Prevalence and risk factors of female urinary incontinence in eastern Turkey

Objectives:   To evaluate the prevalence of urinary incontinence (UI) and determine risk factors for its development in women living in eastern Turkey.
Methods:   A cross-sectional study was conducted on 2275 women aged between 17 and 80 years. A questionnaire examining demographic characteristics, parity and pelvic organ prolapse was given. Presence and types of incontinence were examined using a validated form of the Turkish version of the urogenital distress inventory questionnaire-short form (UDI-6).
Results:   A total of 1054 (46.3%) women reported involuntary loss of urine. Stress UI was present in 46% of women, whereas urge UI was detected in 43% of them. Mean age of patients with and without UI were 44.57 + 11.04 and 35.04 + 9.51, respectively. Age, total number of pregnancies and number of deliveries were shown to be significantly different in patients with and without any type of UI. Multiple logistic regression analysis of the factors revealed that age, total delivery number, pelvic organ prolapse and difficult labor were significantly associated with the presence of UI.
Conclusions:   This is the first study examining the prevalence of UI in women living in eastern Turkey. By using a validated questionnaire, several risk factors for the development of UI were determined. Pelvic organ prolapse and increased number of births were found to be two most significant ones.     

Why do stress and urge incontinence co-occur much more often than expected?

Assuming stress and urge urinary incontinence (UI) are independent, mixed UI prevalence is 17 times higher than expected. We consider three explanatory models. We summarize evidence from previous studies on whether common Risk Factors, Liability (i.e., one UI subtype increases risk of the other), or Severity model (i.e., mixed UI represents an advanced and more persistent stage of a progressive disorder) explains the unexpectedly high prevalence of mixed UI. We found little support to indicate that the excess prevalence of mixed UI is explained by common risk factors. In contrast, evidence does indicate that onset of one UI subtype increases risk of onset of the other subtype. Finally, although the Severity model is intuitively attractive, there is little epidemiologic evidence to support it. Longitudinal studies are needed to determine which model offers a dominant explanation for the high prevalence of mixed UI.     

UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction?

Vaginal childbirth is probably the most important factor in the aetiology of pelvic floor dysfunction (PFD) and results in the combination of some or all of the following conditions: urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). Up until now, it has been difficult to counsel women antenatally regarding risk factors for subsequent PFD, as there has been little good-quality, long-term information available. We now have moderately robust epidemiological data at 12 and 20 years after delivery and objective pathophysiological data (pudendal nerve trauma and levator defects/avulsion). In this commentary, we propose a scoring system (UR-CHOICE) to predict the risk of future PFD based on several major risk factors (UI before pregnancy, ethnicity, age at birth of first child, body mass index, family history (mother and sister) of PFD and baby’s weight and maternal height (if <160 cm and baby >4 kg) that have been identified for subsequent PFD risk. This scoring system will help with counselling for women regarding PFD prevention.     

Prevalence and risk factors for urinary incontinence in Italy

OBJECTIVES: To analyze the frequency and risk factors for urinary incontinence (UI) in Italy. METHODS: Eligible for this cross-sectional study were men aged >/=50 years and women aged >/=40, randomly identified among registered subjects of a network of general practitioners during the period March-October 1997. All subjects were invited by telephonic interview to determine the presence of UI, reported by the subjects as loss of urine in the last year. The subjects with UI were further questioned at home for evaluation of the type, degree and frequency of UI episodes. RESULTS: Of the 5,488 subjects interviewed (2,767 women and 2,721 men), 92 (3%) men and 316 (11%) women reported at least one episode of UI during the year before the interview. The frequence of UI increased with age both in men and women, being 2 and 11% in men and women, respectively, aged 50-60 years and 7 and 16% in those aged >/=70. Of the subjects with UI identified, 229 women and 64 men and a group of 289 subjects without UI were questionned at home using a detailed questionnaire. Six and 55% of men and women, respectively, reported stress incontinence, 20 and 12% urge incontinence and 20 and 24% mixed incontinence. The risk of UI increased with body mass index in women. A history of recurrent urinary infection was associated with UI in men and less markedly in women. No association emerged between education, smoking and alcohol or coffee consumption and risk of UI. Parity was directly associated with the risk of UI in women. CONCLUSIONS: The study offers a quantitative estimate of the prevalence of UI and its main risk factors in this Italian population.     

