Ulla Molander

The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women.

The influence of age, parity, duration of previous oral contraceptive use, hysterectomy and menopause on the prevalence of urinary incontinence was evaluated by means of a postal questionnaire in women 46 to 86 years old who resided in the city of Göteborg, Sweden. A sample of 10,000 women from the 7 birth cohorts of 1900 to 1940 was obtained at random from the population register. The overall response rate was 74.6%. The prevalence of urinary incontinence increased (p < 0.001) in a linear fashion from 12.1% in the 1940 birth cohort to 24.6% in the 1900 birth cohort. The prevalence of urinary incontinence in nulliparous women was 7.7% in the 1930 birth cohort and 5.5% in the 1940 birth cohort. The corresponding figures for women who had experienced 1 delivery were 11.1% and 10.6%, compared to 14.0% and 16.4% among women who had had 3 or more deliveries. Urinary incontinence was more prevalent in women who had undergone hysterectomy (p < 0.05). The prevalence of urinary incontinence was unaffected by the duration of previous oral contraceptive use and there was no evidence to suggest that the prevalence of urinary incontinence increased at the time of the last menstrual period.

The prevalence of urinary incontinence and its influence on the quality of life in women from an urban Swedish population

OBJECTIVES To assess the prevalence of urinary incontinence and its influence on the quality of life. MATERIAL AND METHODS A random sample of every fourth woman aged > or =20 years resident in a primary health care district of the city of Göteborg was obtained from the population register (n=2911). The women were invited by letter to complete a questionnaire concerning urinary incontinence. The women were also requested to assess their quality of life using a visual analogue scale. RESULTS The overall response rate was 77%. The prevalence of urinary incontinence increased (p<0.001) in a linear fashion from 3% in the cohort 20-29 years to 32 % in the cohort of women aged > or =80 years. The proportion of women suffering from stress incontinence decreased (p<0.001) with increasing age, while the proportion of women suffering from urge and mixed incontinence increased (p<0.01) with increasing age. Women with stress incontinence had a greater body weight and had given birth to a greater number of children compared to continent women. There was, however, in this respect no difference between women with urge incontinence and continent women. Women with urinary incontinence reported a poorer quality of life compared to continent women (p<0.01). Women with urge incontinence and women with mixed incontinence reported a poorer quality of life compared to women with stress incontinence (p<0.05). Only 6% of the women from this population had sought medical attention for urinary incontinence. CONCLUSIONS Although urinary incontinence was a prevalent condition, particularly among the elderly and had a negative influence on the quality of life, only a small number of women had sought medical care.

URINARY INCONTINENCE AND LOWER URINARY TRACT SYMPTOMS: AN EPIDEMIOLOGICAL STUDY OF MEN AGED 45 TO 99 YEARS

PURPOSE We assessed the prevalence of urinary incontinence and other lower urinary tract symptoms in men 45 years old or older. MATERIALS AND METHODS A postal questionnaire was sent to a random sample (10,458) of the total population of men 45 years old or older living in Göteborg, Sweden. The response rate was 74%. RESULTS The overall prevalence of urinary incontinence was 9.2% increasing (p < 0.001) linearly from 3.6% in men 45 years old to 28.2% in men 90 years old or older. Daily leakage was reported by 64%, and 31% believed that urinary incontinence limited their social and vocational life. However, only 46% of the men with urinary incontinence had sought medical advice. Overall prevalence of other voiding disturbances included hesitancy in 9.1% of the patients, weak stream in 30.5%, dribbling in 33.7%, sensation of incompletely emptied bladder in 26.4%, nocturia in 56.1% and history of urinary tract infection in the last 2 years in 6.3%. Prevalence of all symptoms increased with increasing age. Childhood enuresis was reported by 9.1%. Impotence was reported by 7.6% and there was a linear increase (p < 0.001) in the number of men reporting impotence up to 80 years of age. CONCLUSIONS The prevalence of urinary incontinence and lower urogenital tract symptoms, such as hesitancy, weak stream, dribbling, sensation of incompletely emptied bladder, nocturia, urinary tract infection and impotence, increased linearly with increasing age.

