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An investigation of the relationship between anxiety and depression and urge incontinence in women: Development of a psychological model

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The study investigated the association between anxiety and depression and urge incontinence and the direction of causal pathways between these variables. A prospective longitudinal postal survey. A random sample of women aged 40 years or more, registered with a general practitioner in Leicestershire or Rutland, was mailed a postal questionnaire. The questionnaire included questions on general health, urinary symptoms and the Hospital Anxiety and Depression Scale (HADS). In total, 12,568 women responded to the baseline postal survey (65.3% response rate) and 9,596 to the first annual follow-up (79.8% response rate). The prevalence and one-year incident rates of these symptoms were compared and contrasted, whilst controlling for confounding variables. A significant proportion of women with urge incontinence reported symptoms of anxiety (56.6%) and depression (37.6%). Anxiety and depression were associated with a number of urinary symptoms and were not exclusive to urge incontinence. Incident cases of anxiety and depression were predicted by the presence of urge incontinence at baseline. Incident cases of urge incontinence were predicted by anxiety at baseline, but not depression. Anxiety, urge incontinence and frequency appeared to interact and exacerbate each other. The findings demonstrated the relevance of emotional factors in the development and maintenance of urge incontinence. Currently, assessment and treatment protocols for urge incontinence concentrate on physical symptoms and toilet behaviours. A more integrated psychological model of urge incontinence is proposed.

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... In a recent review paper, Tarcan et al. [9] concluded that due to their frequency, high rate, and relevance in clinical practice, screening for psychiatric comorbidities ought to be recommended for all age groups with idiopathic lower urinary tract dysfunctions. However, it is worth noting that many studies of the association between OAB and psychiatric disorders have focused on non-clinical samples approached via telephone-or Internet-based instruments and that psychotropic medications taken by study participants have been typically neglected [8,10]. ...
... An increasing body of evidence indicates that psychiatric disorders and OAB symptoms may go together, although causality has not been proven [11,45]. In a prospective, longitudinal study by Perry et al. [10], a large group of women aged 40 years or more, were repeatedly mailed a postal questionnaire including the 30-item Hospital Anxiety and Depression Scale. Cases of de novo urge incontinence were associated with higher levels of anxiety at baseline, but not with depression. ...
... This observation is not surprising as many psychiatric disorders (e.g., depression) and various psychotropic medications are associated with increased BMI, overweight, and obesity [14,18,22]. One may hypothesize that the relationship between urogynecological symptomatology and psychiatric history identified in the present and previous studies [7,8,10] is mediated by an interplay of brain mechanisms and peripheral factors, including body fat accumulation and increased BMI. ...
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Introduction and hypothesis: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. Methods: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. Results: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.
... 6 Different pelvic floor disorders have similar consequences for women, such as poor sexual function, 7 decreased body image and quality of life, 8 and significant psychological distress, expressed by depression 9,10 and anxiety. 11 Treatment of pelvic floor disorders is prompted by patients' perceptions of their symptoms and their desire for an improved quality of life. 12 Thus, subjective evaluation of physical symptoms may have low association with actual physical symptoms; and such evaluation may be related to an individual's personality traits. ...
... There is a well-established relationship between physical and mental health, especially regarding pelvic floor disorders, [9][10][11] and the study findings concur and augment such claims for relationship. The main finding of this study is an association between neuroticism, reported pelvic floor symptoms, and psychological distress; a higher level of neuroticism was associated with higher levels of reported pelvic floor symptoms and psychological distress. ...
... Neuroticism may cause inflated self-reports, resulting in considerable and costly use of health services. 14,25 Congruent with previous studies, [9][10][11] psychological distress was found to be associated with more severe reported pelvic floor symptoms. However, our research strengthens this correlation more than do previous studies, by examining different types of pelvic floor disorders, along with 2 basic personality traits. ...
Article
Objectives: The diagnosis and treatment of pelvic floor disorders may involve subjective self-report symptom measures that may be related to personality traits. We aimed to construct a model that integrates pelvic floor disorders, personality variables (optimism and neuroticism), psychological distress, and related demographic variables. Methods: In a cross-sectional study, conducted between August 2014 and June 2015, 155 women following an intake to an urogynecology outpatient clinic of a tertiary health center completed personality questionnaires of optimism and neuroticism (Life Orientation Test-Revised, 10-item Big Five Inventory), pelvic floor symptoms (Pelvic Floor Distress Inventory Short Form), psychological distress (18-item Brief Symptom Inventory), and a demographic questionnaire. Results: A path analysis mediation model showed that patients who had more pelvic floor symptoms felt more psychological distress and that psychological distress increased as the level of neuroticism increased. As for optimism, the correlation to pelvic floor symptoms was nearly significant. Optimism and neuroticism had indirect effects on psychological distress through pelvic floor symptoms in women with urinary incontinence and pelvic organ prolapse. Neuroticism had a direct effect on psychological distress in these women as well. Conclusions: Our suggested statistical path analysis model supports the important role of personality traits in pelvic floor disorder self-reports and the effect of these traits on psychological distress. Therefore, the optimal treatment for pelvic floor symptoms should include psychological interventions in addition to traditional medical or surgical therapy in hope of reducing psychology distress associated with urinary incontinence and pelvic organ prolapse.
... The total score ranges between 0 and 54. For this study, patients were also classified as in remission -no depression (0-7), with mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16), with moderate depression (17)(18)(19)(20)(21)(22)(23), and with severe depression (≥24). Psychiatrists completed the HRSD questionnaire. ...
... The total score ranges between 0 and 21. The ICIQ-UI SF may be divided into the following four severity categories: slight (1)(2)(3)(4)(5), moderate (6)(7)(8)(9)(10)(11)(12), severe (13)(14)(15)(16)(17)(18), and very severe (19)(20)(21) [7]. The ICIQ-UI SF, a patient self-administered questionnaire, is used widely in routine clinical care of both male and female UI patients. ...
... Furthermore, some authors admitted low participation of patients with increased depressive symptoms in their studies conducted in the general population [2,11]. Thus, our study is the In another one-year longitudinal study, UI at baseline led to depressive symptoms as well [19]. We need to consider several shared pathological pathways in the relationship between UI and depression/ depressive symptoms. ...
Article
Introduction: Urinary incontinence (UI) is a major public health issue because of the high number of individuals affected, its adverse effects on job-related functioning, and the decline in quality of life. The association between UI and symptoms of depression has been evaluated extensively for the general population. However, relationships between UI and depression have not been adequately assessed for specific patient groups. Thus, we investigated the association between UI and depression severity in patients treated for depression. Material and methods: This study was a single-center, prospective, cross-sectional inquiry. We analyzed questionnaire data on UI and depression from depressed patients treated in our Department of Adult Psychiatry. Patients completed the International Consultation on Incontinence Questionnaire Short Form and General Health Questionnaire whereas psychiatrists administered the Hamilton Rating Scale for Depression. Results: One hundred two patients were enrolled in the study. Most patients had mild depression. Patients who were incontinent mostly reported moderate UI and UI was statistically more prevalent in women than in men. Further, with the General Health Questionnaire, depression severity in women was significantly associated with the severity of UI. We did not observe correlation between depression severity analyzed with the Hamilton Rating Scale for Depression and UI. Conclusions: In the cohort of patients treated for depression, UI affected more women than men. In wo- men, UI was associated with the severity of depression. Because UI and depression may coexist and share the symptom burden, particularly in women, clinicians should be aware of the interconnection between these two conditions.
... The BDI and BAI total scores provide a classification of depression and anxiety intensity levels. The classification of the scores for depression are as follows: minimal (0-11), mild (12)(13)(14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), and severe (36-63). The classification of scores for anxiety are as follows: minimal (0-10), mild (11)(12)(13)(14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and severe (31-63). ...
... The classification of the scores for depression are as follows: minimal (0-11), mild (12)(13)(14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), and severe (36-63). The classification of scores for anxiety are as follows: minimal (0-10), mild (11)(12)(13)(14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and severe (31-63). 12,13 Each degree of BDI and BAI scores was compared to ICIQ-OAB and sub scores (frequency, nocturia, urgency, and urgency incontinence) separately. ...