Multiparity,age and overweight/obesity as risk factors for urinary incontinence in pregnancy: a systematic review and meta-analysis

Introduction and Hypothesis

Multiparity, age and high body mass index (BMI) are the most widely investigated factors associated with urinary incontinence (UI) during pregnancy. We hypothesized that multiparity, age 35 years or older and high BMI (prepregnancy and during pregnancy) are risk factors for the occurrence of UI in pregnant women.

Methods

Searches were done on MEDLINE/PubMed (1966–2017), LILACS/BIREME (1982–2017), CINAHL/Ebsco (1981–2017) and Scopus/Elsevier (1950–2017). The following criteria were used for study eligibility: (1) population: low-risk pregnant women in any trimester and without age restriction; (2) exposure factors: multiparity (≥ 2 deliveries), age 35 years or older and high BMI (overweight and obesity); (3) outcome: UI during pregnancy; (4) study design: cohort, case-control or cross-sectional studies that used multivariate logistic analysis. Two independent reviewers performed the entire systematic review process. Data extraction of each article was done and, when possible, included in a meta-analysis. Risk of study bias was assessed by NOS and quality of evidence by GRADE. A significance level of p?≤?0.05 was adopted. The PROSPERO registration number was CRD42014013193.

Results

Of 1176 articles identified through searches, 13 were included after screening and application of eligibility criteria. Very low quality of evidence shows that multiparity (OR?=?2.09; 95% CI: 1.07 to 4.08), age 35 years or older (OR?=?1.53; 95% CI: 1.45 to 1.62) and overweight and obesity during pregnancy (OR?=?1.53; 95% CI: 1.28 to 1.83) are risk factors for UI in pregnancy.

Conclusions

The exposure factors investigated are risk factors for UI in pregnancy based on a very low quality of evidence.

     

Impact of urinary incontinence after stroke: results from a prospective population-based stroke register

AIM: The purpose of this study was to investigate, in a community-based population, the frequency of stroke-related urinary incontinence (UI) and to analyse the long-term impact of UI on prognosis and institutional care. METHODS: Included were 752 acute stroke patients admitted consecutively during a 4-year period. We evaluated the UI by using the Barthel Index during the first 7 days and at 12-months follow-up. RESULTS: During the acute stage, the proportions of patients with full UI, partial UI, and no UI were 41%, 12%, and 47%, respectively (16%, 16%, and 68% at 12-months follow-up). A total of 45% of patients with UI at 12 months were institutionalised compared with 5% of patients without UI. In a multivariate logistic regression model, age, urinary incontinence at day 7, and severe disability at 12 months were demonstrated to be independent factors for a higher frequency of institutional care 12 months after stroke. CONCLUSIONS: On admission in the acute stage, more than 50% of an unselected stroke population have UI. The proportion declines to one third of the surviving patients at 12 months. Stroke survivors who are incontinent in the acute stage have an fourfold higher risk to be institutionalised after 1 year.     

Factors influencing self-perceived disease severity in women with stress urinary incontinence combined with or without urge incontinence

AIMS: The aim of this study was to assess the impact of patient-perceived disease severity (PPDS) on the quality of life (QoL) of women with urinary incontinence (UI) and to identify factors predicting PPDS. METHODS: A total of 109 women (mean age 54.9; range 31-77) with stress UI combined with or without urge UI were included in the primary analyses. The incontinence quality of life (I-QoL) devised during the course of this study was used to assess the QOL impact of UI. RESULTS: PPDS of women with UI increased as I-QoL scores decreased (P<0.001). When analyzed by patient characteristics and objective test results, PPDS increased only with the number of episodes (P=0.005) and pad test weight increased (P=0.010). By multivariate regression analysis, patients who complained of UI "three to four times a day or more" had 6.4-fold higher risk (P=0.027) of perceiving that their symptoms were more severe than those who complained of a UI "one to two times per week or less." Patients with a pad test weight of >25 g had a 4.7-fold higher risk of perceiving their symptoms were more severe than those with a pad test weight of <15 g. CONCLUSIONS: Our results suggest that the frequency of UI episodes and the volume of urine loss are associated with PPDS. In addition, the I-QoL scores deteriorated significantly as the PPDS of incontinence increased. Thus, PPDS may impact on the QoL of women with stress UI combined with or without urge UI.     

