Guri Rortveit

A community-based epidemiological survey of female urinary incontinence: The Norwegian EPINCONT Study

OBJECTIVES The aim was to assess the prevalence of any urinary leakage in an unselected female population in Norway, and to estimate the prevalence of significant incontinence. METHODS The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995-97. Everyone aged 20 years or more was invited. 27,936 (80%) of 34,755 community-dwelling women answered a questionnaire. A validated severity index was used to assess severity. RESULTS Twenty-five percent of the participating women had urinary leakage. Nearly 7% had significant incontinence, defined as moderate or severe incontinence that was experienced as bothersome. The prevalence of incontinence increased with increasing age. Half of the incontinence was of stress type, 11% had urge and 36% mixed incontinence. CONCLUSIONS Urinary leakage is highly prevalent. Seven percent have significant incontinence and should be regarded as potential patients.

Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study

Objective To examine whether modifiable lifestyle factors such as smoking, obesity, physical activity and intake of alcohol or caffeinated drinks were associated with urinary incontinence in women.

Age- and Type-Dependent Effects of Parity on Urinary Incontinence: The Norwegian EPINCONT Study

OBJECTIVE To investigate the association between parity and urinary incontinence, including subtypes and severity of incontinence, in an unselected sample, with special emphasis on age as a confounder or effect modifier. METHODS This was a cross‐sectional study (response rate 80%) with 27,900 participating women. Data on parity and urinary leakage, type, frequency, amount, and impact of incontinence were recorded by means of a questionnaire. A validated severity index was used. Relative risks (RR) with nulliparous women as reference were used as an effect measure. RESULTS Incontinence was reported by 25% of participants. Prevalences among nulliparous women ranged from 8% to 32%, increasing with age. Parity was associated with incontinence, and the first delivery was the most significant. The association was strongest in the age group 20–34 years with RR 2.2 (95% confidence interval [CI] 1.8, 2.6) for primiparous women and 3.3 (2.4, 4.4) for grand multiparous women. A weaker association was found in the age group 35–64 years (RRs between 1.4 and 2.0), whereas no association was found among women over 65 years. For stress incontinence in the age group 20–34 years, the RR was 2.7 (2.0, 3.5) for primiparous women and 4.0 (2.5, 6.4) for grand multiparous women. There was an association with parity also for mixed incontinence, but not for urge incontinence. Severity was not clinically significantly associated with parity. CONCLUSION Parity is an important risk factor for female urinary incontinence in fertile and peri‐ and early postmenopausal ages. Only stress and mixed types of incontinence are associated with parity. All effects of parity seem to disappear in older age.

Symptomatic Pelvic Organ Prolapse Prevalence and Risk Factors in a Population-Based, Racially Diverse Cohort

OBJECTIVE: To estimate the prevalence of and identify risk factors associated with symptomatic pelvic organ prolapse and level of distress in racially diverse women aged older than 40 years. METHODS: The Reproductive Risks for Incontinence Study at Kaiser is a population-based study of 2,001 randomly selected women. Symptomatic prolapse was determined by self-report of a feeling of bulge, pressure, or protrusion or a visible bulge from the vagina. Risk factors were assessed by self-report, interview, physical examination, and record review. Distress was assessed by self-report. Multivariable logistic regression analysis was used to identify independent risk factors. RESULTS: Symptomatic prolapse was reported by 118 (6%) women. Almost 50% of these women reported moderate or great distress, and 35% reported that the symptoms affected at least one physical, social or sexual activity. In multivariable analysis, the risk of prolapse was significantly increased in women with one (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.1–7.2), two (OR 4.1, 95% CI 1.8–9.5), and three or more (OR 5.3, 95% CI 2.3–12.3) vaginal deliveries compared with nulliparous women. Irritable bowel syndrome, constipation, and self-reported fair or poor health status were strongly associated with prolapse, with ORs of 2.8 (95% CI 1.7–4.6), 2.5 (95% CI 1.7–3.7), and 2.3 (95% CI 1.1–4.9), respectively. African-American women were significantly less likely to report symptomatic prolapse compared with white women (OR 0.4, 95% CI 0.2–0.8). CONCLUSION: Symptomatic prolapse is less common among African-American women and more common among women with a prior vaginal delivery, poor health status, constipation, or irritable bowel syndrome. Nearly one half of women with symptomatic prolapse are substantially bothered by their symptoms. LEVEL OF EVIDENCE: II

Help-seeking and associated factors in female urinary incontinence The Norwegian EPINCONT Study

Objectives - To assess the proportion of women who visit their doctor because of urinary incontinence and investigate factors associated with help-seeking. Design - Postal invitation, questionnaire covering many health topics including urinary incontinence, received at a screening station. Setting - The Norwegian EPINCONT Study is part of a large cross-sectional population-based survey performed in the county of Nord-Trøndelag during the period 1995-97. Subjects - 6625 women (out of 27936 participating women), 20 years or older, categorised as incontinent according to their answers to the questionnaire. Results - 26% of the incontinent women had seen a doctor for their incontinence. Increasing age, impact, severity and duration were all significantly associated with consultation rate, as were urge and mixed types compared with stress incontinence, and having visited any doctor during the previous 12 months. Fifty percent of the women with significant incontinence (moderate/severe incontinence perceived as troublesome) had seen a doctor because of their incontinence. Conclusions - Only a fourth of the women with any incontinence, and half of the women with significant incontinence had consulted a doctor. Older age and high impact of the symptoms were the factors most strongly associated with help-seeking.

