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

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Abstract

Introduction and hypothesis

Urinary incontinence (UI) is common and the relationship among its subtypes complex. Our objective was to describe the natural history and predictors of the incontinence subtypes stress, urgency, and mixed, in middle-aged and older US women. We tested our hypothesis that UI subtype history predicted future occurrence, evaluating subtype incidence/remission over multiple time points in a stable cohort of women.

Methods

We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women aged ≥50 in the 2004–2010 Health and Retirement Study. Mixed, stress, and urgency incontinence prevalence (2004, 2006, 2008, 2010) and 2-year cumulative incidence and remissions (2004–2006, 2006–2008, 2008–2010) were estimated. Patient characteristics and incontinence subtype status 2004–2008 were entered into a multivariable, transition model to determine predictors for incontinence subtype occurrence in 2010.

Results

The 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 and 48.7 %. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, and functional limitations. Compared with white women, black women had decreased odds of incident stress incontinence and Hispanic women had increased odds of stress incontinence remission. The age range 80–90 and severe obesity predicted incident mixed incontinence. Functional limitations predicted mixed and urgency incontinence. The strongest predictor of incontinence subtype was subtype history. The 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 the number of remissions was high, a previous history of incontinence subtypes predicted recurrence. Incontinence status is dynamic, but tends to recur over the longer term.

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Funding

The Health and Retirement Study, data products (CORE files 2004, 2006, 2008, 2010 and Cross Wave: Tracker 2010 file public use dataset). Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740). Ann Arbor, Michigan, USA. The current research was also supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health through grant number 8UL1TR000041, The University of New Mexico Clinical and Translational Science Center.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, MSC10-5580 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA

    Yuko M. Komesu, Loren H. Ketai, Rebecca G. Rogers & Gena C. Dunivan

  2. University of New Mexico Clinical and Translational Science Center, Albuquerque, NM, USA

    Ronald M. Schrader

Authors
  1. Yuko M. Komesu
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  2. Ronald M. Schrader
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  3. Loren H. Ketai
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  4. Rebecca G. Rogers
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  5. Gena C. Dunivan
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Corresponding author

Correspondence to Yuko M. Komesu.

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Conflicts of interest

Y.M. Komesu: Co-PI for “Brain Centered Therapy versus Medication for Urgency Urinary Incontinence—An RCT,” grant number 5R-01AT007171-03, NIH PA-10-067, funding source: NIH (primary: NCCIH); R. Schrader: Co-Investigator grant number 5R-01AT007171-03 (see above); L.H. Ketai: Co-PI grant number 5R-01AT007171-03 (see above); R.R. Rogers: Co-Investigator grant number 5R-01AT007171-03 (see above), Up-to-Date and McGraw-Hill royalties, Associate Editor IUJ, Editorial Board Female Pelvic Medicine and Reconstructive Surgery and Obstetrics & Gynecology, DSMB Chair Transform Trial, ABOG Subspecialty Board Member; G.C. Dunivan: Liberate Site PI, American Urogynecologic Society Education Committee.

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Komesu, Y.M., Schrader, R.M., Ketai, L.H. et al. Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history. Int Urogynecol J 27, 763–772 (2016). https://doi.org/10.1007/s00192-015-2888-1

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  • DOI: https://doi.org/10.1007/s00192-015-2888-1

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