A Cross-Sectional,Population-Based,Multinational Study of the Prevalence of Overactive Bladder and Lower Urinary Tract Symptoms: Results from the EPIC Study

The EPIC study was the first large-scale, multinational, population-based, cross-sectional survey to estimate the prevalence of lower urinary tract symptoms (LUTS) using current (2002) International Continence Society (ICS) definitions, with a focus on LUTS subtypes, overactive bladder (OAB), and urinary incontinence (UI). This study was conducted between April and December 2005 using randomly selected men and women ≥18 yr of age living in Canada, Germany, Italy, Sweden, and the United Kingdom. The results of the EPIC study are fairly consistent with the literature, showing that LUTS are highly prevalent; 64.3% of the 19,165 respondents reported experiencing at least one LUTS. Storage LUTS were considerably more prevalent than were voiding and postmicturition LUTS in both men and women. The prevalence of OAB was comparable in men (10.8%) and women (12.8%) and increased with age in both sexes. Nocturia was the most prevalent symptom in both men (48.6%) and women (54.5%). UI was more prevalent among women (13.1%) than men (5.4%). Among women, stress UI and other UI were the most prevalent types of UI; among men, other UI and urgency UI were most prevalent. Rates of physician-diagnosed depression were significantly higher in respondents with OAB, with or without UI, than in respondents without OAB. Further analyses of EPIC data will be available soon and should yield information about OAB regarding bother and impact on quality of life; risk factors and comorbidities; coping and health care-seeking behaviours; and impact on sexuality, mental health, and work productivity.     

Preventing urinary incontinence during pregnancy and postpartum: a review

Urinary incontinence (UI) is a common condition in association with pregnancy. Incident UI in pregnancy or postpartum are significant risk factors for UI later in life. Epidemiological studies on UI during pregnancy and postpartum list numerous variables associated with UI. For women, the main focus is on pelvic floor muscle training to prevent UI. However, several other modifiable risk factors are likely to contribute to prevention of UI during pregnancy and postpartum. This review investigated modifiable risk factors for UI during pregnancy and postpartum and also reviewed randomized controlled trials on prevention of UI in association with pregnancy. Systematic searches for publications until September 2012 on prevention of UI during pregnancy and postpartum were performed. Based on available evidence, the following recommendations to prevent UI during pregnancy and postpartum were made: women should be advised not to smoke before or during pregnancy (grade B), aim at normal weight before pregnancy (grade B), and aim at regaining prepregnancy weight postpartum (grade B). Occasional low-intensity training should be advocated (grade B), and constipation should be avoided during pregnancy (grade B) and postpartum (grade C). Women should be advised to perform pelvic floor muscle training during pregnancy and postpartum (grade A) and to use perineal warm packs during delivery (grade B). Cesarean section to prevent UI cannot be recommended (grade D). If lifestyle recommendations are addressed in association with pregnancy, incidence of UI during pregnancy and postpartum is likely to decrease.     

Prevalence of and Risk Factors for Urinary Incontinence in Home Hospice Patients

Urinary incontinence (UI) is a debilitating and embarrassing condition that is prevalent among aging males and females. Little is known about UI in the home hospice setting. We sought to determine UI prevalence and risk factors in a cohort of 15 432 home hospice patients over 4 yr. Most of the study patients were female (59%) and aged ≥75 yr. This was a retrospective observational study and no patients were excluded. The median length of service was 19 d. Approximately one-third of patients were diagnosed with UI during their hospice stay. Female sex and age were associated with a greater risk of UI. Diagnoses that increased the risk of UI included dementia and stroke. The risk of UI diagnosis was lower among those without a health care proxy, as well among those with higher Palliative Performance Scale scores. UI affects a substantial number of patients in home hospice and there are no guidelines for its diagnosis or mitigation. There is a pressing need to further understand the impact of UI on home hospice patients.