... Two thirds of women included in this study presented with moderate or severe anxiety. These rates are similar to prevalence assessed by Coyne et al and Perry et al 17,23 although Alves et al showed a smaller percentage of patients with OAB and anxiety. 19 These results could be influenced by the fact that the previously cited study was conducted with only 166 elderly women. ...
Article
Aim: Depression and anxiety are prevalent psychiatric conditions and are associated with overactive bladder. The objective of this study was to determine prevalence and severity of anxiety and depression associated with overactive bladder (OAB) in women. Methods: 274 women with clinical diagnosis of OAB were recruited from 2012 to 2015. They were submitted to the International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Results: Severe or moderate depression was present in 59.8% of women and severe or moderate anxiety was identified in 62.4%. Higher scores of depression and anxiety were associated with higher scores of ICIQ-OAB (P = 0.0031 and 0.0049). Women with severe depression had higher nocturia score than those with mild depression (P = 0.0046). Also, women with severe depression had higher urgency incontinence score than those with minimal depression (P = 0.0261). Patients with severe anxiety had higher nocturia score than those with minimal anxiety (P = 0.0118) and women with moderate anxiety had higher urgency incontinence score than with minimal anxiety (P = 0.0300). Conclusions: Moderate or severe depression and anxiety are prevalent in women with OAB. There is a correlation between intensity of OAB symptoms with depression and anxiety. Anxiety and depression levels are mainly related with urgency incontinence and nocturia.
... In a population-based survey of 3536 women, major depression was associated with severe UI [2]. Other crosssectional studies have also shown associations, but the prevalence of UI, depression, and anxiety vary due to different definitions of UI and different cut-offs and definitions of anxiety and depression [32][33][34][35]. In a recent study, UI during and after pregnancy was associated with postpartum depression, OR 3.81 (1.57-9.25) ...
... There are both psychological and biological explanation models for the associations between anxiety/depression and UI. Living with a condition associated with shame, loss of control, unpredictability and decreased quality of life, may lead to psychological stress, anxiety and depression symptoms [35]. ...
Article
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Background Anxiety and depression are in both cross-sectional and longitudinal studies associated with urinary incontinence (UI) in women, strongest for the urgency component of UI. The role of psychotropic drugs in this association, especially antidepressants, has been questioned, but not clarified. The present study aimed to explore the associations between UI and anxiety/depression and the possible impact of psychotropic drugs on these associations. Methods We conducted a cross-sectional, population-based study with questionnaire data from 21,803 women ≥20 years in the Norwegian Nord-Trøndelag Health Study merged with the Norwegian Prescription Database, which contains information on all dispensed prescriptions. We used multivariate logistic regression to investigate the association between UI (any UI, and by type and severity) and anxiety/depression (by different score on Hospital anxiety and depression scale), and the influence of psychotropic drugs on this association (by different volume of drug use). Results Compared with normal anxiety- and depression score, having moderate/severe anxiety or depression (HADS≥11) increased the prevalence of UI from 27.6 to 37.8% (OR 1.59 (1.40–1.81), p < 0.001) for anxiety and from 28.0 to 43.7% (OR 1.79 (1.46–2.21), p < 0.001) for depression. According to type of UI, mixed UI was most strongly associated with a high HADS-score with an odds ratio 1.84 (1.65–2.05) for anxiety and 1.85 (1.61–2.13) for depression. Compared to no UI, severe UI was associated with depression with odds ratios of 2.04 (1.74–2.40), compared with no UI. Psychotropic drug use did not influence the associations between UI and anxiety/depression. We found high prevalence of UI among users of various psychotropic drugs. After adjustments, only antidepressants were associated with UI, with OR 1.36 (1.08–1.71) for high defined daily dose of the drug. Anxiolytics were associated with less UI with OR 0.64 (0.45–0.91) after adjustments for anxiety. Conclusion This study showed that anxiety, depression and use of antidepressants are associated factors with UI, strongest for urgency and mixed type of UI, with increasing ORs by increasing severity of the conditions and increased daily dose of the medication. Use of antidepressants did not influence the associations between UI and anxiety/depression.
... We have also used a cut-offs of HADS-D 8-10 to indicate mild depression and ≥11 for moderate/severe depression. The developers of the HADS have recommended these cutoff points for mild (8)(9)(10), moderate (11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21) depression [10,11]. To quantify the severity of depression symptoms, we have analyzed the HADS-D data as a continuous variable. ...
... A few population-based cohort studies have tried to clarify the relationship between depression and OAB. In an one-year longitudinal study of women aged 40 years and over, incident cases of depression was predicted by the presence of urgency incontinence at baseline; while incident cases of urgency incontinence was not predicted by depression at baseline [18]. In two longitudinal studies involving older patients aged 65 and above, depression at baseline predicted new onset urgency incontinence at the 1-year follow up in one study and at the 6-year follow up in the second study [19,20]. ...
Article
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Background To investigate the relationship between depression and overactive bladder (OAB)/urinary incontinence symptoms among the clinical OAB population. Methods Patients who were diagnosed with overactive bladder (OAB) and age-matched control subjects without OAB were enrolled. Depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-D). OAB/incontinence symptoms were assessed using the validated questionnaires: ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, and OAB-q. Results 27.5 % of OAB patients in our study had depression (HADS ≥8), and 12 % of OAB patients had moderate to severe depression (HADS-D ≥11). OAB patients reported significantly higher HADS-D depression scores compared to age-matched controls (5.3 ± 3.9 versus 2.8 ± 3.9, p = 0.004). OAB patients with depression reported more severe incontinence symptoms (ICIQ-UI), greater bother and more impact on quality of life (UDI-6, IIQ-7) compared to OAB patients without depression (p = 0.001, 0.01, <0.001, respectively). However there were no differences in ICIQ-OAB and OAB-q. Among OAB patients, there were positive correlations between the severity of depression symptoms and OAB/incontinence symptoms (p-values <0.001 to 0.035). Conclusions 27.5 % of OAB patients have depression. OAB patients with depression reported more severe urinary incontinence symptoms, greater bother and more impact on quality of life compared to those without depression. Future studies are needed to further examine the mechanistic links between depression and OAB/urinary incontinence.
... times more likely to develop LUTS (Huang et al., 2017). In another study, UI and frequency were predictors of incident cases of anxiety (measured using HADS), and anxiety was a predictor of incident cases of UI (Perry et al., 2006). ...
... A large longitudinal cohort study provides evidence for bidirectional relationships between LUTS and anxiety disorders (Huang et al., 2017), and a second longitudinal study showed that anxiety (measured using HADS) was both a risk factor for and a consequence of UI (Perry et al., 2006). ...
Article
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Background Lower urinary tract symptoms (LUTS), such as voiding symptoms, overactive bladder, and interstitial cystitis, and anxiety disorders are often comorbid conditions in patients. However, the existing evidence regarding the rates and nature of the co-occurrence of these conditions has not been systematically evaluated. The aim of this study was to examine these relationships. Methods We conducted a systematic review and meta-analysis to examine the relationship between LUTS and anxiety. We searched for articles published from January 1990 to July 2019 in PubMed, CENTRAL, PsycINFO, and Google Scholar. Outcomes were anxiety-related disorders and symptoms (clinically significant anxiety) and LUTS. We performed random-effects meta-analyses, inspected funnel plots, and applied the Egger's test to evaluate publication bias. We followed PRISMA guidelines and recorded our protocol on PROSPERO (ID = CRD42019118607). Results We identified 814 articles, of which 94 fulfilled inclusion criteria, and 23 had sufficient data for meta-analysis. The odds ratio (OR) for clinically significant anxiety among individuals with LUTS was 2.87 (95% CI: 2.38,3.46, p < .001). The OR for LUTS among individuals with clinically significant anxiety was 2.87 (95% CI: 1.07,7.74, p < .001), although very few studies examined this relationship. A large value of I² index suggests high heterogeneity between studies. Conclusion The results demonstrate a significant association between clinically significant anxiety and LUTS in both females and males. There were limited studies on younger individuals and on individuals ascertained for clinically significant anxiety, which should motivate further study in these areas. Understanding the co-occurrence of these conditions will lead to better prevention and interventions to ameliorate the progression of the symptoms and improve the quality of life. A thorough assessment of anxiety may provide more optimal care for LUTS patients.
