Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life

OBJECTIVE: The purpose of this study was to estimate the prevalence and impact upon quality of life of anal incontinence (AI) in women aged 18 to 65. STUDY DESIGN: Consecutive women presenting for general gynecologic care were given a bowel function questionnaire. Women with AI were prompted to complete the Fecal Incontinence Severity Index (FISI) and Fecal Incontinence Quality of Life Scale (FIQL). RESULTS: The cohort was composed of 457 women with a mean age of 39.9 +/- 11 years. AI prevalence was 28.4% (95% CI 24.4-32.8). After logistic regression, IBS (OR 3.22, 1.75-5.93), constipation (OR 2.11, 1.22-3.63), age (OR 1.05, 1.03-1.07), and BMI (OR 1.04, 1.01-1.08) remained significant risk factors. The mean FISI score was 20.4 +/- 12.4. Women with only flatal incontinence scored higher, and women with liquid loss scored lower on all 4 scales of the FIQL. CONCLUSION: AI is prevalent in women seeking benign gynecologic care, and liquid stool incontinence has the greatest impact upon quality of life.     

Urinary incontinence: prevalence and risk factors at 16 weeks of gestation

Objective To evaluate the prevalence of urinary incontinence at 16 weeks of gestation and to identify possible maternal and obstetric risk factors.
Design Cross-sectional study and cohort study.
Setting Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark.
Population Cross-sectional study: 7795 women attending antenatal care. Cohort study: a sub-group of 1781 pregnant women with one previous delivery at our department.
Results Prevalence and maternal risk factors: the prevalence of urinary incontinence within the preceding year was 8.9% among women at 16 weeks of gestation (nulliparae, 3.9%. para 1, 13.8%, para 2+, 16.2%). Stress or mixed incontinence occurred at least weekly in 3% of all the women. After adjusting for age, parity, body mass index, smoking, previous abortions, and previous lower abdominal or urological surgery in a logistic regression model, primiparous women who had delivered vaginally had higher risk of stress or mixed urinary incontinence than nulliparous women (OR 5.7; 95% CI 3.9–8.3). Subsequent vaginal deliveries did not increase the risk significantly. Young age, body mass index > 30, and smoking were possible risk factors for developing urinary incontinence. Obstetric factors: weight of the newborn > 4000 g (OR 1.9; 95% CI 14–3.6) increased the risk of urinary incontinence; mediolateral episiotomy in combination with birthweight > 4000 g also increased the risk (OR 3–5; 95% CI 1.2–10.2); a number of other intrapartum factors did not increase the risk of urinary incontinence.
Conclusions The first vaginal delivery was a major risk factor for developing urinary incontinence; subsequent vaginal deliveries did not increase the risk significantly. Birthweight > 4000 g increased the risk; episiotomy in combination with birthweight > 4000 g also increased the risk.     

北京郊区女性尿失禁及盆腔脏器脱垂发病情况及其对生活质量影响的抽样调查

目的 调查北京郊区女性尿失禁及盆腔器官脱垂发病情况及其对生活质量的影响。方法 按照整群抽样的方法，选取生活在北京市房山区某自然村18岁以上的常住已婚女性，进行问卷调查，并行妇科检查和B超检查。结果 全村符合调查的女性202人，回收问卷190份，应答率94．1％。调查结果显示，尿失禁的患病率为67例（35．3％）。子宫脱垂49例（25．8％），阴道前壁膨出79例（41．6％），阴道后壁膨出61例（32．1％）。尿失禁对女性日常生活、情绪和性生活的影响率分别为29．9％、23．9％、29．9％，尿失禁以轻度尿失禁为主（占82．1％），尿失禁合并子宫脱垂占31．3％，合并阴道前壁膨出59．7％，合并阴道后壁膨出44．8％。结论 整群抽样调查显示，北京郊区女性尿失禁及盆腔脏器脱垂均较常见，尿失禁患者多合并盆腔脏器脱垂，尤其是阴道前壁膨出，并对生活质量有较大影响。     

Urinary incontinence: prevalence and risk factors at 16 weeks of gestation.

