General Obstetrics and Gynecology: Gynecology
Risk factors for urinary incontinence among middle-aged women

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Objective

The purpose of this study was to identify risk factors for urinary incontinence in middle-aged women.

Study design

We conducted a cross-sectional analysis of 83,355 Nurses' Health Study II participants. Since 1989, women have provided health information on mailed questionnaires; in 2001, at the ages 37 to 54 years, information on urinary incontinence was requested. We examined adjusted odds ratios of incontinence using logistic regression.

Results

Forty-three percent of the women reported incontinence. After adjustment, black (odds ratio, 0.49; 95% CI, 0.40-0.60) and Asian-American women (odds ratio, 0.57; 95% CI, 0.46-0.72) were at reduced odds of severe incontinence compared with white women. Increased age, body mass index, parity, current smoking, type 2 diabetes mellitus, and hysterectomy all were associated positively with incontinence. Women who were aged 50 to 54 years had 1.81 times the odds of severe incontinence compared with women who were <40 years old (95% CI, 1.66-1.97); women with a body mass index of ≥30 kg/m2 had 3.10 times the odds of severe incontinence compared with a body mass index of 22 to 24 kg/m2 (95% CI, 2.91-3.30).

Conclusion

Urinary incontinence is highly prevalent among these middle-aged women. Potential risk factors include age, race/ethnicity, body mass index, parity, smoking, diabetes mellitus, and hysterectomy.

Section snippets

Study population

The Nurses' Health Study II began in 1989 when 116,671 female, registered nurses completed a mailed questionnaire. At enrollment, study participants were 25 to 42 years of age and lived in 14 states. Follow-up questionnaires are mailed biennially to update information on lifestyle and health; information on urinary incontinence was first requested in 2001. Follow-up remains high, at 90% to date (including a small proportion of known deaths). The study was approved by the Institutional Review

Results

The mean age of the study population was 44.8 years (Table I). Self-reported incontinence was highly prevalent: 43% of women reported leaking urine at least once a month. Black women and Asian women reported urinary incontinence less frequently than white women. Overall, of women who leaked urine at least once a month, 6% reported leaking enough to wet their outer clothing or the floor.

After adjustment for potential confounding factors, there was a highly significant trend of increasing

Comment

Among the >80,000 participants of the Nurses' Health Study II who were aged 37 to 54 years, 43% reported leaking urine at least once per month during the previous year. After multivariate adjustment, the prevalence of incontinence was higher in white women than in Asian or black women. In addition, the prevalence of incontinence increased with increasing age and BMI and was higher in parous women as compared with nulliparous women. We found that current smoking, diabetes mellitus, and

References (29)

  • D. Howard et al.

    Racial differences in the structure and function of the stress urinary continence mechanism

    Obstet Gynecol

    (2000)
  • R.V. Baragi et al.

    Differences in pelvic floor area between African American and European American women

    Am J Obstet Gynecol

    (2002)
  • A.C. Diokno et al.

    Medical correlates of urinary incontinence in the elderly

    Urology

    (1990)
  • S. Hunskaar et al.

    Epidemiology and natural history of urinary incontinence

    Int Urogynecol J Pelvic Floor Dysfunct

    (2000)
  • Cited by (0)

    Supported by grants DK62438, CA50385 from the National Institutes of Health.

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