Vaginal delivery parameters and urinary incontinence: The Norwegian EPINCONT study

OBJECTIVE The study was undertaken to investigate the effect of nine delivery parameters on urinary incontinence in later life. STUDY DESIGN Incontinence data from the EPINCONT study were linked to the Medical Birth Registry of Norway. Effects of birth weight, gestational age, head circumference, breech delivery, injuries in the delivery channel, functional delivery disorders, forceps delivery, vacuum delivery, and epidural anesthesia were investigated. The study covered women younger than 65 years, who had had vaginal deliveries only (n=11,397). RESULTS Statistically significant associations were observed between any incontinence and birth weight 4000 g or greater (odds ratio [OR] 1.1, 95% CI 1.0-1.2); moderate or severe incontinence and functional delivery disorders (OR 1.3, 95% CI 1.1-1.6); stress incontinence and high birth weight (OR 1.2, 95% CI 1.1-1.3) and epidural anesthesia (OR 1.2, 95% CI 1.0-1.5); and urge incontinence and head circumference 38 cm or larger (OR 1.8, 95% CI 1.0-3.3). CONCLUSION The effects were too weak to explain a substantial part of the association between vaginal delivery and urinary incontinence, and statistically significant results may have incurred by chance.

Urinary incontinence during pregnancy

OBJECTIVE: To investigate incidence and prevalence of urinary incontinence during pregnancy and associated risk factors. METHODS: The data collection was conducted as part of the Norwegian Mother and Child Cohort Study at the Norwegian Institute of Public Health. We present questionnaire data about urinary incontinence obtained from 43,279 women (response rate 45%) by week 30. We report data on any incontinence, in addition to type, frequency, and amount of incontinence. Potential risk factors were investigated by logistic regression analyses. RESULTS: The prevalence of incontinence increased from 26% before pregnancy to 58% in week 30. The corresponding figures for nulliparous women were 15% and 48%, and for parous women 35% and 67%. The cumulative incidence was 46%. Stress urinary incontinence was the most common type of incontinence in week 30 of pregnancy, experienced by 31% of nulliparous and 42% of parous women. The majority of pregnant women had leakage less than once per week and droplets only, both before and during pregnancy. Parity was a strong and significant risk factor for incontinence in adjusted analyses both before pregnancy (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.4–2.7 for primiparous and OR 3.3, 95% CI 3.1–3.5 for multiparous women) and during pregnancy (ORs 2.0, 95% CI 1.9–2.1 and 2.1, 95% CI 2.0–2.2, respectively). Age and body mass index were weaker, but still statistically significant, risk factors. CONCLUSION: The prevalence of urinary incontinence increases substantially during pregnancy. Incontinence both before and during pregnancy seems to be associated with parity, age, and body mass index. LEVEL OF EVIDENCE: II

The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study

Objective  The objectives of this study were to investigate prevalence of urinary incontinence at 6 months postpartum and to study how continence status during pregnancy and mode of delivery influence urinary incontinence at 6 months postpartum in primiparous women.

Risk of stress urinary incontinence twelve years after the first pregnancy and delivery

OBJECTIVE To estimate the impact of onset of stress urinary incontinence in first pregnancy or postpartum period, for the risk of symptoms 12 years after the first delivery. METHODS In a longitudinal cohort study, 241 women answered validated questions about stress urinary incontinence after first delivery and 12 years later. RESULTS Twelve years after first delivery the prevalence of stress urinary incontinence was 42% (102 of 241). The 12-year incidence was 30% (44 of 146). The prevalence of stress urinary incontinence 12 years after first pregnancy and delivery was significantly higher (P<.01) in women with onset during first pregnancy (56%, 37 of 66) and in women with onset shortly after delivery (78%, 14 of 18) compared with those without initial symptoms (30%, 44 of 146). In 70 women who had onset of symptoms during first pregnancy or shortly after the delivery but remission 3 months postpartum, a total of 40 (57%) had stress urinary incontinence 12 years later. In 11 women with onset of symptoms during the first pregnancy or shortly after delivery but no remission 3 months postpartum, a total of 10 (91%) had stress urinary incontinence 12 years later. Cesarean during first delivery was significantly associated with a lower risk of incontinence. Other obstetric factors were not significantly associated with the risk of incontinence 12 years later. Patients who were overweight before their first pregnancy were at increased risk. CONCLUSION Onset of stress urinary incontinence during first pregnancy or puerperal period carries an increased risk of long-lasting symptoms.

Familial risk of urinary incontinence in women: population based cross sectional study

Abstract Objective To determine whether there is an increased risk of urinary incontinence in daughters and sisters of incontinent women. Design Population based cross sectional study. Setting EPINCONT (the epidemiology of incontinence in the county of Nord-Trøndelag study), a substudy of HUNT 2 (the Norwegian Nord-Trøndelag health survey 2), 1995-7. Participants 6021 mothers, 7629 daughters, 332 granddaughters, and 2104 older sisters of 2426 sisters. Main outcome measures Adjusted relative risks for urinary incontinence. Results The daughters of mothers with urinary incontinence had an increased risk for urinary incontinence (1.3, 95% confidence interval 1.2 to 1.4; absolute risk 23.3%), stress incontinence (1.5, 1.3 to 1.8; 14.6%), mixed incontinence (1.6, 1.2 to 2.0; 8.3%), and urge incontinence (1.8, 0.8 to 3.9; 2.6%). If mothers had severe symptoms then their daughters were likely to have such symptoms (1.9, 1.3 to 3.0; 4.0%). The younger sisters of female siblings with urinary incontinence, stress incontinence, or mixed incontinence had increased relative risks of, respectively, 1.6 (1.3 to 1.9; absolute risk 29.6%), 1.8 (1.3 to 2.3; 18.3%), and 1.7 (1.1 to 2.8; 10.8%). Conclusion Women are more likely to develop urinary incontinence if their mother or older sisters are incontinent.