OBJECTIVE: To evaluate the prevalence of urinary incontinence at 16 weeks of gestation and to identify possible maternal and obstetric risk factors. DESIGN: Cross-sectional study and cohort study. SETTING: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark. POPULATION: Cross-sectional study: 7795 women attending antenatal care. Cohort study: a sub-group of 1781 pregnant women with one previous delivery at our department. RESULTS: Prevalence and maternal risk factors: the prevalence of urinary incontinence within the preceding year was 8.9% among women at 16 weeks of gestation (nulliparae, 3.9%, para 1, 13.8%, para 2+, 16.2%). Stress or mixed incontinence occurred at least weekly in 3% of all the women. After adjusting for age, parity, body mass index, smoking, previous abortions, and previous lower abdominal or urological surgery in a logistic regression model, primiparous women who had delivered vaginally had higher risk of stress or mixed urinary incontinence than nulliparous women (OR 5.7; 95% CI 3.9-8.3). Subsequent vaginal deliveries did not increase the risk significantly. Young age, body mass index > 30, and smoking were possible risk factors for developing urinary incontinence. Obstetric factors: weight of the newborn > 4000 g (OR 1.9; 95% CI 1.0-3.6) increased the risk of urinary incontinence; mediolateral episiotomy in combination with birthweight > 4000 g also increased the risk (OR 3.5; 95% CI 1.2-10.2); a number of other intrapartum factors did not increase the risk of urinary incontinence. CONCLUSIONS: The first vaginal delivery was a major risk factor for developing urinary incontinence; subsequent vaginal deliveries did not increase the risk significantly. Birthweight > 4000 g increased the risk; episiotomy in combination with birthweight > 4000 g also increased the risk.     

Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle-aged women

OBJECTIVE: To investigate the prevalence of and factors associated with overactive bladder in middle-aged women. DESIGN: Cross sectional population-based study. SETTING: Southern Sweden and the Women's Health in the Lund Area study (WHILA 1995-2000) where 6917 (64% of the invited) women, 50-59 years old in 1995, participated. POPULATION: From the WHILA study, 1500 women reporting troublesome urinary incontinence (INCONT-1) and 1500 without incontinence (CONT-1) were selected by computerised randomisation and received the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire in January 2001. METHODS: Overactive bladder was defined in two versions using the ICS definition of 2002 as either urgency alone (OAB-1) or urgency combined with frequency more than eight times per day and/or nocturia twice or more per night (OAB-2). Risk factors were analysed by multiple logistic regression analyses. MAIN OUTCOME MEASURES: Prevalence figures and odds ratios with corresponding 95% confidence intervals. RESULTS: The prevalence of OAB-1 was 46.9% in the INCONT-1 and 16.7% in the CONT-1 group, and that of OAB-2 was 21.6% and 8.1%, respectively. Most urgency occurred in combination with stress incontinence (i.e. as mixed incontinence). The overlap between stress and urge symptoms increased with the frequency of stress incontinence episodes (P < 0.001). Metabolic risk factors were body mass index (BMI) >/= 30 for OAB-1, OAB-2 and stress incontinence, positive metabolic screening for OAB-1, family history of diabetes for OAB-2 and elevation of BMI >/= 25% since the age of 25 for stress incontinence. Stress incontinence was associated with the current use of hormonal replacement therapy. CONCLUSIONS: Overactive bladder and stress incontinence are intimately associated with each other. Both OAB and stress incontinence are associated with abnormal metabolic factors, mainly increased BMI.     

Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence,risk factors and impact on quality of life in Taiwanese women: An observational cohort study

Objective

The study was to investigate the prevalence and risk factors of stress urinary incontinence (SUI) and its impact on the quality of life during pregnancy and 12 months after delivery.

上海市成年女性尿失禁的流行病学研究

目的:了解上海市成年女性尿失禁(UI)的患病率及相关高危因素。方法:2012年1月至9月采用UI调查问卷对上海市城区和农村成年女性进行横断面调查,同时调查UI相关流行病学因素,调查采用一对一问答方式。共完成调查问卷7884份,使用多因素Logistic回归分析方法确定UI高危因素。结果:上海市成年女性的UI患病率为28.7%,其中压力性尿失禁(SUI)患病率最高,为23.5%,混合性尿失禁(MUI)为2.5%,急迫性尿失禁(UUI)为2.1%,UI患病率随着年龄增高而逐渐增加。绝经(OR=1.10)、阴道分娩次数≥2次(OR=1.49)、妊娠超过20周次数≥2次(OR=1.34)、首次阴道分娩年龄20岁(OR=1.58)、盆腔手术史(OR=1.38)、最大新生儿出生体重4000g(OR=2.66)、低教育程度(OR=1.14)、器械助产(OR=2.75)、体重指数(BMI)≥30kg/m2(OR=2.37)、高血压(OR=1.33)及糖尿病(OR=1.14)均为高危因素。结论:上海市成年女性UI患病率较高,以SUI为主,患病率随年龄增大而上升。产科因素为UI发病主要高危因素。     

