Urinary Incontinence Highly Prevalent in American Women

Fran Lowry

September 19, 2011

September 19, 2011 (Providence, Rhode Island ) — Urinary incontinence is extremely prevalent among American women 40 years and older, yet less than one third seek care, and even fewer are seen by pelvic floor specialists, according to a study presented here at the American Urogynecologic Society (AUGS) 32nd Annual Scientific Meeting.

"Little is known about the early stages of urinary incontinence and about its true prevalence," Vatche Minassian, MD, MPH, from Geisinger Health Systems, Danville, Pennsylvania, told AUGS delegates. "Most of what we know is based on the tip of the iceberg — those relatively few women who seek care."

Dr. Vatche Minassian

Dr. Minassian and his colleagues sought to "build the iceberg of disease" in women with urinary incontinence by establishing prevalence estimates of the spectrum of the disorder, from none at all to significant disease.

The researchers approached participants in the General Longitudinal Overactive Bladder Evaluation–UI (GLOBE-UI) study, a population-based study of the natural history of urinary incontinence in women 40 years and older, and asked them to fill out the bladder health survey.

Of the 7772 women who received the bladder health survey, 3221 (41.4%) responded; of these, 1326 (41.2%) reported having urinary incontinence.

About one quarter of the women (n = 344; 26%) reported urinary incontinence for 2 years or less; 353 (27%) reported urinary incontinence for 2 to 4 years, and 577 (24%) reported urinary incontinence for 5 or more years.

Half of the women reported moderate symptoms of urinary incontinence, and 25% had either mild or severe urinary incontinence.

In looking at the electronic health records of these women, the investigators found that only 367 (28%) sought care for their urinary incontinence, as indicated by an ICD9 urinary incontinence diagnosis.

Further, only 269 (20%) of the women were receiving care, and just 157 (12%) were referred to or were being cared for by a pelvic floor specialist.

Care Is Available

"I hope that this study educates people in general, and women in particular, that urinary incontinence is highly prevalent and that care is available," Dr. Minassian told Medscape Medical News.

Urinary incontinence is not usually discussed or addressed at the primary care level, he added. "Women should speak up to get the proper care."

Urinary Continence Not a Normal Part of Aging

Commenting on this study for Medscape Medical News, Karen Noblett, MD, professor and division director for urogynecology at the University of California, Irvine, said the study is important because the true prevalence of urinary incontinence is always underestimated.

"This study highlights the fact that many women suffer from these conditions but don't seek care."

Dr. Noblett said she and her group are trying to find out why women fail to seek treatment.

"We are a tertiary care center, and women will come in and tell us they've been leaking for 30 years. Our question is: Why did you wait? Is it due to misperceptions about the treatment options? Is it because they think it's a normal part of aging and there's nothing they can do? Is it fear of surgery, or lack of knowledge about what is available?

She predicted that learning what those barriers are will allow more women to come forward and seek help for their urinary incontinence.

"It won't just be the tip of the iceberg that we are seeing," she said. "Women will feel more comfortable and understand that there are many treatment options. It doesn't necessarily require surgery and it's not a normal part of aging. It's common, but not normal."

This study was funded by the National Institutes of Health. Dr. Minassian and Dr. Noblett have disclosed no relevant financial relationships.

American Urogynecologic Society (AUGS) 32nd Annual Scientific Meeting: Abstract 17. Presented September 16, 2011.

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