... Furthermore, both storage and voiding LUTS had higher risk for anxiety and depression as well. This result is consistent with those of other longitudinal studies that found patients with LUTS were at -higher risk of developing depression [20][21], and as anxiety [12,22]. Moreover, clinical trials have shown that successful treatment of LUTS led to fewer anxiety/depression symptoms regardless of the investigated intervention [23][24]. ...
... Moreover, both anxiety and depression had higher risk for storage and voiding LUTS as well. This finding is in line with other longitudinal studies that reported the risk of developing LUTS is higher among patients with depression [11,[25][26], and among anxiety patients [20,22]. Our data suggest a significant correlation between LUTS and anxiety as well as depression, and that the association between these two conditions could be bidirectional in nature. ...
... Similar to our findings, anxiety was associated with new urinary symptoms in 3 previous longitudinal studies, but all focused on UI rather than OAB. [20][21][22] Further, in 1 study UI associated with functional impact predicted the development of any anxiety disorder (OR, 2.6; 95% CI, 1.1e6.2), suggesting a bidirectional association between anxiety and UI. ...
... 1,24 In the current study, depression was associated with lower odds of remission of OAB, but not with incident OAB. Similarly, others did not find that depression was a risk factor for incident UI. 21,22 In contrast, Melville et al 25 found major depression predicted new UI symptoms 6 years later. Differences in these results may reflect the use of different definitions for depression or UI, as well as imprecision in the estimates. ...
... 22 A large percentage of women with urinary incontinence can have depression, anxiety or other psychological issues. 23,24,27,28 The effects of incontinence on emotional health, body image and social activity are a serious problem. It is possible that incontinence affects these people's perceptions of skin sensitivity in general and for specific body sites. ...
... Symptom exacerbation due to stress is prevalent in many disease states, including functional disorders of the urinary bladder (e.g., OAB, PBS/IC) and may be partly due to disruption of the HPA axis (Westropp and Buffington, 2002;Nazif et al., 2007). The prevalence of micturition disorders is high among individuals with anxiety disorders (Perry et al., 2006;Fan et al., 2008;Coyne et al., 2009). However, the mechanisms underlying the effects of stress on micturition reflex function are unclear. ...
Article
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Complex organization of CNS and PNS pathways is necessary for the coordinated and reciprocal functions of the urinary bladder, urethra and urethral sphincters. Injury, inflammation, psychogenic stress or diseases that affect these nerve pathways and target organs can produce lower urinary tract (LUT) dysfunction. Numerous neuropeptide/receptor systems are expressed in the neural pathways of the LUT and non-neural components of the LUT (e.g., urothelium) also express peptides. One such neuropeptide receptor system, pituitary adenylate cyclase-activating polypeptide (PACAP; Adcyap1) and its cognate receptor, PAC1 (Adcyap1r1), have tissue-specific distributions in the LUT. Mice with a genetic deletion of PACAP exhibit bladder dysfunction and altered somatic sensation. PACAP and associated receptors are expressed in the LUT and exhibit neuroplastic changes with neural injury, inflammation, and diseases of the LUT as well as psychogenic stress. Blockade of the PACAP/PAC1 receptor system reduces voiding frequency in preclinical animal models and transgenic mouse models that mirror some clinical symptoms of bladder dysfunction. A change in the balance of the expression and resulting function of the PACAP/receptor system in CNS and PNS bladder reflex pathways may underlie LUT dysfunction including symptoms of urinary urgency, increased voiding frequency, and visceral pain. The PACAP/receptor system in micturition pathways may represent a potential target for therapeutic intervention to reduce LUT dysfunction.
... Wielu naukowców widzi także związek między występowaniem depresji a OAB [32,33]. Związek pomiędzy pojawieniem się i nasileniem objawów OAB a progresją depresji został już wielokrotnie opisany zarówno u kobiet, jak i u mężczyzn [34][35][36][37][38][39]. Podobna korelacja została zaobserwowana w naszej pracy. ...
Article
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Aim. Lower urinary tract symptoms (LUTS) are highly prevalent and costly condition worldwide. Numerous studies have demonstrated their negative impact on health-related quality of life (HRQL), as well as on physical and mental health. The co-existence of LUTS and psychiatric symptoms is common and has been described by psychiatrists, urologists and gynecologists. However, data are lacking regarding the perception of urological symptoms by psychiatrists in their day-to-day clinical practice. Methods. 31-question survey was designed to learn what is the perception of LUTS among psychiatrists. Survey link was sent by email to all psychiatrists registered to the Polish Association of Psychiatry via the association’s email lists. The SurveyMonkey website was used as a platform where responses were collected and stored. Results. 953 physicians completed the questionnaire. Majority of investigated psychiatrists only ‘occasionally’ask their patients about voiding dysfunctions. Respondents estimated the frequency of voiding dysfunctions in their patients as ‘moderately frequent’with a ‘10–30%’ prevalence. However, discrepancies between different subgroups of psychiatrists have been noted. Furthermore, psychiatrists may not be fully aware of the effects of psychiatric treatment (psychotherapy/pharmacotherapy) on LUTS improvement, as well as possible deteriorations of voiding dysfunctions with psychiatric disorder progression. Conclusions. This survey showed that the perception of urological symptoms by psychiatrists in their patients may be limited. Therefore, it is necessary to adequately inform and educate psychiatrists in terms of the impact of urological symptoms on patients’management, prognosis and quality of life.
... podobnych jak w OAB, z objawami lękowymi i depresyjnymi (np. [8,11,43]) sugeruje ich połączenie z takimi cechami osobowości, jak neurotyczność, tendencja do przeżywania emocji negatywnych czy bojaźliwość. Ponieważ objawy "pseudourologiczne" w obrazie klinicznym znanym z psychoterapii zwykle wiążą się z ograniczeniem swobody poruszania się (analogicznie do agorafobii, często zresztą w jej obrazie) i radzenia sobie "na zewnątrz" domu lub rodziny (przez co mogą hamować procesy separacyjno-indywiduacyjne), bardzo prawdopodobne wydaje się także ich powiązanie z cechami przeżywania i osobowości odnoszącymi się do psychasteniczności, niesamodzielności, niezaradności, poczucia braku wpływu, uzależnienia od otoczenia, zewnątrzsterowności, a wtórnie -do negatywnej samooceny i trudności w budowaniu relacji. ...
Article
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Objectives: Evaluation of the association between the occurrence of lower urinary tract symptoms in patients qualified for psychotherapy and the severity and profile of their neurotic personality disorders. Material and methods: Retrospective analysis of questionnaires included in the medical records of 2,450 patients qualified for psychotherapy in 2004-2014 in terms of correlations between the symptoms of pollakiuria and unconscious urinary incontinence, and the global severity of neurotic symptoms (OWK), global severity of neurotic personality disorders (XKON) and abnormal values of 24 scales of the KON-2006 questionnaire. Correlations in the form of OR coefficients with 95% confidence intervals were estimated using logistic regression analyzes. Results: Lower urinary tract symptoms are associated with a significantly greater severity of neuroticism, both described by the global severity of symptoms (OWK) as well as by the global neurotic personality disorder index (XKON) and abnormal values of the KON-2006 questionnaire scales. The occurrence of both symptoms was associated with the following scales: 'Negative self-esteem' and 'Envy', the occurrence of pollakiuria - with the scales 'Feeling of being dependent on others', 'Demobilization', 'Conviction of life helplessness' and 'Feeling of lack of influence', the occurrence of unconscious urinary incontinence - with the scales 'Feeling of being alienated' and 'Exaltation' for both genders, and only in men 'Risk avoidance' (low 'Risk tendencies'), 'Conviction of life helplessness', 'Difficulties in interpersonal relations'. Extreme severity of pollakiuria was more strongly associated with many of the mentioned scales, and also slightly differently with other scales, e.g., in men - with the 'Sense of overload' and 'Imagination, fantasizing'. Conclusions: Neurotic personality traits described by abnormal values of the KON-2006 questionnaire scales are associated with the presence (and also to some extent with the severity) of psychogenic lower urinary tract symptoms. Connections may be bi-directional - in some cases experiencing and self-description of personality traits may be secondary to suffering associated with pollakiuria and incontinence.