Pelvis architecture and urinary incontinence in women

OBJECTIVES: To examine anatomic features in the pelvic bones and muscles in women with urinary incontinence (UI). MATERIAL AND METHODS: Between October 2005 and January 2006, 212 consecutive women underwent pelvic computerized tomography in our center. Preceding the examination, all women completed a clinical and demographic questionnaire including detailed questions about UI. Several anatomic parameters using multiplanar reformation and three-dimensional techniques (volume rendering) were examined. We specifically evaluated different bony parameters, pelvic floor muscle angles, densities, and cross-sectional areas. Ninety-three women (46.5%) had UI; the remaining women served as the control group. A logistic regression model was used to evaluate risk factors for UI. RESULTS: The mean age was 55.5 yr (range: 19-90). Women who suffered from UI were older (60.97 vs. 50.77 yr, p<0.0001), had higher body mass index (27.65 vs. 25.49, p<0.01), had more previous hysterectomies (21.5% vs. 6.5%, p<0.005), underwent more pelvic irradiation (9.7% vs. 1.8%, p<0.05), and had more diabetes mellitus (31.2% vs. 13.1%, p<0.005). Patient's age and previous hysterectomy were found to be the major clinical risk factors for UI (OR: 1.029, p=0.002; OR: 2.94, p=0.024, respectively). Logistic regression analysis on all clinical and morphologic variables yielded the following risk factors: pelvic-inlet diameter (OR: 1.216, p<0.0001), pelvic-inlet anterior-posterior diameter (OR: 1.109, p=0.003), pelvic-outlet diameter (OR: 1.077, p=0.011) and transverse perineal muscle cross-section diameter (OR: 0.773, p<0.0001). CONCLUSIONS: Pelvic inlet and outlet dimensions are major risk factors for developing UI in women. These findings may lead to a better comprehension of the pathophysiology of UI in women.     

Clinical epidemiological insights into urinary incontinence

Introduction and hypothesis

Urinary incontinence (UI) is very common and heterogeneous among women with limited knowledge of progression or prognosis. Evidence based on clinical epidemiology can help to better understand the natural history of UI.

Methods

We examine the challenges of UI definition and its subtypes, its impact on quality of life and health-seeking behavior. We review the proposed pathophysiology of UI subtypes and known risk factors as they relate to our current knowledge of the disease state. Finally, we emphasize the role of epidemiology in the process of acquiring new insight, improving knowledge, and translating this information into clinical practice.

Results

Stress UI is most common overall, but mixed UI is most prevalent in older women. The three UI subtypes have some common risk factors, and others that are unique, but there remains a significant gap in our understanding of how they develop. Although the pathophysiology of stress UI is somewhat understood, urgency UI remains mostly idiopathic, whereas mixed UI is the least studied and most complex subtype. Moreover, there exists limited information on the progression of symptoms over time, and disproportionate UI health-seeking behavior. We identify areas of exploration (e.g., epigenetics, urinary microbiome), and offer new insights into a better understanding of the relationship among the UI subtypes and to develop an integrated construct of UI natural history.

Conclusion

Future epidemiological strategies using longitudinal study designs could play a pivotal role in better elucidating the controversies in UI natural history and the pathophysiology of its subtypes leading to improved clinical care.