The prevalence of urinary incontinence and its influence on the quality of life in women from an urban Swedish population.

OBJECTIVES: To assess the prevalence of urinary incontinence and its influence on the quality of life. MATERIAL AND METHODS: A random sample of every fourth woman aged > or =20 years resident in a primary health care district of the city of G?teborg was obtained from the population register (n=2911). The women were invited by letter to complete a questionnaire concerning urinary incontinence. The women were also requested to assess their quality of life using a visual analogue scale. RESULTS: The overall response rate was 77%. The prevalence of urinary incontinence increased (p<0.001) in a linear fashion from 3% in the cohort 20-29 years to 32 % in the cohort of women aged > or =80 years. The proportion of women suffering from stress incontinence decreased (p<0.001) with increasing age, while the proportion of women suffering from urge and mixed incontinence increased (p<0.01) with increasing age. Women with stress incontinence had a greater body weight and had given birth to a greater number of children compared to continent women. There was, however, in this respect no difference between women with urge incontinence and continent women. Women with urinary incontinence reported a poorer quality of life compared to continent women (p<0.01). Women with urge incontinence and women with mixed incontinence reported a poorer quality of life compared to women with stress incontinence (p<0.05). Only 6% of the women from this population had sought medical attention for urinary incontinence. CONCLUSIONS: Although urinary incontinence was a prevalent condition, particularly among the elderly and had a negative influence on the quality of life, only a small number of women had sought medical care.     

Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women

OBJECTIVE: To document prevalence of mild, moderate, and severe urinary incontinence among ethnically diverse perimenopausal women, identify risk factors, and assess the effect of severity on women's daily lives using treatment seeking, bother, and nighttime voiding as indicators. METHODS: Baseline data from the longitudinal cohort of the Study of Women's Health Across the Nation, a prospective, multiethnic, multisite study of the natural history of menopausal transition was used (n = 3302). Interview and self-completed questionnaires assessed most variables of interest. Body mass index and diabetes mellitus were measured clinically. Incontinence severity was derived by multiplying frequency by volume leaked. Risk factors and effect on treatment seeking, bother, and nighttime voiding were assessed by the construction of multiple logistic regression models for each ethnic group and the total population. RESULTS: Mean age was 46.4 years. Incontinence prevalence was 57%, with nearly 15% categorized as moderate and 10% as severe. Biologic factors constituted the most important risk for severity, specifically perimenopausal compared with premenepausal status (odds ratio [OR] 1.35), body mass index (OR 1.04), diabetes mellitus (OR 1.55), and current smoking (OR 1.38). Nonwhite groups had lower risk, but the relationship of ethnicity is complex. Severity was associated with likelihood of discussing with a health care provider, with bothersomeness, and with likelihood of nighttime voiding. CONCLUSION: Large numbers of perimenopausal women experience urinary incontinence with 25% wearing protection or changing undergarments on several days per week. Mutable factors predicting severity included body mass index and current smoking.     

伴急迫性尿失禁的女性膀胱过度活动症发生率及其对生活质量的影响

目的调查中国成年女性膀胱过度活动症中伴有急迫性尿失禁的发生率及其对生活质量的影响状况。方法特定的女性人群样本的抽样研究,根据ICS最新OAB诊断标准设计问卷,生活质量评估依据King′s问卷,排尿困难的判断采用美国泌尿外科症状评分表。人群选择为2006年9月至12月在北京大学人民医院门诊因非泌尿系统疾病就诊的1050例女性。结果共回收1036份有效问卷,伴有急迫性尿失禁OAB的发生率为11.8%,其中30岁以下人群发生率为9.8%,30岁组人群发生率为14.8%,40岁组人群发生率为22.1%,50岁组人群发生率为23.0%,60岁及以上人群的发生率为30.3%。伴急迫性尿失禁OAB对生活质量总体影响率为54.9%,其中影响做家务为24.6%,影响休闲活动为34.4%,影响娱乐活动为18.0%,影响乘坐公共汽车能力为10.7%,影响社交活动为14.8%,影响心理情绪为32.0%。结论伴急迫性尿失禁OAB在女性人群中发生率较高,并明显影响患者的生活质量。     

