increased risk of isolated UI. Greater physical illness in both genders increased risk of isolated FI (OR = 1.204, p =.006). CONCLUSIONS: These findings suggest that serum B(12) at levels of 300 pg/ml or less are not associated with isolated UI or isolated FI but may play a role in DI. A possible association of low B(12) levels with DI is intriguing because of the implications for treatment and prevention. More immediately, medication side effects should be considered when evaluating this problem.     

The epidemiology of urinary incontinence in older women: incidence, progression, and remission

OBJECTIVES: To examine the epidemiology of urinary incontinence (UI) in older women.
DESIGN: Prospective study.
SETTING: Nurses' Health Study.
PARTICIPANTS: Incidence of UI was determined in 23,792 women aged 54 to 79 without UI at baseline. Progression or remission of UI was determined in 28,813 women with UI at least monthly at baseline.
MEASUREMENTS: UI was ascertained according to questionnaires in 2000 and 2002. Rates of incident UI and progression or remission of prevalent UI were calculated. Logistic regression was used to estimate relative risks of UI associated with risk factors.
RESULTS: In women with no urine leakage at baseline, 9.2% reported leakage at least monthly after 2 years. For women with leakage at least weekly, the incidence was 3.6%; of these cases, stress UI had the highest incidence, followed by mixed and urge UI. Relationships between UI and age differed for stress UI, which decreased with age (relative risk (RR)=0.63, 95% confidence interval (CI)=0.43–0.92 for aged 70–79 vs 54–59), and urge and mixed UI, which increased with age (RR=2.28, 95% CI=1.09–4.75 and RR=2.11, 95% CI=1.24–3.61, respectively). For prevalent UI in 2000, 32.1% of subjects with leakage once a month progressed to leakage at least once a week over follow-up. Only 8.9% with frequent leakage in 2000 reported improvement to monthly leakage or less, with 2.0% having complete remission.
CONCLUSION: The incidence of UI is high in older women, and progression from occasional to frequent leaking is common. Urge UI, for which there are limited effective treatments, increases with age, thus research on UI prevention in older women is particularly important.     

Risk factors for fecal and urinary incontinence after childbirth: the childbirth and pelvic symptoms study

OBJECTIVE: To identify risk factors for postpartum FI and UI. METHODS: Secondary analysis of data from the CAPS study, which estimated the prevalence of postpartum FI and UI in primiparous women with clinically recognized anal sphincter tears after vaginal delivery, compared with women who delivered vaginally without recognized tears or by cesarean before labor. A total of 921 women were enrolled while in the hospital and 759 (82%) were interviewed by telephone 6 months postpartum. FI was assessed using the FISI and UI using the Medical, Epidemiological, and Social Aspects of Aging Questionnaire. FI risk factor analyses were conducted within each group, because of higher prevalence in the tear group. UI analyses were conducted with the groups combined. RESULTS: In women with sphincter tears, FI at 6 months was associated with white race (OR 6.1, 95% CI 1.3-29.4), antenatal UI (OR 2.2, CI 1.1-4.3), 4th versus 3rd degree tear (OR 2.0, CI 1.0-4.0), older age at delivery (OR 1.6 per 5 yr, CI 1.2-2.1), and higher body mass index (BMI) (OR 1.3 per 5 kg/m(2), CI 1.0-1.7). No factors were associated with FI in the vaginal or cesarean control groups. Across all groups, risk factors for postpartum UI were antenatal UI (OR 3.5, CI 2.4-5.2), less education (OR 2.0, CI 1.4-2.8), and higher BMI (OR 1.2 per 5 kg/m(2), CI 1.1-1.4); cesarean delivery was protective (OR 0.5, CI 0.3-0.9). CONCLUSIONS: Postpartum FI and UI are associated with few modifiable risk factors. However, the presence of antenatal UI and high BMI may help clinicians target at-risk women for early intervention.     

