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The iceberg of health care utilization in women with urinary incontinence

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Introduction and hypothesis

The objective of the study was to estimate prevalence of urinary incontinence (UI) health care utilization in women from the population up to specialty care.


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.


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 2 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.


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.

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Conflicts of interest

This research was funded by National Institute of Health/National Institute of Diabetes and Digestive and Kidney Diseases, grant # RO1 DK082551. No author on this paper has a conflict of interest.

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Correspondence to Vatche A. Minassian.

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Minassian, V.A., Yan, X., Lichtenfeld, M.J. et al. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J 23, 1087–1093 (2012).

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