An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women

The prevalence of urinary incontinence (UI) and related urogenital symptoms (UGS) was investigated in a random sample (n = 4206) of women from the 1900-20 birth cohorts residing in the city of Göteborg. It was reported by 16.9% of the respondents that they currently had UI and by 22.7% that they had regularly suffered from this complaint at some time in their lives. The prevalence of UI increased (P less than 0.001) with rising age, from 13.9% in the 1920 birth cohort to 24.6% in the 1900 birth cohort. Over 50% of the sufferers reported daily incontinence. An objective assessment was performed in a subsample (n = 300) of the women complaining of UI. In 14 cases (4.6%) the diagnosis could not be confirmed, while in the remainder UI was classified by type as follows: stress incontinence 24%, urge incontinence 49% and mixed incontinence 27%. The number of urinary tract infections (UTI) reported by the respondents increased (P less than 0.001) with rising age. UGS such as pruritus, burning, pain and vaginal discharge were reported by 11% of the respondents. The reported frequency of local vaginal discomfort did not increase with age, unlike that of UI and UTI. Systemic or local oestrogen treatment was being received by 9.2% of the respondents.

A Longitudinal Population-based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Women

BACKGROUND Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies. OBJECTIVE To describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression. DESIGN, SETTING, AND PARTICIPANTS A longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged > or = 20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n=2911), and available for reassessment in 2007 (n=1408). METHODS A self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire. RESULTS AND LIMITATIONS In 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p<0.001), and 3% (p<0.05), respectively, from 1991 to 2007. The incidence of UI and OAB were 21% and 20%, respectively, and the corresponding remission rates were 34% and 43%, respectively. Women with OAB symptoms were classified as OAB dry or OAB wet, depending on the presence or absence of concomitant UI. The prevalence of OAB dry did not differ between the two assessment occasions (11% and 10%, respectively), but the prevalence of OAB wet increased from 6% to 16% (p<0.001). CONCLUSIONS UI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms were considerable.

Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms: A Longitudinal Population-Based Survey in Men Aged 45–103 Years

BACKGROUND Lower urinary tract symptoms (LUTS) such as urinary incontinence (UI) and overactive bladder (OAB) are highly prevalent conditions, but there are few studies describing progression and remission of LUTS in men, especially over the long term. OBJECTIVE To describe the prevalence of UI, OAB, and LUTS using current International Continence Society definitions in the same men studied longitudinally over time. DESIGN Prospective, population-based, longitudinal study. SETTING AND PARTICIPANTS In 1992, 10 458 men aged 45-99 yr, resident in the city of Gothenburg, were selected at random from the Population Register. MEASUREMENTS The men received a postal questionnaire about the presence of LUTS, as well as questions on social, medical, health-related quality of life (HRQoL), and demographic data. Responders in 1992 were reassessed 11 yr later in 2003 using a similar questionnaire. RESULTS AND LIMITATIONS In 2003, 4072 of the 7763 men who responded in 1992 were still available in the Population Register and 3257 men (80%) aged 56-103 yr, responded. Prevalence of UI and OAB had increased (p<0.01) in the same men assessed in 1992 (4.5% and 15.6%, respectively) and 2003 (10.5% and 44.4%, respectively). The prevalence of nocturia, urgency, slow stream, hesitancy, incomplete emptying, postmicturition dribble, and the number of daytime micturitions had also increased (p<0.01). Only a minority reported regression of symptoms. Men with UI or OAB reported a poorer (p<0.001) HRQoL compared with men without UI or OAB. CONCLUSIONS There was a marked increase in the prevalence of UI, OAB, and other LUTS in the same men assessed longitudinally over this 11-yr period. UI and OAB had a negative influence on HRQoL, and men who developed UI or OAB had a greater deterioration in HRQoL than men who had no change in their UI/OAB status over time.