The Effect of Medication Use on Urinary Incontinence in Community‐Dwelling Elderly Women

OBJECTIVES: To evaluate whether use of certain medications with potential urological effects is associated with development of incident urinary incontinence in community‐resident older women. DESIGN: Longitudinal cohort study. SETTING: Pittsburgh, PA, and Memphis, TN. PARTICIPANTS: Nine hundred fifty‐nine healthy black and white women aged 65 and older enrolled in the Health, Aging and Body Composition Study without baseline (Year 1) self‐reported urinary incontinence. MEASUREMENTS: Use of alpha blockers, anticholinergics, central nervous system medications (opioids, benzodiazepines, antidepressants, antipsychotics), diuretics (thiazide, loop, potassium sparing), and estrogen (all dosage forms) was determined during Year 3 interviews. Self‐reported incident (≥weekly) incontinence in during the previous 12 months was assessed at Year 4 interviews. RESULTS: Overall, 20.5% of these women reported incident incontinence at Year 4 (3 years from baseline). The most common medication used with potential urological activity was a thiazide diuretic (24.3%), followed by estrogen (22.2%); alpha blockers were the least commonly used (2.3%). Multivariable logistic regression analyses revealed that current users of alpha blockers (adjusted odds ratio (AOR)=4.98, 95% confidence interval (CI)=1.96–12.64) and estrogen (AOR=1.60, 95% CI=1.08–2.36) had a greater risk of urinary incontinence than nonusers. There was no greater risk (P>.05) of urinary incontinence with the current use of anticholinergics, central nervous system medications, or diuretics. No statistically significant race‐by–medication use interactions were found (all P>.05). CONCLUSION: These results corroborate earlier reports that, in elderly women, use of alpha blockers or estrogens is associated with risk of self‐reported incident urinary incontinence.     

Dietary Nutrients and Urinary Incontinence in Japanese Adults

Objectives: To investigate the association between dietary nutrients and urinary incontinence (UI) among Japanese adults. Methods: A total of 1017 adults (710 men and 307 women) were recruited from the community in central and southern Japan. A structured questionnaire, incorporating the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and a validated food frequency questionnaire, was administered to participants by face‐to‐face interview. Information on dietary nutrients intake from each food item was obtained using the Japanese food composition tables. Logistic regression analyses were performed to determine the association between nutrients intake and the prevalence of UI. Results: The observed prevalence of UI was 8.7% (n = 62) for men (mean age 62.5 years) and 29% (n = 89) for women (mean age 62.0 years) based on the ICIQ‐SF criterion. Of the 50 dietary nutrients and micronutrients considered, soluble fiber (P = 0.03) and omega‐6 polyunsaturated fatty acids (P = 0.01) were found to be inversely associated with the UI prevalence for men, whereas increasing the intake of lutein/zeaxanthin appeared to be marginally associated (P = 0.04) with a reduced risk of UI for women. Conclusion: Three dietary nutrients have been identified to be associated with UI in middle‐aged and older Japanese adults. Further research and clinical trials are needed to ascertain the effects of dietary nutrients on UI.     

Effects of exercise treatment with or without heat and steam generating sheet on urine loss in community‐dwelling Japanese elderly women with urinary incontinence

Aim: To determine the effects of exercise treatment with or without heat and steam generating sheet (HSGS) on reducing urine loss in community‐dwelling elderly women with urinary incontinence (UI). Methods: One hundred and forty‐seven community‐dwelling women aged 70 years and older with stress, urge and mixed UI were randomly assigned to exercise + HSGS (n = 37), exercise only (n = 37), HSGS only (n = 37) or an education group (n = 36). Exercise + HSGS, and exercise groups received exercise training twice a week for 3 months. When the HSGS was placed on the lower back, the temperature of the skin surface rose to 38–40°C and it continued to generate heat and steam for over 5 h. The HSGS group used one sheet per day continuously for 3 months. Urine loss and fitness data were collected at baseline and after intervention. Results: The intervention groups showed significant improvements in muscle strength and walking speed compared to the education group. Exercise and HSGS showed urine loss cure rates of 54.1%, exercise 34.3% and HSGS 21.6% after treatment; whereas, the education group (2.9%) showed no significant improvement (χ²=21.89, P < 0.001). Combining the HSGS to the exercise intervention showed a 61.5% cure rate for stress UI, 50.0% urge UI and 40.0% mixed UI. Conclusion: This data suggests that exercise treatment with HSGS is more effective for treating urine loss regardless of UI type. The HSGS can be used as a supplementary treatment method to enhance the effects of exercise on women with urge, mixed and stress UI. Geriatr Gerontol Int 2011; 11: 452–459.     

