In Postmenopausal Women, Risk Factors for Incontinence Differ Depending on Disorder's Type
Nov. 16, 1999 (New York) -- According to a study published in the journal
Obstetrics and Gynecology, risk factors for involuntary leakage of urine
(urinary incontinence) in postmenopausal women are specific to the type of
incontinence that develops:
? "Stress" incontinence, which results from coughing or some other
sudden, voluntary motion.
? "Urge" incontinence, the inability to resist a sudden urge to
? "Mixed" incontinence, combining both the stress and urge
The researchers say their findings suggest that risk-factor modification and
prevention efforts require different approaches.
The study findings showed that the major risk factors for urge urinary
incontinence were increasing age, diabetes, and urinary tract infections --
also the risk factors for mixed incontinence when the major component was urge.
However, these factors were not predictors of stress urinary incontinence.
The study used data from the Heart and Estrogen/Progestin Replacement Study
(HERS) to determine the presence of -- and risk factors for -- stress, urge,
and mixed urinary incontinence in 2,763 older women who had coronary heart
disease. The women, primarily white, were asked to complete questionnaires on
voiding habits and incontinence.
In women with stress urinary incontinence, white race was a major predictor
of risk; when compared with blacks, white women had an almost threefold greater
risk. Other risk factors included higher body mass index (BMI) and higher
waist-to-hip ratio. These factors also were predictors of mixed incontinence
when the major component was stress.
Weekly stress incontinence was present in 13% of the women, urge
incontinence in 14%, and mixed incontinence in 28%.
More than half the women reported urinary incontinence in the week before
filling out the questionnaire, with most reporting an average of six daytime
and two nighttime voidings in 24 hours. Women with urge and mainly-urge mixed
incontinence had the highest frequency of day and night voidings overall.
"Clearly, as women get older, urge incontinence becomes more
prevalent," Jeanette S. Brown, MD, tells WebMD. "[The] link with
diabetes as a risk factor hasn't been fully explored. We think that is very
important to bring to light, as is this issue of urinary tract infections.
These are women who reported two or more urinary tract infections in the prior
year." Brown is associate professor in the department of obstetrics,
gynecology and reproductive sciences and the department of epidemiology and
biostatistics, Mount Zion Women's Health Center, University of California, San
Brown says the study helps fill some of the gaps in knowledge regarding
at-risk populations for incontinence. Traditionally, incontinence studies in
premenopausal women have had small numbers of patients and have not divided
patients by type of incontinence, Brown says. "By dividing them by type, we
saw that the risk factors are very different," she says. "So when we
think about the bigger picture of preventing or modifying risk factors, it
gives us some things to focus on."
Her group is presently focusing on intervention trials to see if
modification of certain risk factors results in improvements. One such study
involves a weight-reduction strategy in obese women with stress, urge, and
mixed incontinence. Another planned trial will evaluate the suggestion that
better control of diabetes may reduce the risk of incontinence or minimize its