The prevalence of probable overactive bladder, associated risk factors and its effect on quality of life among Turkish midwifery students

Objectives

To evaluate the associated risk factors of probable overactive bladder (OAB) and to determine the effect of OAB on quality of life through validated questionnaires in Turkish midwifery students.

Study design

279 midwifery students were invited to participate, and 265 (95.0%) were included in the study, which was approved by the local ethics committees. The relationship between quality of life and probable OAB was evaluated using Turkish language-validated questionnaires (OABq SF, NQOL). Chi-square test, t-test and logistic regression were used for the statistical analysis, and p < 0.05 was considered significant.

Results

The participants’ mean age was 21.74 ± 2.15 years. The prevalence of OAB was 35.4%. There was a significant relationship between the presence of probable OAB and familial urinary incontinence history and childhood nocturnal enuresis. In the logistic regression analysis, family history was associated with an OR of 2.11 (95% CI: 1.08–4.10) for OAB, and nocturia with an OR of 2.69 (95% CI: 1.16–6.21) for OAB. Drinking moderate amounts of tea and carbonated drinks daily did not affect OAB, but extreme consumption of these beverages was associated with an OR of 2.98 (95% CI: 1.26–7.03) for OAB. OAB significantly worsens quality of life according to all the quality of life indices.

Conclusion

OAB is not a rare condition among young people. It appears that the quality of life was adversely influenced by OAB among both younger and older people. Familial urinary incontinence and childhood nocturnal enuresis were found to be risk factors for OAB. There is insufficient evidence to restrict tea or carbonated drinks consumption in young people with OAB unless their consumption is extreme.     

Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences.

We investigated the prevalence and the consequences of urinary incontinence in a group of 1299 women aged 35 to 79. Incontinence was present in 344 women (26.5%), in 5.9% the incontinence occurred at least once daily. The prevalence was highest in the younger age-groups and lowest between 65 and 69 years of age, thereafter it increased again. Almost half of the incontinent women used protective sanitary towels. In contrast to this, only 13.3% considered themselves handicapped by their symptoms, and only 28.2% had ever sought medical help, although the symptoms had been present for as long as 7.5 years on average. The major reason for not seeking medical help was that the symptoms were not considered to be so serious.     

Flatus and faecal incontinence: prevalence and risk factors at 16 weeks of gestation

Objective To evaluate the prevalence of anal incontinence at 16 weeks of gestation and to identify possible maternal and obstetrical risk factors.
Design Cross sectional study and cohort study.
Setting Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark.
Participants Cross sectional study: 7557 women attending antenatal care. Cohort study: a subgroup of 1726 pregnant women with one previous delivery at our department.
Results The prevalence of anal incontinence within the preceding year was 8.6%. Incontinence of liquid and solid stools was reported in 2.3% and 0.6%, respectively. Isolated flatus incontinence at least once a week was reported in 4.2%. The risk of flatus incontinence at least once a week was increased with age > 35 years (OR 1.6; 95% CI 1.1–2.4) and with previous lower abdominal or urological surgery (OR 1.5, 95% CI 1.1–2.1) in a logistic regression model controlling for maternal factors. Increasing parity did not increase the risk. The risk of flatus incontinence was increased after anal sphincter tear and birthweight > 4000 g in a logistic regression model controlling for maternal and obstetric variables. Episiotomy was insignificantly associated, while spontaneous perineal tear > 3 cm and a number of other intrapartum factors were not associated.
Conclusion True faecal incontinence is rare among younger women. However, an age > 35 years and previous lower abdominal or urological surgery increased the risk of flatus incontinence in contrast to increasing parity. This suggests that childbirth plays a minor role compared with age. However, when analysing obstetric variables separately, a birthweight > 4000 g, and anal sphincter tears were significant risk factors for flatus incontinence.