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In Postmenopausal Women, Risk Factors for Incontinence Differ Depending on Disorder's Type

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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 void.

? "Mixed" incontinence, combining both the stress and urge types.

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 Francisco.

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