Jeanette S. Brown

Urinary Incontinence: Does it Increase Risk for Falls and Fractures?

OBJECTIVE: To determine if urge urinary incontinence is associated with risk of falls and non‐spine fractures in older women.

Urinary incontinence in older women: Who is at risk?

Objective To estimate prevalence of and identify factors associated with urinary incontinence in older women. Methods A cross-sectional study involved 7949 community-dwelling women, with a mean (± standard deviation) age of 76.9 ± 5.0 years, recruited from population-based listings to participate in the Study of osteoporotic Fractures. The prevalence and severity of urinary incontinence during the previous 12 months were assessed by questionnaire. Factors potentially associated with urinary incontinence were assessed by questionnaire, interview, and physical examination. Multivariate logistic regression analysis was sused to determine the independent associations between these factors and the primary outcome of daily incontinence. Results Forty-one percent (3285) of the women reported urinary incontinence, with 14% (1130) reporting daily incontinence. In multivariate analysis, the prevalence of daily urinary incontinence increased significantly with age (odds ratio [OR] 1.3 per 5 years, 95% confidence interval [CI] 1.2–1.5), prior hysterectomy (OR 1.4 95% CI 1.1–1.6), higher body mass index (OR 1.6 per 5 units. 95% CI 1.4–1.7), history of stroke (OR 1.9, 95% CI 1.3–2.7), diabetes (OR 1.7, 95% CI 1.2–2.4), chronic obstructive pulmonary disease (OR 1.4, 95% CI 1.1–1.9), and poor overall health (OR 1.6, 95% CI 1.3–2.0). Faster gait speed (OR 0.8 per 0.2 units, 95% CI 0.6–1.0) was associated with decreased incontinence. Conclusion Urinary incontinence is a common problem in older women, more common than most chronic medical conditions. Of the associated factors that are preventable or modifiable, obesity and hysterectomy may have the greatest impact on the prevalence of daily incontinence.

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

Sexual Activity and Function in Middle-Aged and Older Women

OBJECTIVE: Data on the sexual activity of middle-aged and older women are scant and vary widely. This analysis estimates the prevalence and predictors of sexual activity and function in a diverse group of women aged 40–69 years. METHODS: The Reproductive Risk Factors for Incontinence Study at Kaiser (RRISK) was a population-based study of 2,109 women aged 40–69 years who were randomly selected from long-term Kaiser Permanente members. Women completed self-report questionnaires on sexual activity, comorbidities, and general quality of life. Logistic and linear regression and proportional odds models were used when appropriate to identify correlates of sexual activity, frequency, satisfaction, and dysfunction. RESULTS: Mean age was 55.9 (± 8) years and nearly three fourths of the women were sexually active. Of the sexually active women, 60% had sexual activity at least monthly, approximately two thirds were at least somewhat satisfied, and 33% reported a problem in one or more domains. Monthly or more frequent sexual activity was associated with younger age, higher income, being in a significant relationship, a history of moderate alcohol use, and lower body mass index (BMI) (all P < .05). Satisfaction with sexual activity was associated with African-American race, lower BMI, and higher mental health score (all P < .05). More sexual dysfunction was associated with having a college degree or greater, poor health, being in a significant relationship, and a low mental health score (all P < .05). CONCLUSION: Middle-aged and older women engage in satisfying sexual activity, and one third reported problems with sexual function. Demographic factors as well as some issues associated with aging can adversely affect sexual frequency, satisfaction, and function. LEVEL OF EVIDENCE: II-3

Prevalence and Risk Factors for Urinary Incontinence in Women With Type 2 Diabetes and Impaired Fasting Glucose: Findings from the National Health and Nutrition Examination Survey (NHANES) 2001–2002

OBJECTIVE—Diabetes is associated with increased risk of urinary incontinence. It is unknown whether women with pre-diabetes, or impaired fasting glucose (IFG), have increased prevalence of incontinence. We determined the prevalence of, and risk factors for, incontinence among U.S. women with diabetes and IFG. RESEARCH DESIGN AND METHODS—The 2001–2002 National Health and Nutrition Examination Survey measured fasting plasma glucose and obtained information about diabetes and urinary incontinence among 1,461 nonpregnant adult women. Self-reported weekly or more frequent incontinence, both overall and by type (urge and stress), was our outcome. RESULTS—Of the 1,461 women, 17% had diabetes and 11% met criteria for IFG. Prevalence of weekly incontinence was similar among women in these two groups (35.4 and 33.4%, respectively) and significantly higher than among women with normal fasting glucose (16.8%); both urge and stress incontinence were increased. In addition to well-recognized risk factors including age, weight, and oral estrogen use, two microvascular complications caused by diabetes, specifically macroalbuminuria and peripheral neuropathic pain, were associated with incontinence. CONCLUSIONS—Physicians should be alert for incontinence, an often unrecognized and therefore undertreated disorder, among women with diabetes and IFG, in particular those with microvascular complications. The additional prospect of improvements in their incontinence may help motivate some high-risk women to undertake difficult lifestyle changes to reduce their more serious risk of diabetes and its sequelae.

The “Costs” of Urinary Incontinence for Women

OBJECTIVE: To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. METHODS: In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (

Postmenopausal Hormone Therapy Does It Cause Incontinence

2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25–100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. RESULTS: Mean age was 56 ± 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from

Urinary incontinence in older community-dwelling women : The role of cognitive and physical function decline

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Racial Differences in Pelvic Organ Prolapse

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Prevalence and Risk Factors for Urinary Incontinence in Overweight and Obese Diabetic Women: Action for Health in Diabetes (Look AHEAD) study

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