Urinary incontinence in US women: a population-based study

BACKGROUND: Urinary incontinence (UI) is a common disorder that is increasingly important as our population ages. Less is known about UI in younger women, and few large surveys have been able to determine risk factors by linking their data to patients' medical findings. METHODS: We conducted a population-based, age-stratified postal survey of 6000 women aged between 30 and 90 years who were enrolled in a large health maintenance organization in Washington State. RESULTS: The response rate was 64% (n = 3536) after exclusion criteria were applied. The population-based prevalence of UI was 45%. Prevalence increased with age, from 28% for 30- to 39-year-old women to 55% for 80- to 90-year-old women. Eighteen percent of respondents reported severe UI. The prevalence of severe UI also increased notably with age, from 8% for 30- to 39-year-old women to 33% for 80- to 90-year-old women. Older age, higher body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), greater medical comorbidity, current major depression, a history of hysterectomy, and parity increased the odds of having UI. Not being white and having had only cesarean deliveries decreased the odds of having UI. Major depression (odds ratio, 2.48; 95% confidence interval, 1.65-3.72) and obesity, defined as having a BMI of 30 or greater (odds ratio, 2.39; 95% confidence interval, 1.99-2.87), had the strongest association with UI. Among women with UI, age, BMI, medical comorbidity, current major depression, diabetes, a history of hysterectomy, and having had only cesarean deliveries were significantly associated with severe UI. CONCLUSIONS: Urinary incontinence is highly prevalent in women across their adult life span, and its severity increases linearly with age. Age, BMI, race, medical comorbidity, current major depression, a history of hysterectomy, parity, and having only had cesarean deliveries are each independent factors significantly associated with the likelihood of having UI.     

A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

OBJECTIVES: To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes. DESIGN: Randomized controlled trial. SETTING: Six nursing homes (NHs). PARTICIPANTS: One hundred twelve NH residents. INTERVENTION: Intervention subjects were offered toileting assistance, exercise, and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months. MEASUREMENTS: Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on a subset of 29 residents. RESULTS: The intervention significantly increased physical activity, frequency of toileting, and food and fluid intake. UI improved (P=.049), as did frequency of bowel movements (P<.001) and percentage of bowel movements (P<.001) in the toilet. The frequency of FI did not change. Eighty‐nine percent of subjects who underwent anorectal testing showed a dyssynergic voiding pattern, which could explain the lack of efficacy of this intervention program alone on FI. CONCLUSION: This multicomponent intervention significantly changed multiple risk factors associated with FI and increased bowel movements without decreasing FI. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber), biofeedback therapy, or both to improve bowel function.     

Urinary incontinence and psychological distress in community-dwelling older African Americans and whites

OBJECTIVES: To compare the association between urinary incontinence (UI) and psychological distress in older African Americans and whites. DESIGN: A population-based longitudinal survey. SETTING: Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981. PARTICIPANTS: African Americans and whites aged 50 and older at follow-up interviews performed between 1993 and 1996 for whom complete data were available (n=747). MEASUREMENTS: Participants were classified as incontinent if any uncontrolled urine loss within the 12 months before the interview was reported. Psychological distress was assessed using the General Health Questionnaire (GHQ). RESULTS: African Americans with UI were more likely to experience psychological distress as measured using the GHQ than were African Americans without UI (unadjusted odds ratio=4.22, 95% confidence interval=1.72-10.39). In multivariate models that controlled for age, sex, education, functional status, cognitive status, and chronic medical conditions, this association remained statistically significant. The association between UI and psychological distress did not achieve statistical significance in whites. CONCLUSION: The effect of UI on emotional well-being may be greater for African Americans than for whites.     

Prevalence of Incontinence During Rehabilitation in Patients Following a Stroke

According to current studies, the prevalence of urinary incontinence (UI) ranges from 25% to 45%, while prevalence of poststroke or new-onset UI ranges from 21% to 56% and is higher among older adults. On admission to postacute rehabilitation, double incontinence (UI with fecal incontinence [FI]) is more prevalent (33%) than isolated UI (12%) and isolated FI (8%)—figures that decrease at discharge from stroke rehabilitation (double incontinence, 15%; isolated UI, 8%; isolated FI, 5%). Impaired awareness of UI is more prevalent (ranges from 12% in young old group to 58% in older age group) than urge UI (9–42%) and seems to be a more specific prognostic indicator of poor functional outcome. Therefore, rehabilitation professionals should place more attention on impaired awareness of the need to void and double incontinence during stroke rehabilitation.