... 4 A perda de urina constitui, ainda nos dias de hoje, um assunto tabu, que impõe restrições sociais, em grande parte por causa do sentimento de vergonha associado à perda de urina em público e que impede a mulher de realizar atividades fora de casa como caminhar, correr ou dançar. 5 Para além da influência na área social, a IU é um fator com grande influência no estado emocional e psicológico da mulher, estando associada à presença de distúrbios concomitantes como a depressão e a ansiedade, 6 e apresenta um papel muito relevante nas relações interpessoais. 7 Outro aspeto a considerar é o impacto na vida sexual, dado que 26% das mulheres com IU reconhecem a consequência negativa neste âmbito. ...
Article
Introduction: The prevalence of urinary incontinence in Portuguese women is 21.4% and has a very negative impact on quality of life including women's sexual activity. Pelvic floor rehabilitation is the first line treatment used in stress urinary incontinence and may be a tool in the treatment of sexual dysfunction in women with urinary incontinence. The aim of this review is to ascertain whether pelvic floor rehabilitation can improve sexual function in women with stress urinary incontinence. Material and methods: We reviewed 12 articles in PubMed using the keywords: 'urinary incontinence', 'female sexual dysfunction' and 'pelvic floor physical therapy'. Results: Pelvic floor rehabilitation is linked to a decrease in frequency of urinary leakage episodes as well as an improvement of coital incontinence. Furthermore, sexual function evaluation scores post-treatment revealed a positive change. Higher parity, higher adherence to treatment, improvement in the strength of pelvic floor muscles, and a decrease in the frequency of urine leakage were associated with higher improvement in sexual function. Discussion: Sexual function should be considered in the approach of urinary incontinence and standard tools of evaluation are essential tools for clinical assessment and follow-up. More evidence is required to identify the role of pelvic floor rehabilitation in sexual dysfunction of Portuguese women with urinary incontinence. Conclusion: Pelvic floor rehabilitation improves sexual function of women with stress urinary incontinence not only because it decreases the episodes of urine leakage but also because it strengthens pelvic floor muscles.
... Furthermore, in an observational study of women with LUTS, greater urinary incontinence was associated with higher levels of depression and anxiety as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) [11]. Of note, the most common anxiety disorder associated with urinary urge incontinence is panic disorder [12,13], perhaps related to these patients having an increased sensitivity to internal sensations. ...
Article
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Approximately one in four American women report bothersome urinary symptoms (e.g., urgency, frequency), which greatly impact quality of life, including mental health. Bidirectional relationships have been found between urinary symptoms and anxiety, such that urinary symptoms worsen emotional distress (i.e., anxiety and depression), and in turn anxiety can exacerbate these symptoms. Current methods to treat urinary symptoms, such as physical therapy and medications, do not address their emotional impact. As such, our multidisciplinary team is conducting a randomized control trial (RCT) of cognitive-behavior therapy (CBT) using the Unified Protocol (UP) versus supportive therapy in the context of integrated behavioral treatment in the urogynecology context. Women with bothersome urinary symptoms and anxiety are recruited from the Northwestern Medicine Integrated Pelvic Health Program (IPHP) -a transdisciplinary clinic including urogynecologists, urologists, colorectal surgeons, nurses, and physical therapists- and Northwestern Medicine Urology. Participants are randomized to one of two interventions: UP or supportive therapy. All participants attend therapy once per week for 12 weeks. Assessments of urinary symptoms, anxiety, and other indicators of psychological and physical functioning are completed at baseline, mid-treatment, post-treatment, and at 3- and 6-month follow-ups using patient-reported outcomes. The study has been preregistered on clinicaltrails.gov (ID: NCT03623880) and is currently ongoing.
... All of these types, especially mixed type, affect the quality of life [5]. In some studies, a significant association between depression and urinary incontinence has been reported [2,[6][7][8][9][10][11][12][13][14]. ...
Article
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Introduction: Urinary incontinence is a common disorder that often affects the elderly. The prevalence of depression in people with urinary incontinence varies from 20-40%. Objective: This study aimed to investigate and compare the prevalence of depression in postmenopausal women with and without urinary incontinence. Materials and Methods: This comparative study with cross-sectional design was, conducted on 284 postmenopausal women in two groups of with and without urinary incontinence (controls). After recording their demographic characteristics, they all completed the Beck Depression Inventory-II (BDI-II). Chi-square, Mann-Whitney U test and logistic regression were used to assess depression score and severity of depression. Results: The mean age of participants was 57.62±9.62. The mean score of depression in women with urinary incontinence was higher than in the control group (8.85±7.35 vs. 6.11±5.03), and this difference was significant (P=0.001). According to the Chi-square test, the probability of depression in women with urinary incontinence was two-fold higher than that of controls (21.3% vs. 9.86%). Using logistic regression and controlling the effects of socio demographic variables, the odds of depression in women with urinary incontinence were 2.5 times higher than the control group (P=0.01). Conclusion: Depression and urinary incontinence in postmenopausal women are seemed to be related to each other. It is recommended that depression be screened in postmenopausal women with urinary incontinence
... Interviews on the quality of life of 82 incontinent women revealed that 26% had major depression and 29% had major anxiety 28 . Perry et al. 29 reported on results of a questionnaire survey of 12 568 women. Among women with urge incontinence 56.6% reported symptoms of anxiety and 37.6% depression: double the reported incidence of women without urge incontinence. ...
... Different causative models have been described, among which the "antecedent hypothesis" (psychological disorder causes the onset of OAB), the "consequence hypothesis" (OAB is responsible for the commencement of psychological disorders), the "common pathway hypothesis" (both conditions shared a common causative underlying etiology) and finally the assumption that both conditions evolve separately. 37 These complex associations are multifactorial and not just bidirectional. Both OAB and psychological disorders are influenced by factors which can be seen as protective or risk factors, and may be related to the patient himself (internal factors) or to the environment (external factors). ...
Article
Aims Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment. Methods The paper is based on a selective review of the literature and in‐depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019. Results Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment. Conclusions Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.
... El estudio también reveló que, entre los pacientes con VH, la severidad de la depresión estaba correlacionada con los síntomas de la incontinencia. Anteriormente, otros trabajos poblacionales habían sugerido la relación causal entre la depresión y el síndrome de VH (64)(65)(66). ...
... Depression has also been suggested to be associated with UI (8,9). Previous studies have found that UI leads to anxiety and hysteria (10,11). Other studies have reported associations of UI with social isolation, loneliness, falls, nursing home admission, hospitalization and increased need for informal care, especially among older women (12)(13)(14)(15). ...
Article
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Background The aim of the present study was to determine the validity and reliability of the Malay versions of the Incontinence Praying Ability (I-PA) and the Incontinence Quality of Life (I-QoL) questionnaires among childbearing-aged Muslim women. Methods This cross-sectional study included 338 childbearing-aged Muslim women (mean age: 31.1 years; SD=5.57) who attended clinics at Hospital Universiti Sains Malaysia. Confirmatory factor analysis was conducted to determine the construct validity of the Malay versions of the I-PA and the I-QoL, while composite reliability was used to examine their internal consistency reliability. Results The hypothesised models of the I-PA and the I-QoL consisted of 10 items with one latent variable and 22 items with three latent variables, respectively. The hypothesised models of the I-PA and the I-QoL did not have good fit. Modifications included co-varying the residual terms for items within the subscales, which resulted in improved fit indices for the I-PA (CFI=0.976 TLI=0.961, RMSEA=0.068) and the I-QoL (CFI=0.948, TLI=0.938, RMSEA=0.063). The composite reliability of the I-PA was 0.93, and the I-QoL ranged from 0.91 to 0.94. Conclusion The Malay versions of the I-PA and I-QoL were considered to be valid, reliable questionnaires measuring incontinence QoL among Muslim women of childbearing age.
... Patients are prone to negative psychosocial states such as low self-esteem, conceit, embarrassment, anxiety, depression, and social isolation. [6][7][8] It also increases the probabilities of bedsores, urinary tract infections and skin dermatitis. [2,9] On the one hand, PSUI has a huge impact on patients' quality of life. ...
