The iceberg of health care utilization in women with urinary incontinence

Abstract

Objective To estimate prevalence of urinary incontinence (UI) health care utilization in women from the population to specialty care. Method The General Longitudinal Overactive Bladder Evaluation – UI (GLOBE-UI) is a population-based study on the natural history of UI in women ≥ 40 years of age. Prevalence of UI was estimated by using the bladder health survey (BHS). Survey data were linked with electronic health records to build the different steps of the iceberg of disease. Descriptive statistics were used to estimate the prevalence estimates at all levels of the iceberg. Results A total sample of 7,059 women received the BHS. Of those, 3,316 (47%) responded. Prevalence of UI was 1,366 (41%). Women with or without UI did not differ by age or marital status. However, women with versus without UI were more parous (91% vs 87%), significantly more overweight or obese (74% vs 61%), and more likely to have a college education or higher (54% vs 46%), P<0.01. Nine-hundred fifty eight (73%) women with UI reported duration of more than two years and 72% reported moderate to severe UI symptoms. Of all 1,366 women with BHS UI diagnosis, only 339 (25%) sought care, 313 (23%) received some care, and 164 (12%) received subspecialty care. Conclusion UI is a highly prevalent disease. Only a minority with UI appears to seek care and a fraction sees a pelvic floor specialist. It is important not only to educate women, but also primary care providers about this highly prevalent yet treatable condition.

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

“…Moreover, some studies sampled women with UI from clinic patients that may not necessarily be representative of the general population with the full spectrum of UI. Additionally, since the majority of women with UI do not discuss their symptoms with their physicians, clinical patients represent only the tip of the iceberg, and the overwhelming majority of women with UI remain undetected in the community (22). Thus, overall, the existing literature can be difficult to interpret.…”

The Epidemiology of Pelvic Floor Disorders and Childbirth

“…In a population-based sample of women 40 years or older, the prevalence of UI was 41%, but only 25% of symptomatic women sought care, 23% received some care, and 12% received subspecialty care. 15 In a community-based Internet survey of women older than 45 years, 19% reported accidental bowel leakage but only 29% of those had sought care. 16 Thus, the incidence of care seeking provides an underestimate of the public health burden of PFDs among US women.…”

Factors affecting doctor visits of postmenopausal women with urinary incontinence

“…Thus, we think that patients who see a doctor for any reason should be interrogated in detail, and those who cannot express their complaints of UI because of shame should be encouraged by health providers. Various studies have emphasized that health workers should be trained on the issue that UI is a treatable disease and that communication with patients is very important …”

“…Urinary incontinence (UI) is defined as the involuntary leakage of urine and is treated in a lower number of patients than those actually affected . There are basically three types of UI: stress, urgency, and overflow incontinence.…”