     

Prevalence and risk factors of urinary incontinence in young and middle-aged women

Objective To assess the prevalence of and risk factors for urinary incontinence (UI) in young and middle-aged women. Subjects and methods During 1998 the prevalence of overall, stress, urge and mixed UI was assessed in women working in a French academic hospital. Women (2800) received a questionnaire at the same time as their yearly interview with a staff physician in occupational medicine. The usual risk factors for constitutional events, i.e. increasing age, obesity (defined as a body mass index of > or = 25), obstetric events (pregnancy, previous Caesarean delivery, previous vaginal delivery, postpartum incontinence) and gynaecological events (hysterectomy) were evaluated. Results Of the 1700 women (mean age 40.0 years) who returned the questionnaire, 467 (27.5%, 95% confidence interval, CI, 25.4-29.7) reported UI, comprising 210 (12.4%, 10.8-14.0) with stress UI, 28 (1.6%, 1.1-2.4) with urge UI and 229 (13.5%, 11.9-15.2) with mixed UI. Thirty-eight women (8.1%) had frequent urinary leakage, comprising one (0.5%), four (14.3%) and 33 (14.4%) with stress, urge and mixed UI. The prevalence of UI increased significantly with age > or = 40 years, with a relative risk (95% CI) of 2.16 (1.86-2.57), and with pregnancy (2.22, 1.71-2.87), previous vaginal delivery (2.15, 1.72-2.69), postpartum incontinence (2.57, 2.22-2.97), and hysterectomy (1.52, 1.11-2.08). Obesity (1.14, 0.99-1.32) and previous Caesarean delivery (2.15, 1.72-2.69) did not significantly increase the risk of UI. The risk factors for stress UI were age > or = 40 years, pregnancy, previous vaginal delivery, postpartum incontinence and hysterectomy, but there was no relationship between stress UI and obesity or previous Caesarean delivery. Conclusion There was a high prevalence of UI among young adult and middle-aged women hospital workers who had easy access to medical resources. Gynaecological and obstetric events (pregnancy, particularly previous vaginal delivery and hysterectomy) were the most prominent risk factors, especially for stress UI.     

Genetic influences are important for most but not all lower urinary tract symptoms: a population-based survey in a cohort of adult Swedish twins

Background

The relative importance of genetic and environmental factors for the occurrence of lower urinary tract symptoms (LUTS) is poorly understood.

Objective

To (1) estimate the prevalence of urinary incontinence (UI), overactive bladder (OAB), and other LUTS and (2) to assess the heritability of these symptoms.

Design, setting, and participants

Cross-sectional survey of LUTS in a national population-based cohort of Swedish twins 20–46 yr of age (n = 42 582) from the Swedish Twin Registry.

Measurements

Prevalence rates were determined and heritability of LUTS (in female twins) was assessed using indicators of twin similarity.

Results and limitations

A total of 25 364 twins completed the questionnaire (response rate: 59.6%). LUTS were more common in women (UI: 7%; OAB: 9%; nocturia: 61%; micturition frequency: 18%) than in men (UI: 1%; OAB: 5%; nocturia: 40%; micturition frequency: 11%), and prevalence increased with age. The strongest genetic effects were observed for UI, frequency, and nocturia. The lowest estimate for genetic effects was observed for OAB where environmental effects dominated, and more specifically shared family environment accounted for a third or more of the total variation. For stress UI, a fifth of the total variation in susceptibility to the disorder could be attributed to shared environment. Nonshared environmental effects were seen in the range of 45–65% for the various LUTS. The prevalence of LUTS was low in the men, and there were too few male cases to compute measures of similarity or heritability estimates.

Conclusions

This study provides robust evidence of a genetic influence for susceptibility to UI, frequency, and nocturia in women. In contrast, shared environmental factors seem more important for the predisposition to develop OAB, which may reflect familial patterns such as learning from parental behaviours.     