Effect of oral oestriol on vaginal flora and cytology and urogenital symptoms in the post-menopause

The effect of oral oestriol (3 mg/day for 4 weeks followed by 2 mg/day for a further 6 weeks) on the vaginal bacterial flora, vaginal cytology and urogenital symptoms was assessed in a double-blind, placebo-controlled study in 35 women with symptoms of the urogenital oestrogen deficiency syndrome. No significant differences were observed with regard to the occurrence or severity of urogenital symptoms, vaginal pH, karyopyknotic index (KPI) or the baseline results of vaginal bacterial cultures in the 18 patients (mean age 71.6 +/- 1.0 years) treated with oestriol and the 17 women (mean age 72.6 +/- 1.4 years) who received placebo tablets. A decrease in both vaginal pH (P less than 0.001) and the proportion of faecal-type bacteria (P less than 0.05), and an increase in the KPI (P less than 0.01) and the proportion of lactobacilli (P less than 0.001) were recorded after 10 weeks of treatment with oral oestriol. At the end of the following 10 medication-free weeks all of these parameters except vaginal pH had returned to values that were not significantly altered from the corresponding baseline levels. In the patients treated with placebo no significant changes occurred in vaginal pH, KPI or the proportion of lactobacilli in vaginal cultures during the course of this study. Urogenital symptoms improved in both groups after medication (and even after the medication-free period) in relation to the baseline assessment, which reflects the latters subjective nature.

Family and friends provide most social support for the bereaved

Social support is important in the bereavement period. In this study, the respondents were family members and friends to a patient who had died at a palliative care unit. The aim was to explore wishes and needs for, access to and effects of social support in the bereaved. We found that the grieving person’s wishes for social support from their network and the network also provided most social support. The network consisted of the close family, the origin family, relatives and friend. Support from the professional staff was required when the network was dysfunctional or when the grieving person did not want to burden members of his/her own network. The need for social support from professional staff was most needed close to the death and some time after.

Factors influencing vaginal cytology, pH and bacterial flora in elderly women

Objective. To evaluate factors influencing the vaginal micro‐environment in elderly women. Study design. Vaginal pH, cytology (Karyopyknotic index, KPI) and bacterial cultures were assessed in 350 women (age 72.2 ± 1.4 years, range 65–84 years) who were not taking estrogens. Results. Vaginal pH was 6.5 ± 0.1, KPI was 3.0 ± 0.9% and bacteria of fecal type dominated. However, in some women the vaginal micro‐environment resembled that of fertile women, with a predominance of laclobacilli (n = 68), low pH (n = 41) and an increased maturation index (n = 57). KPI was higher (p > 0.001) in women weighing ≥ 85 kg, or with a body mass ≥ 9th decentile or with a diastolic blood pressure ≥ 100 mmHg and in women (p > 0.05) with a high menopausal age (≥ 53 years). Vaginal pH was lower (p > 0.001), KPI was higher (p > 0.01) and there was an increased (p >0.05) presence of lactobacilli in smokers compared to non‐smokers.

Urinary incontinence and related urogenital symptoms in elderly women

The aims of this study were to investigate the prevalence of urinary incontinence (UI), urinary tract infections (UTI) and related urogenital symptoms (UGS) in a representative sample of elderly women (Papers I & II), and to investigate factors (Papers II & III) influencing the prevalence of UI in these women. The effects of treatment with oral estriol and placebo on the vaginal bacterial flora, vaginal cytology and urogenital symptoms in elderly women suffering from the urogenital estrogen deficiency syndrome were compared (Paper IV). A health care programme, based on an algorithm model, for the investigation and treatment of elderly women suffering from UI and related UGS, was designed and applied to a large group of elderly women (Paper V).