Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history

Abstract

Introduction & Hypothesis Urinary incontinence (UI) is common and the relationship between its subtypes is complex. Our objective was to describe the natural history and predictors of incontinence subtypes, Stress, Urgency and Mixed, in mid-aged and older U.S. women. We hypothesized that past UI subtype history predicted future UI subtype status and sought to determine the extent to which this occurred. Methods We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women ≥50 in the 2004–2010 Health and Retirement Study database. Mixed, Stress, Urgency incontinence prevalence (2004,2006,2008,2010) and 2-year cumulative incidence and remissions (2004–6,2006–8 2008–10) were estimated. Patient characteristics and incontinence subtype status 2004–2008 were entered into a multivariable model to determine predictors for incontinence subtype occurrence in 2010. Results Prevalence of each subtype in this population (median age 63–66) was 2.6%–8.9%. Subtype incidence equaled 2.1–3.5% and remissions for each varied between 22.3–48.7%. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, functional limitations. Compared to White women, Black women had decreased odds of incident Stress Incontinence, Hispanic women had increased odds of Stress Incontinence remission. Age 80–90 and severe obesity predicted incident Mixed Incontinence. Functional limitations predicted Mixed and Urgency Incontinence. The strongest predictor of incontinence subtypes was incontinence subtype history. Presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence [Odds Ratio (OR) Stress Incontinence=30.7, Urgency OR=47.4, Mixed OR=42.1]. Conclusions Although remissions were high, prior history of incontinence subtypes predicted recurrence. Incontinence status is dynamic but tends to recur over the longer term.

Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI‐RS 2018

“…Waetjen et al noted that a BMI increase of 5 kg/m 2 increased SUI by 30% and UUI by 15%. Also in elderly women, obesity is reported as an incontinence predictor and BMI had a specific effect on mixed urinary incontinence prediction . Chronically increased BMI is also associated with an elevated risk of UI in later life.…”

“…Also in elderly women, obesity is reported as an incontinence predictor and BMI had a specific effect on mixed urinary incontinence prediction. 22 Chronically increased BMI is also associated with an elevated risk of UI in later life. Symptom severity also appears to worsen with the duration of increased BMI status, again confirming the detrimental effect of obesity on continence.…”

Incidence and remission of stress, urge, and mixed urinary incontinence in midlife and older women: A longitudinal cohort study

“…Longitudinal studies focusing on these different major categories of UI are extremely rare. 13,14 Only cohort studies, however, can illuminate the epidemiology of UI by clarifying the chronology and direction of the effects of the risk factors identified in cross-sectional studies. Longitudinal studies thus make it possible to better provide the causality of the factors studied.…”

Long‐term outcomes for transobturator tension‐free vaginal tapes in women with urodynamic mixed urinary incontinence

“…The unprecedented growth of the elderly population in the western world highlights the importance of studying the long‐term outcomes of the interventions used for treatment of chronic conditions, including urinary incontinence (UI). In 2016, a large epidemiology study in the United States showed prevalence in UI of 19‐26% and increasing with age; this was most apparent for urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI). Interestingly, the prevalence of stress urinary incontinence (SUI) did not seem to increase with age in this study.…”