Article
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Background: With the rising incidences stroke, the Post-Stroke Urinary Incontinence (PSUI) has become one of the common clinical sequelae. PSUI not only lowers the quality of life of patients, but also impacts tremendously to mental health. As a treasure of Chinese medicine, acupuncture and its related therapies have been widely accepted in clinical treatment of PSUI. Recently, there have been many clinical studies on the treatment of PSUI with acupuncture and related therapies, but the best way to treat PSUI is controversial. Therefore, the purpose of this paper is to provide an optimal ranking regarding acupuncture and its related therapies for PSUI. Methods: The five domestic and foreign databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database will be systematically searched. The time range of the literature search is from the date of establishment to August 31, 2020. The main evaluation outcome was the number of patients after treatment, and the frequency of urinary incontinence. The secondary evaluation outcome was International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Barthel Activities of Daily Living Index (Barthel ADL Index) and the incidence rate of adverse events. The methodological quality of the article will evaluated by Cochrane Collaboration's Tool and the quality of evidence will evaluated through Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. The Network Meta-Analysis (NMA) will be completed using Stata statistical software. Results: The final results of this study will be published in a peer-reviewed journal. Conclusion: This network meta-analysis will compare the efficacy and safety of different acupuncture therapies in the treatment of PSUI and summarize the best treatment options, which will help patients and doctors to choose effective acupuncture methods in time.
... These conflicting results may result from antidepressants that have distinct characteristics, or that exert various effects on different receptors. Several studies reported a positive association of OAB in subjects with depressive symptoms and anxiety [30]. OAB symptoms can be disturbing, and along with the need for healthcare, may also cause depression and anxiety. ...
Article
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Purpose In this study, we investigated overactive bladder (OAB) functions in male patients who used antidepressant drugs (ADs) that were previously examined in female patients, based on conflicting data in literature regarding the effects of AD on OAB and the differences between male and female urinary system physiologies (anatomical and hormonal). Methods The study included 202 male patients (a control group of 90 healthy subjects, and an experimental group of 112 patients taking ADs for different disorders). All the patients completed the overactive bladder-validated 8 (OAB-V8) questionnaire, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and the Beck Depression Inventory (BDS). Results The OAB-V8, ICIQ-SF, and BDS scores for the antidepressant users were significantly higher than those of the control group. The highest prevalence of OAB symptoms was observed in patients taking venlafaxine (68.2%), and the lowest prevalence was in patients taking sertraline (28.0%). Moreover, the frequency of OAB between the antidepressant groups was statistically significant. The univariate logistic regression analyses showed a significant relationship between the presence of OAB, antidepressant usage, BDS score, and the age of a patient. In the multivariate logistic regression analyses, the association between the presence of OAB and antidepressant usage was statistically significant. Conclusions The present study showed that the incidence of OAB and the severity of OAB symptoms increased in males using antidepressants for various disorders. This may have been due to unique pharmacological effects, on a molecular or individual level, of serotonin-norepinephrine reuptake inhibitors.
... Dysfunctional and automatic negative thoughts are common cognitive obstacles for these women. Their thoughts and behaviors perpetuate emotional distress and may result in feelings of shame, reduced self-esteem, anxiety, and depression (Molinuevo and Batista-Miranda, 2012;Perry et al., 2006). ...
Article
Background There are many diagnoses in the field of gynecology that can severely impact the lives of patients and that are associated with an increased risk of developing depression. The goal of this study was to investigate which gynecological diagnoses are associated with depression. Methods This retrospective case-control study based on the Disease Analyzer database (IQVIA) included 5893 women aged 18 years or older with depression and 5893 age-matched pairs followed in 256 gynecological practices in 2019 (index date). A multivariate logistic regression model was used to study the association between 33 pre-defined diagnoses documented within five years prior to the index date and depression diagnosis. Results In total, 9 diseases were significantly associated with diagnosis of depression. The strongest association was observed for breast cancer (Odds Ratio (OR: 2.11 (95% Confidence Interval (CI): 1.76–2.52)), followed by female infertility (OR: 1.91 (95% CI: 1.48–2.47)), cancer of female genital organs excl. breast (OR: 1.87 (95% CI: 1.32–2.66)), and sexual dysfunction (OR: 1.63 (95% CI: 1.27–2.09). Other diseases that showed a significant association with depression included endometriosis, mastodynia, candidiasis, infections with a predominantly sexual mode of transmission, and urinary incontinence. Patients with a higher number of different disorders were more likely to be diagnosed with depression (ORs from 1.40 for two disorders to 2.38 for >6 disorders as compared to no disorders). Conclusion A wide range of diseases documented in gynecologists’ practices were associated with depression diagnosis. Understanding all of these associations may help gynecologists to refer women promptly to psychologists or psychiatrists who may help to manage depression in this population.
... As the world's older population continues to grow, pelvic floor disorders, mainly urinary incontinence and pelvic organ prolapse are becoming major health problems [1]. Different pelvic floor disorders have similar consequences for women, such as decreased body image and quality of life [2], significant psychological distress, expressed by depression [3], anxiety [4] and poor sexual function [5,6]. ...
Article
Objective: There is conflicting evidence regarding the impact of urinary incontinence and pelvic organ prolapse on overall sexual function. However, psychological variables thought to be associated with sexual function, have not been fully explored. We assessed the sexual functioning of women with pelvic floor disorders while measuring for psychological factors such as distress and genital self-image. Study design: In a cross-sectional study, 155 women in an urogynecology outpatient clinic of a tertiary health center completed a demographic questionnaire, the Brief Symptom Index-18 (BSI-18), Pelvic Floor Distress Inventory-20 (PFDI-20), Genital Self-Image Scale-20 (GSIS-20) and the Female Sexual Function Index (FSFI). Results: Linear regression showed that when controlling for age and depression, GSIS significantly predicted FSFI total score (Beta=0.38, p<0.001) and the Desire subscale (Beta=0.55, p<0.001). Due to the low response rate in the GSIS and FSFI questionnaires, a preliminary analysis was conducted to characterize the responders. On univariate logistic regression, response to the GSIS was negatively correlated with age (OR=0.94, p=0.02) and being in a relationship (OR=2.3, p=0.016), yet the effect of being in a relationship was diminished in a multivariate model that included age. Conclusion: The main variable associated with overall sexual function in women with pelvic floor disorders was low genital self-image. This variable is more important than self-reported symptoms, type of specific disorder or other demographic variables. Older women tended not to complete the scales concerning more intimate matters. We suggest that urogynecologists should inquire about genital self-image as well as sexual function in this population.
Chapter
The term functional urologic disorders covers a wide range of conditions related broadly to altered function rather than structure of the lower urinary tract, mainly of impaired urine voiding or storage. Confusingly, for a neurologic readership, these disorders of function may often be due to a urologic, gynecologic, or neurologic cause. However, there is a subset of functional urologic disorders where the cause remains uncertain and, in this chapter, we describe the clinical features of these disorders in turn: psychogenic urinary retention; Fowler's syndrome; paruresis (shy-bladder syndrome); dysfunctional voiding; idiopathic overactive bladder, and interstitial cystitis/bladder pain syndrome. Some of these overlap in terms of symptoms, but have become historically separated. Psychogenic urinary retention in particular has now largely been abandoned as a concept, in part because of the finding of specific urethral electromyogram findings in patients with this symptom now described as having Fowler's syndrome, and their successful treatment with sacral neurostimulation. In this chapter we review the poorly researched interface between these “idiopathic” functional urologic disorders and other functional disorders (e.g., irritable-bowel syndrome, fibromyalgia) as well as specifically functional neurologic disorders. We conclude that there may be a relationship and overlap between them and that this requires further research, especially in those idiopathic functional urologic disorders which involve disorders of the urethral sphincter (i.e., voluntary muscle).
Article
Urinary and fecal incontinence affect older women's social participation and mental health. This study examined the relationship between incontinence severity and depressive symptoms, focusing on the mediating effect of social participation, based on secondary analysis of structured interview data collected in December 2010 from 467 women age 60 and over in mainland China. Incontinence was significantly and positively associated with depressive symptoms but negatively associated with social participation. Social participation was significantly and negatively associated with depressive symptoms and fully mediated the relationship between incontinence and depressive symptoms. These findings can inform mental health interventions for incontinent older women, including preventing and responding to depressive symptoms by promoting social participation.
