Yngvild S. Hannestad

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.

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.

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.

Diabetes and urinary incontinence – prevalence data from Norway

Background. Few large epidemiological studies have investigated whether diabetes might increase the risk for, or cause greater severity of, urinary incontinence. The aim of the present study was to investigate the association between diabetes and urinary incontinence, including the possible influence of diabetes on the severity of incontinence. Methods. The study was a cross‐sectional, population‐based, study from the county of Nord‐Trøndelag, Norway, from 1995 to 1997. Data were collected by means of questionnaires, simple clinical measurements, and some blood tests. A total of 21,057 women, 20 years or older, answered the questions on both diabetes and incontinence, and 685 women were identified with diabetes. Results. The prevalence of incontinence among women with diabetes was 39% compared to 26% in women without diabetes. The women with diabetes had more urge and mixed incontinence. The associations between diabetes and urge incontinence (OR: 1.49; 95% CI: 1.03–2.16), mixed incontinence (OR: 1.32; 95% CI: 1.05–1.67), and severe incontinence (OR: 1.54; 95% CI: 1.21–1.96) were still significant after adjusting for age, body mass index, parity and smoking. Conclusion. We found a strong association between diabetes and urinary incontinence, especially for urge incontinence and severe degree of incontinence.

Diabetes related risk factors did not explain the increased risk for urinary incontinence among women with diabetes. The Norwegian HUNT/EPINCONT study

BackgroundPrevious studies have shown an association between diabetes mellitus (DM) and urinary incontinence (UI) in women, especially severe UI. The purpose of this study was to investigate whether diabetes related variables could explain this association.MethodsThe study is part of the EPINCONT study, which is based on the large Nord-Trøndelag Health Study 2 (HUNT 2), performed in the county of Nord-Trøndelag, Norway, during the years 1995 - 1997. Questions on diabetes and UI were answered by a total of 21 057 women aged 20 years and older. Of these 685 were identified as having diabetes, and thus comprise the population of our study. A variety of clinical and biochemical variables were recorded from the participants.ResultsBlood-glucose, HbA1c, albumine:creatinine ratio (ACR), duration of diabetes, diabetes treatment, type of diabetes, cholesterol and triglycerides did not significantly differ in women with and without UI in crude analyses. However, the diabetic women with UI had more hospitalizations during the last 12 months, more homecare, and a higher prevalence of angina and use of oestrogene treatment (both local and oral/patch). After adjusting for age, BMI, parity and smoking, there were statistically significant associations between any UI and angina (OR 1.89; 95% CI: 1.22 - 2.93), homecare (OR 1.72; 95% CI: 1.02 - 2.89), and hospitalization during the last 12 months (OR 1.67; 95% CI: 1.18 - 2.38). In adjusted analyses severe UI was also significantly associated with the same variables, and also with diabetes drug treatment (OR 2.10; 95% CI: 1.07 - 4.10) and stroke (OR 2.47; 95% CI: 1.09 - 5.59).ConclusionNo single diabetes related risk factor seems to explain the increased risk for UI among women with diabetes. However, we found associations between UI and some clinical correlates of diabetes.

Association between mode of delivery and pelvic floor dysfunction.

BACKGROUND Normal vaginal delivery can cause significant strain on the pelvic floor. We present a review of the current knowledge on vaginal delivery as a risk factor for urinary incontinence and pelvic organ prolapse compared to caesarean section. MATERIAL AND METHOD We conducted a literature search in PubMed with an emphasis on systematic review articles and meta-analyses. The search was completed in January 2014. We also included articles from our own literature archives. RESULTS Compared to vaginal delivery, caesarean section appears to protect against urinary incontinence, but the effect decreases after patients reach their fifties. The risk of pelvic organ prolapse increases (dose-response effect) with the number of vaginal deliveries compared to caesarean sections. There are few reliable studies on the association between mode of delivery and anal incontinence, but meta-analyses may indicate that caesarean section does not offer protection after the postpartum period. Women with previous anal sphincter rupture during vaginal delivery are a sub-group with an elevated risk of anal incontinence. The degree of severity of pelvic floor dysfunction is frequently unreported in the literature. INTERPRETATION The prevalence of urinary incontinence and pelvic organ prolapse is lower in women who have only delivered by caesarean section than in those who have delivered vaginally. For urinary incontinence this difference appears to level out with increasing age. There is no basis for identifying sub-groups with a high risk of pelvic floor injury, with the exception of women who have previously had an anal sphincter rupture. Caesarean section will have a limited primary preventive effect on pelvic floor dysfunction at a population level.

Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study

Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.