Factors Associated with Prevalent and Incident Urinary Incontinence in a Cohort of Midlife Women: A Longitudinal Analysis of Data: Study of Women's Health Across the Nation

Abstract

To compare the characteristics of and baseline factors associated with prevalent and incident urinary incontinence in a diverse cohort of midlife women, the authors analyzed the baseline and first five annual follow-up visits of the Study of Women's Health Across the Nation (SWAN), 1995-2001. From responses to annual questionnaires, the authors defined prevalent incontinence as at least monthly incontinence reported at baseline and incident incontinence as at least monthly incontinence first reported over follow-up. They used multiple logistic regression for their comparison. The mean age of their cohort at baseline was 45.8 (standard deviation: 2.7) years. Prevalent incontinence was 46.7%, and the average incidence was 11.1% per year. Most women reported stress, but a higher proportion developed urge incontinence (15.9% vs. 7.6% at baseline). African Americans (29.5%) and Hispanics (27.5%) had the lowest prevalence of incontinence; African Americans (11.6%) and Caucasians (13.4%) had the highest average annual incidence. Parity, diabetes, fibroids, and poor social support were associated with prevalent incontinence, while high body mass index, high symptom sensitivity, and poor health were associated with incident incontinence. In midlife women, incident incontinence is mild with different characteristics and baseline risk factors; overweight women have a higher risk of developing incontinence.

Body weight through adult life and risk of urinary incontinence in middle-aged women: results from a British prospective cohort

“…12,13,16,17 Although BMI has been most closely linked with stress incontinence, only a handful of studies have shown an association with urge incontinence in women. 8,15,35 In this study, the raised risk of urge incontinence was only restricted to women who were obese at the age 36 and 43 years and was considerably attenuated in the fully adjusted model. As it has been described previously, 11 this may be that both are due to a common underlying 'anxiety state'.…”

“…8 From the Study of Women across the Nation, it was found that women who were overweight at baseline (mean age 45.8 years) had a higher risk of developing incontinence over the next 5 years. 8 However that study did not consider BMI at earlier ages or include confounders across the life course. A number of crosssectional studies have also found a significant association between BMI and incontinence, but have not distinguished between symptoms of stress or urge incontinence.…”

“…6,7 Depending upon definitions used and the study population involved, urinary incontinence afflicts from 12 to 47% of middle-aged and younger women compared with 17-55% of older women. [8][9][10] From our previous findings from the Medical Research Council (MRC) National Survey of Health and Development (NSHD) cohort, one out of two women at the age of 48 years reported symptoms for stress incontinence over the past year and one out of five women for symptoms of urge incontinence. 11 It was the first prospective study to show that childhood enuresis was associated with urge incontinence at 48 years of age (regular bedwetters at age 6 years had twice the risk) than the remaining sample.…”

Population Based Study of Incidence and Predictors of Urinary Incontinence in Black and White Older Adults

“…From the longitudinal studies of community-dwelling older adults, risk factors for incident incontinence in men and women include age and impairment in functional status. 2,3 Among women, estrogen, 4,7 hysterectomy, 4 and increased body mass index 6 correlated with incident incontinence. White race/ethnicity has been associated with an increased risk of incident incontinence in women, 4 whereas among peri-menopausal women, African American race/ethnicity was a risk factor for increased urge incontinence.…”

“…White race/ethnicity has been associated with an increased risk of incident incontinence in women, 4 whereas among peri-menopausal women, African American race/ethnicity was a risk factor for increased urge incontinence. 6 The purpose of this study was to determine the incidence of urinary incontinence in older adults and examine potential risk factors associated with the development of incontinence over a three-year period, as part of the University of Alabama at Birmingham (UAB) Study of Aging. 8 …”