Article
Aims: Pelvic floor dysfunctions (PFDs), like voiding complaints, urinary and fecal incontinence, and prolapse, are prevalent and associated with decrease in quality of life. PFDs are often complex and multifactorial in origin showing interrelationships between different PFD and with affective conditions. The primary aim of this study is to describe the prevalence of affective complaints in a cohort of Pelvic Care Centre (PCC) patients. The secondary aim is to describe associations between PFDs and depression or anxiety. Methods: A cross sectional cohort study at an University Hospital's PCC. First contact patients were included in a triage system and filled out questionnaires regarding pelvic floor complaints and Hospital Anxiety and Depression Scale (HADS) scores. Linear (dummy-) regression analysis of HADS scales was performed to test the effects of relevant clinical predictors related, and not directly related, to pelvic floor problems, and demographic characteristics of the patients. Results: From 1862 eligible first-contact PCC patients, 1510 (mean age 57.1) had completed the questionnaire (352 missing, 18.9%). The prevalence of anxiety and depression complaints was 30.9% and 20.3%, respectively. The variance explained for depression score by PFDs was 0.12 and 0.074 for anxiety. Conclusion: Anxiety and depression are prevalent (30.9% and 20.3%, respectively) in a cohort of PFDs. PFDs can explain variance within anxiety and depression complaints. Corrected for other contributing variables, 12% of depression and 7.4% of anxiety was directly related to PFDs. We advocate a multidisciplinary approach, containing psychometric assessment for PFDs in order to obtain better diagnostic results and personalized treatment options.
Chapter
Urinary and fecal incontinence affects a significant portion of the elderly population. While reported prevalence rates vary widely, incontinence tends to increase with age and becomes a relatively common affliction in those over 50. Although urinary and fecal incontinence increases with age, neither are natural sequelae of aging, but disorders which could be treated. Occlusion of the skin, often induced by incontinence pads or other containment devices, has a profound influence on the skin surface. Incontinence in aged skin has the potential to produce chemical irritation, mechanical injury, and increased susceptibility to incontinence dermatitis, dermal infections (both fungal and bacterial), intertrigo, vulvar folliculitis, pruritus ani, and pressure ulcers. Urinary incontinence also represents a psychosocial burden and is associated with a variety of psychiatric disorders. Dermatologists who are knowledgeable about geriatric issues can help to maintain the health and quality of life of their older patients.
Article
Background: Caffeine has been associated with a dose-dependent variety of mental health changes, which have been found to precede or be a complication of overactive bladder (OAB) symptoms after menopause. The current study examines the effects of low and moderate caffeine intake on anxiety, depression, sleep, and stress in postmenopausal females with OAB. Materials and Methods: Eighty-one females were randomized in a prospective, double-blind, placebo-controlled study. Participants were allocated to 200 mg/day caffeine, 400 mg/day caffeine, and placebo capsules for 1 week each in a crossover design and evaluated using validated mental health questionnaires. Symptoms during each treatment phase were measured using Beck Anxiety and Depression Inventory, Insomnia Severity Index, and Perceived Stress Scale. Linear regression models were used to examine the impact of low (200 mg/day) and moderate (400 mg/day) dose of caffeine and placebo on mental health. Results: Fifty-six female participants finished the study. The mean age was 69.2 years (58.0-84.0 years). Two females dropped out during the treatment phase with 400 mg/day caffeine intake due to side effects associated with headaches and nausea. Moderate dose of caffeine showed a small positive effect on mental health, specifically a decrease in anxiety during 7 days of exposure (p < 0.05). Conclusions: Moderate caffeine use may decrease anxiety in postmenopausal patients with underlying OAB, whereas depression, insomnia, and perceived stress were not affected by low-to-moderate caffeine intake. Our results support that counseling efforts on moderate caffeine consumption in postmenopausal patients underline that low-to moderate caffeine intake may be appropriate and possibly beneficial unless contraindicated due to other underlying conditions. Clinical Trials Registration: clinicaltrials.gov (NCT02180048).
Chapter
The complexity of LUTS is greater when viewed in some of the contexts with which they are particularly associated. Mixed urinary incontinence reflects co-existence of both storage and voiding LUTS, each substantially affecting the patient’s quality of life. Pelvic organ prolapse (POP) is common and can cause voiding difficulty; furthermore, POP treatment can allow emergence of stress incontinence that was largely unrecognized before the operation. For men, erectile dysfunction (or concern about developing it) can affect treatment choice. LUTS are commonplace in metabolic syndrome, indicating how the complex physiology of the system is vulnerable to medical conditions. Urinary tract and sexually transmitted infections are exceptionally important factors complicating LUTS mechanisms and assessment. Prostatitis is an inflammation of the prostate which may be caused by infection or non-infectious causes, and is another cause of storage and voiding LUTS. The psychological impact of symptoms, assessment, and treatment are exceptionally influential in prognosis at every stage. Both adolescence and advanced age bring additional challenges.
Article
Aims: In light of mounting evidence supporting the association of brain regions with the control of urine storage and voiding, the high placebo effect in OAB studies as well as certain anecdotal observations from clinical practice with OAB patients, the role of the brain in OAB was explored. Methods: At the ICI-RS 2017 meeting, a panel of Functional Urologists and Basic Scientists presented literature data generating a proposal to discuss whether there is "brain OAB" and how we could recognize it. Results: Existing data point toward organic brain causes of OAB, in particular concerning white matter disease (WMD) and aging, but with currently speculative mechanisms. Imaging techniques have revealed connectivity changes between brain regions which may explain brain-peripheral interactions in OAB patients, further to acknowledged structural and functional changes in the central nervous system (CNS). Furthermore, psychological disorders like stress and depression have been identified as causes of OAB, with animal and human studies proposing a neurochemical and neuroendocrine pathophysiological basis, involving either the serotoninergic system or the hypothalamic-pituitary-adrenal axis. Finally, childhood data suggest that OAB could be a developmental disorder involving the CNS, although childhood OAB could be a different condition than that of adults in many children. Conclusions: Future research should aim to identify the pathogenesis of WMD and the aging processes affecting the brain and the bladder, with possible benefits in prevention strategies, as well as connectivity disorders within the CNS, the pathophysiology of OAB in childhood and the neurochemical pathways connecting affective disorders with OAB.
Article
Introduction and hypothesisWe examined obstetric and maternal-newborn factors and UI history for stress urinary incontinence (UI) and urge UI during pregnancy and the first year postpartum.Methods This prospective cohort study included 1447 pregnant women who underwent prenatal examinations and completed an Incontinence Questionnaire-Urinary Incontinence Short Form before pregnancy, during early, mid- and late pregnancy, and at five visits during the first year postpartum. Data were analyzed using univariate/multivariate generalized estimating equation (GEE) logistic regression analyses.ResultsThe prevalence rates of stress UI during late pregnancy (42.5%) and urge UI at 3–5 days postpartum (10.4%) were the highest throughout pregnancy and the first year postpartum. After adjusting for covariates, gestational age increased the risks of stress UI (p < 0.001) and urge UI (p = 0.003); stress UI during pre-pregnancy, number of previous vaginal deliveries and concurrent high body mass index (BMI) increased stress UI (all p < 0.05); urge UI during pre-pregnancy and full-time work increased urge UI (both p < 0.05) during pregnancy. During the postpartum period, vaginal delivery increased stress UI (p < 0.001) and urge UI (p = 0.041); stress UI during pre-pregnancy and pregnancy, women aged ≥ 30 years and vacuum extraction/forceps delivery increased stress UI (all p < 0.05). Urge UI during early, mid- and late pregnancy increased stress UI (all p < 0.05).Conclusions Gestational age increased stress and urge UI, while previous vaginal deliveries and high BMI increased stress UI; full-time work increased urge UI during pregnancy. Vaginal delivery increased both UIs, and vacuum/forceps delivery and maternal age increased stress UI during postpartum.