New Biological Insights on the Link Between Radiation Exposure and Breast Cancer Risk

Radiation exposure is a well-documented risk factor for breast cancer in women. Compelling epidemiological evidence in different exposed populations around the world demonstrate that excess breast cancer increases with radiation doses above 10 cGy. Both frequency and type of breast cancer are affected by prior radiation exposure. Many epidemiological studies suggest that radiation risk is inversely related to age at exposure; exposure during puberty poses the greatest risk while exposures past the menopause appear to carry very low risk. These observations are supported by experimental studies in mice and rats, which together provide the basis for the pubertal ‘window of susceptibility’ hypothesis for carcinogenic exposure. One line of experimental investigation suggests that the pubertal epithelium is more sensitive because DNA damage responses are less efficient, an other suggests that radiation affects stem cells self-renewal. A recent line of investigation suggests that the irradiated microenvironment mediates cancer risk. Studying the biological basis for radiation effects provides potential routes for protection in vulnerable populations, which include survivors of childhood cancers, as well as insights into the biology for certain types of sporadic cancer.     

Incidence and remission of female urinary incontinence over 6.5 years: analysis of a health screening project

OBJECTIVES: To analyse the incidence and remission of female urinary incontinence (UI) over 6.5 years and to identify risk factors for the development of UI. METHODS: Women who underwent a health investigation in 1998 or 1999 in the area of Vienna completed the Bristol Female Lower Urinary Tract Symptoms questionnaire. In 2005, all women (n=925) aged >/=20 yr in 1999 who were still living in the area of Vienna were invited to recomplete the questionnaire. RESULTS: The response rate was 47.7% (n=441; age range, 20-84 yr), and the mean follow-up was 6.5 yr. The overall prevalence of UI was 32% at baseline and increased to 43% in 6.5 years. The mean annual cumulative incidence of UI was 3.9%, with the lowest rate (2.3%) in the youngest age group (20-39 yr) and the highest (7.3%) in those aged 70 yr or older. The mean annual full remission rate was 2.9%, with no clear age dependency. More than half (55.6%) of the women with a full remission had only a mild form of UI at baseline. In a multivariate analysis, urgency (p=0.008) and age (p=0.024) were correlated to the risk of de novo UI. CONCLUSIONS: This longitudinal study demonstrates that UI is not necessarily a progressive process but rather is a dynamic one.     

Help-seeking behaviour and associated factors among women with urinary incontinence in France, Germany, Spain and the United Kingdom

OBJECTIVES: To assess the proportion of women who consult their doctor about urinary incontinence (UI), and explore factors associated with help-seeking in France, Germany, Spain and the UK. METHODS: A representative sample of 29,500 women received a 13 item postal questionnaire to identify those with UI. A randomly selected sub-sample of 2953 women with UI received a more detailed follow-up questionnaire. RESULTS: There was a response rate of 58% in the initial survey and 53% in the second. Thirty-one percent of all women had consulted a doctor about their UI symptoms with more women consulting in France and Germany than in the UK and Spain. A number of factors relating to general health care, UI and women's attitudes were found to be associated with help-seeking after adjusting for women's age, UI duration and frequency, and 'bothersomeness' of UI; factors traditionally associated with help-seeking. After adjusting for these factors, willingness to take long-term medication and having spoken to others about UI were found to be strong predictors of help-seeking in all four countries.     

Achieving continence with antimuscarinic therapy for overactive bladder: effects of baseline incontinence severity and bladder diary duration

OBJECTIVE: To examine the continence ('dryness') rate as an outcome measure of the efficacy of antimuscarinic treatment, and to explore how changes in bladder diary duration, baseline severity of urinary incontinence (UI), and study population characteristics affected this outcome. PATIENTS AND METHODS: Urgency UI is a symptom of overactive bladder (OAB) and antimuscarinic agents are a first-line treatment for OAB symptoms; several studies have used dryness rate as an efficacy endpoint, calculated as the percentage of patients who record no UI episodes in a diary period. We performed a post hoc analysis of data from a 12-week, multicentre, randomized, double-blind, placebo-controlled trial of tolterodine extended-release (ER) in patients with symptoms of urinary frequency (> or =8 voids/24 h) and urgency UI (> or =5 episodes/week). Patients with stress UI were excluded. Diary entries from the 3-, 5-, and 7-day periods immediately preceding the baseline and the week 12 visit were used to assess the relationships between the percentage of patients reporting total dryness at week 12, diary duration (3, 5, or 7 days), baseline number of weekly UI episodes (1-6, 7-13, 14-20, > or = 21), and population analysed (intent-to-treat, ITT, or per protocol, PP). The mean changes in weekly UI episodes from baseline to week 12 are also reported by diary duration and baseline frequency of UI for patients treated with tolterodine-ER. RESULTS: The total dryness rates decreased with increasing diary duration and greater frequency of UI at baseline. Analysis of the ITT population also showed lower dryness rates than the PP population. However, the mean reductions in weekly UI episodes for the ITT and PP populations were consistent across diary duration for each level of baseline UI frequency. CONCLUSION: 'Dryness' varies with diary duration, baseline frequency of UI, and the population analysed. Comparisons of dryness rates between studies might lead to erroneous conclusions when these factors are not considered.     

