Few Older Women Discuss Urinary Incontinence With Health Care Providers

By Lisa Rapaport

May 16, 2020

(Reuters Health) — Only about one in three older women with urinary incontinence discusses her condition with a clinician, suggests an analysis of data from the Nurses Health Study (NHS).

Researchers examined survey data collected from 94,692 women with urinary incontinence (UI), ranging in age from 49 to 91, in two NHS cohorts. Even among these healthcare professionals, just 34% said they had discussed their UI with a clinician. Women with daily UI were more likely than women with monthly UI to have discussed it with a healthcare provider (odds ratio 4.36).

"We found that frequency, duration and severity of symptoms was linked to having these conversations, with women with more symptoms having higher odds of having a conversation with a clinician," said Dr. Giulia Lane, a fellow in neurology and pelvic reconstruction in the department of neurology at the University of Michigan, in Ann Arbor.

In addition, "Women who accessed the healthcare system for other care, like having physical exams or mammography, were more likely to have had a conversation with a clinician," Dr. Lane said by email.

For example, women who had preventive health screenings were more likely to speak to a provider about urinary incontinence, with odds more than doubled for the NHS II cohort (OR 2.19), with a mean age of 59 years, and increased in the NHS I cohort (OR 1.5), with a mean age of 77.

When researchers looked at both cohorts as a single group, they found that women over age 80 were less likely than women under 55 to discuss urinary incontinence with a provider (OR 0.81), according to the results in Journals of Gerontology: Series A.

Severe symptoms were also associated with a greater chance of these discussions taking place. With severe symptoms, based on the frequency and amount of urinary leakage, women were almost twice as likely to talk to a provider as women with mild symptoms (OR 1.97).

One limitation of the study is that the findings were based on participants' subjective reports of any symptoms or discussions with their providers, the study team notes. The researchers also lacked data to examine whether any discussions of urinary incontinence were initiated by patients or providers.

Some women may not consider incontinence an illness, particularly if their symptoms are mild or infrequent, said Dr. Xavier Fritel of the University of Poitiers in France.

"Incontinence is still a taboo," Dr. Fritel, who wasn't involved in the study, said by email. "During many centuries the term of 'incontinence' meant lack of control over sexual impulses and was a sin."

Even today, some women may feel uncomfortable bringing it up, Dr. Fritel added.

"That suggests that health providers need to ask older women about continence," Dr. Fritel said.

SOURCE: https://bit.ly/363TMXI Journals of Gerontology: Series A, online April 30, 2020.