Article
Introduction and hypothesisThe association between overactive bladder (OAB) syndrome and sexual dysfunction is well documented. Intra-detrusor onabotulinumtoxinA (Botox) has proven to be effective treatment for OAB syndrome. Our aim was to examine the impact of intravesical Botox injection on sexual function in patients with OAB, by systematically reviewing the literature.Methods We reviewed the literature for studies that reported a change in sexual function after Botox treatment in patients suffering from OAB. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using pre-agreed keywords, from database inception to December 2020. Statistical analyses were performed using Review Manager (RevMan; v.5.4).ResultsInitial results yielded 455 citations. Seven articles met our inclusion criteria. One article was double-reported, leaving 6 studies in the systematic review. Three observational before-and-after studies used the Female Sexual Function Index (FSFI) with sufficient information, and therefore were included in our meta-analysis. The pooled number of participants in all studies was 119 patients. In the meta-analysis, there was significant improvement in the following domains of the FSFI after Botox injection; desire (mean difference (MD) −0.51, p = 0.02), arousal (MD −0.86, p = 0.02), lubrication (MD −0.57, p = 0.03), orgasm (MD −0.65, p = 0.0003) and satisfaction (MD −0.46, p = 0.05). Pain was the only domain that did not show improvement (MD −0.07, p = 0.79). The total FSFI score was reported in 88 patients (two studies) showing significant improvement (MD −0.77, p = 0.006).Conclusions We report a systematic review of the effect of Botox treatment on sexual function in patients with OAB. Although studies are small, the results indicate a positive effect in patients with OAB.
Article
Background: This study aimed to examine satisfaction with life in patients with urinary incontinence and patients who underwent an operative procedure due to urinary incontinence. Methods: Women with a medical indication for surgery due to urinary incontinence problems but who had not yet had surgery (N = 110) and same-age women who had had a surgical procedure for urinary incontinence (N = 101) completed a set of questionnaires. Results: The results showed that women with urinary incontinence had significantly higher life satisfaction than women who underwent the operation. Contrary to expectations, women with urinary incontinence problems reported equal levels of life satisfaction to a comparable sample of postmenopausal normative women. Higher levels of life satisfaction were related to higher education level, employment, higher perceived socioeconomic level, and urban place of living. Conclusion: It is important for physicians to address the problem of urinary incontinence with their patients and to examine the present anxiety symptoms, given that they may affect their subjective wellbeing.
Article
Objective: Although available diagnostic criteria are intelligible, combination of OAB and anxiety in the same patient presents a perfect example of medical causality dilemma, commonly stated as the question: "which came first: the chicken or the egg?". The aim of this review article is to address available insights in bidirectional association between OAB and anxiety. Methods: In this review article, we included different types of studies whose results are presented as relative risk (RR) or odds ratio (OR) with a 95% accuracy. A literature search was conducted with the use of the PubMed and EMBASE electronic databases focusing on identifying articles published in English between 1990 and 2020. Results: The electronic searches, after duplicate records removal, provided a total of 126 citations. Of these, 107 were excluded after title/abstract screening (not relevant to the review). We examined the full text of 19 publications remaining to summarize possible mechanisms between OAB and anxiety. According to examined literature, our result synthesis provides insight in epidemiology, pathophysiology, diagnostic and therapeutic approach of both conditions. Conclusion: Temporal relationship between OAB and anxiety is not very well documented because available longitudinal cohort studies are limited. The limitation of the published literature is that most were population-based symptom studies demonstrating high risk of bias. Although data from analysed studies suggest that anxiety and OAB and anxiety might be casually related, studies provided on clinical population are warranted. In addition to the traditional urologic factors, we recommend that psychosocial factors such as anxiety should be assessed routinely in patients with OAB.
Article
Introduction and hypothesisWomen with overactive bladder (OAB) report psychological distress, anxiety and depression, but short-term associations between these symptoms are poorly studied. Our objectives were to study daily associations between OAB symptoms and psychological symptoms and test whether these associations were stable when reassessed after 3 months. We hypothesized that OAB symptoms are positively associated with anxiety and depression symptoms over a short-term (daily) basis.Methods Female patients with OAB [bothersome urgency and/or urgency urinary incontinence (UUI)] assessed OAB and mood symptoms at baseline and 3 months using a 3-day bladder diary and visual analog scale (VAS) ratings (0–100 mm) for anxiety, depression and stress. Daily OAB and mood symptom associations were tested using Spearman correlations. Generalized estimating equation (GEE) models tested associations between daily urgency scores and each psychological rating adjusting for covariates, time and a time-symptom interaction term.ResultsParticipants (n = 69) had mean (SD) age 63.3 (13.4) years. Baseline diary outcomes [median (IQR)/day] included day voids 8 (7–11), nocturia 0 (0–1), UUI episodes 1 (0–3) and urgency score 1.75 (1–2.25). Anxiety and depression diagnoses (dx) and treatment (tx) were common (anxiety dx 30.4%, tx 21.7%; depression dx 47.8%, tx 37.7%), but daily anxiety, depression and stress ratings were low [median (IQR) mm 10 (3–35), 5 (1–16), and 16 (4–39), respectively]. Daily urgency scores correlated with anxiety (r = 0.30–0.40, days 1–3, p ≤ 0.01 for all), depression (r = 0.24–0.35, p ≤ 0.05 all) and stress (r = 0.27–0.34, p ≤ 0.03 all). GEE models indicated no significant change in these associations between baseline and 3 months, and OAB treatment did not impact the associations.Conclusions Urgency scores were positively associated with same-day ratings of anxiety, depression and stress in OAB patients.
Article
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Extended summary Background Lower urinary tract dysfunction (LUTD) in childhood might affect lower urinary tract function and psychological wellbeing later in life. This study presents long-term functional outcome, psychological outcome and quality of life (QOL) of adolescents and young adults treated for childhood LUTD compared to healthy age-matched controls. In addition, association with past treatment outcomes is evaluated. Study design A single-centre cross-sectional study of former patients treated in childhood (currently 16–26 years old) was conducted. Participants completed a survey composed from validated questionnaires: the Overactive Bladder Questionnaire, the Hospital Anxiety and Depression Scale, the Pediatric Quality of Life Inventory and the Short Form 36 Health Survey. Results Fifty-two former patients (out of 133) agreed to participate and returned the survey (mean age 21 ± 4.1 years). Sixty-nine control subjects were included (mean age 21 ± 2.9 years). Urinary tract symptoms were more common in former patients than controls. Storage symptoms more frequently reported were (urge) urinary incontinence, stress urinary incontinence (SUI) and nocturia. Voiding symptoms more frequently reported were intermittency and feeling of incomplete emptying, figure 1. There were no differences in urinary tract symptoms and urinary incontinence subdivided by childhood treatment outcome (complete response, partial response or no response), respectively p=0.17 and p=0.58. Results of the overactive bladder questionnaire revealed higher urinary symptom bother scores (score 14 versus 5 p<0.01) and lower disease-specific QOL (score 95 versus 98 p=0.02) in former patients compared to controls. General QOL and psychosocial wellbeing were not significantly different between the groups. A childhood treatment duration extending 2,5 years was an independent prognostic factor for subsequent urinary tract symptoms later in life (OR=1.5, 95% CI 1.1-2.0). Psychological comorbidity was more often present in former patients (35%) versus controls (10%), p<0.01. Conclusion Adolescents and young adults treated for childhood LUTD are more prone to report urinary tract symptoms later in life, especially if treatment duration was extensive. However general QOL and psychosocial wellbeing later in life are not or only mildly affected.
Article
Exposure to psychological/mental stress can affect urinary function, and lead to and exacerbate lower urinary tract dysfunctions. There is increasing evidence showing stress-induced changes not only at phenomenological levels in micturition, but also at multiple levels, lower urinary tract tissues, and peripheral and central nervous systems. The brain plays crucial roles in the regulation of the body's responses to stress; however, it is still unclear how the brain integrates stress-related information to induce changes at these multiple levels, thereby affecting urinary function and lower urinary tract dysfunctions. In this review, we introduce recent urological studies investigating the effects of stress exposure on urinary function and lower urinary tract dysfunctions, and our recent studies exploring “pro-micturition” and “anti-micturition” brain molecules related to stress responses. Based on evidence from these studies, we discuss the future directions of central neurourological research investigating how stress exposure-induced changes at peripheral and central levels affect urinary function and lower urinary tract dysfunctions. Brain molecules that we explored might be entry points into dissecting the stress-mediated process for modulating micturition.