Urinary incontinence among community‐dwelling people aged 40 years or older in Japan: Prevalence,risk factors,knowledge and self‐perception

Background : Urinary incontinence (UI) is a common problem in adults, especially among the elderly. We examined the prevalence and risk factors of UI and potential factors hindering individuals from seeking treatment for UI among a community‐dwelling population aged over 40 years. Methods : Data were collected by mailing a 23‐item urinary incontinence questionnaire to a random sample of community‐dwelling individuals aged 40–75 years (n = 3500) in seven towns of Shiga Prefecture, Japan. Collected data were then used to estimate the prevalence of UI and to provide information regarding subtypes of UI, knowledge and self‐perception about UI. Results : The overall response rate was 52.5%. Prevalence of UI for male and female respondents were 10.5% and 53.7%, respectively. The incidence of urge incontinence increased as age increased in the male group. In women, stress incontinence was prevalent at all ages and the incidence of urge incontinence increased over 70 years of age. Urinary incontinence was more likely as activities of daily living limitations and cystitis increased. Women with a history of hysterectomy or diabetes mellitus and men who had stroke were at increased risk for UI. Of those who reported UI, only 3% had ever consulted doctors or other health care professionals concern‐ ing it, 25% recognized their condition as a disease and 38% considered it curable by appropriate treatments. In addition, 63% regarded UI as an unavoidable consequence of aging, 63% con‐ sidered their condition was embarrassing and 54% were reluctant to seek treatment from a health professional. Conclusions : Although UI is common among community‐dwelling individuals over 40 years of age, the majority of affected individuals remained untreated due to lack of knowledge and/or a negative perception of UI. Thus, community education on UI may be needed to increase the number of UI patients who receive treatment.     

Risk factors for urinary incontinence among postmenopausal Mexican women

Introduction and hypothesis

Previous studies of racial/ethnic variation in urinary incontinence (UI) suggest that population-specific studies of UI risk factors are needed to develop appropriate public health recommendations. We assessed UI risk factors among postmenopausal Mexican women enrolled in the Mexican Teachers’ Cohort.

Methods

We conducted a cross-sectional study among 15,296 postmenopausal women who completed the 2008 questionnaire. UI cases were women who reported experiencing UI during menopause. Self-reported potential UI risk factors included age, reproductive variables, smoking status, adiposity, and several health conditions. We estimated multivariate-adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for UI using multivariable logistic regression.

Results

Among these postmenopausal women, the prevalence of UI was 14 %. Odds of UI were higher among women with ≥4 children vs nulliparous women (OR 1.43, 95 % CI 1.04–1.96) or body mass index (BMI) ≥30 vs <22 kg/m² (OR 2.00, 95 % CI: 1.55–2.57). Age at first birth <20 vs 20–24 years, past or current vs never smoking, larger waist-to-hip ratio, and history of asthma, high blood pressure, or diabetes were also associated with higher odds of UI (OR 1.2–1.3). We found a trend of lower odds of UI with older age.

Conclusions

Our data suggest that information about UI and UI prevention strategies might be particularly useful for Mexican postmenopausal women with 4 or more children or higher BMI. Further studies with longitudinal UI data, in addition to data on UI severity and subtype, are needed to provide more specific information about UI risk factors to Mexican women.