Article
Résumé Introduction Le syndrome clinique d’hyperactivité vésicale (SCHV) est une pathologie fréquente ayant un retentissement fonctionnel important chez les patients qui en souffrent. Objectif Effectuer une synthèse des connaissances actuelles sur la définition, l’épidémiologie et le retentissement du SCHV. Méthode Une revue systématique de la littérature à partir de Pubmed, Embase, Google Scholar a été menée en juin 2020. Résultats Le SCHV est défini par la survenue d’urgenturies avec ou sans incontinence urinaire, habituellement associées à une pollakiurie ou une nycturie en l’absence d’infection urinaire ou de pathologie locale organique évidente (tumeur, infection, calcul). En France, le SCHV affecte 14 % de la population générale et cette prévalence augmente avec l’âge. Cette pathologie est une source d’altération majeure de la qualité de vie avec un retentissement physique (chutes, fractures, troubles du sommeil, fatigue), psychique (anxiété, dépression) social (limitation des loisirs, isolement) et économique. Conclusion Le SCHV est défini de manière standardisée. Il s’agit d’une pathologie fréquente ayant des conséquences fonctionnelles importantes avec une altération notable de la qualité de vie.
Article
Background Although numerous treatments exist for fecal incontinence (FI), no consensus exists on the best treatment strategy. The aim was to review the literature and to compare the clinical outcomes and effectiveness of treatments available for FI. Materials and method A systematic literature review was performed, from inception to May 2018, of the following databases: MEDLINE, EMBASE, Science Citation Index Expanded, Cochrane Library. The search terms used were “faecal incontinence” and “treatment”. Only randomized controlled trials (RCTs) comparing treatments for FI were considered. A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method. Result Forty-seven RCTs were included comparing 37 treatments and reporting on 3748 participants. No treatment ranked best or worst with high probability for any outcome of interest. No significant difference was identified between treatments for frequency of FI per week, or in changing the resting pressure, maximum resting pressure, squeeze pressure, and maximum squeeze pressure. Radiofrequency resulted in more adverse events compared to placebo. Sacral nerve stimulation (SNS) and zinc-aluminium improved the fecal incontinence quality of life questionnaire (FIQL) lifestyle, coping, and embarrassment domains compared to placebo. Transcutaneous posterior tibial nerve stimulation (TPTNS) improved the FIQL embarrassment domain compared to placebo. Autologous myoblasts and zinc-aluminium improved the FIQL depression domain compared to placebo. SNS, artificial bowel sphincter (ABS), and zinc-aluminium significantly improved incontinence scores compared to placebo. Injection of non-animal stabilized hyaluronic acid/dextranomer (NASHA/Dx) resulted in more patients with ≥50% reduction in FI episodes compared to placebo. Conclusion SNS, ABS, TPTNS, NASHA/Dx, zinc-aluminium, and autologous myoblasts resulted in isolated improvements in specific outcomes of interest. No difference was identified in incontinence episodes, no treatment ranked best persistently or persistently improved outcomes, and many included treatments did not significantly benefit patients compared to placebo. Large multicentre RCTs with long-term follow-up and standardized inclusion criteria and outcome measures are needed.
Article
Overactive bladder (OAB) and frailty are multidimensional syndromes, and the prevalence of both increases with age. Little evidence exists for a direct association between OAB and frailty, but urinary urgency may well be a precursor of frailty in older people. Frail older adults are no less deserving of treatment than fit older adults, and lifestyle, behavioral, and pharmacological interventions remain the primary options for treatment, with some evidence for efficacy. Data on onabotulinumtoxinA therapy or percutaneous tibial nerve stimulation in frail older adults are sparse. Frail older adults are often excluded from drug trials, but evidence is accumulating that antimuscarinics and, to a lesser extent, beta-adrenergic agonists are safe, well-tolerated, and effective in older adults. Cognitive impairment associated with frailty should not be used as justification for avoiding the use of antimuscarinics. More studies are required to better understand the association between OAB and frailty, as both are associated with poor outcomes and may be amenable to intervention. Drug trials for OAB treatments should be encouraged to include frail older adults, as this population is highly affected yet often excluded.
Article
Full-text available
Objective We explored the relationship between urinary incontinence (UI) and depression or anxiety. Methods We searched the Cochrane Library, Embase, and PubMed for articles on the association between depression, anxiety, and UI. We calculated pooled 95% confidence intervals (CIs) and odds ratios (ORs). Results Twelve articles (31,462 participants) were included. The UI group had significantly higher depression and anxiety levels than the non-UI group (OR = 1.73, 95%CI: 1.64–1.82, I ² = 75.5%). In subgroup analysis, depression and anxiety were significantly higher in participants with UI than in those without UI (OR = 1.95, 95%CI: 1.82–2.10, I ² = 64.3% and OR = 1.54, 95%CI: 1.43–1.65, I ² = 59.2%, respectively). In subgroup analysis by age, participants with UI had significantly higher depression and anxiety, regardless of age, than the non-UI group (OR = 1.59, 95%CI: 1.29–1.95, I ² = 59.1% and OR = 1.98, 95%CI: 1.62–2.43, I ² = 75.5%, respectively). Conclusion Patients with UI had significantly higher depression and anxiety levels than those without UI. Depression and anxiety were higher in patients with UI than in those without UI, regardless of age. Larger sample sizes and more high-quality studies are needed to validate our findings.
Article
Introduction and hypothesisWe aimed to determine the prevalence of urinary incontinence (UI) in nulliparous female university students and to provide an overview of risk factors associated with urinary continence.MethodsA total of 1,397 female university students aged 18–28 years were enrolled into this cross-sectional questionnaire study. The self-administered questionnaires, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder V8 (OAB-V8), demographics, and general characteristics were recorded. The frequency, type, and severity of urinary incontinence and related factors were evaluated.ResultsThe mean age of the students was 20.27 ± 1.69 years. The prevalence of UI in female university students was 18.4% (n = 258). ICIQ-SF total score was 0.85 ± 2.11 (0–14). OAB–V8 total score was 5.97 ± 5.35 (0–40) and 27.0% of participants had scores of ≥8. Elevated BMI, childhood enuresis, constipation, exercising, positive family history for UI, accommodation in a dormitory, and holding urine at school are risk factors associated with UI in female university students.Conclusion We demonstrated that UI is a common condition among female university students. The identification of the associated risk factors will help to further raise the knowledge and awareness of the problem, and preventive strategies may be proposed to young women to improve the quality of life and psychological well-being.
Article
Aims: To analyze factors related to the incidence and remission of stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence (MUI) among women at midlife. Methods: A total of 2115 women participants in a prospective longitudinal survey (GAZEL cohort) were included. In 2000 and 2008, a specific questionnaire about urinary incontinence (UI) symptoms was sent to all participants. Incidence, remission, and risk factors associated with each type of UI were considered. Results: Within our population followed up for 8 years, we observed an overall incidence rate of UI of 21.9% (95% CI, 19.6-24.2%) and a remission rate of 33.3% (30.1-36.5%). For the different UI types, the incidence and remission rates were respectively 14.9% (12.9-24.2%) and 37.9% (37.8-42.0%) for SUI, 3.2% (2.2-4.2%) and 25.5% (3.5-37.5%) for UUI, 3.1% (2.1-4.1%) and 24.6% (19.3-29.9%) for MUI. Educational level, increase in body mass index (BMI), BMI and depression at inclusion were associated with SUI incidence. The history of surgery for UI was associated with the incidence of UUI and MUI. Surgery for SUI was significantly associated with remission, while pelvic floor rehabilitation and vaginal delivery were significantly associated with a lower SUI remission. Vaginal delivery was also negatively associated with MUI remission. Conclusions: The influence of the standard risk factors seems to differ in each type of UI.
Article
Objectives To evaluate the impact of the presence and severity of urinary incontinence (UI) on pregnancy-related anxiety. Study design: This prospective case–control study included 160 pregnant women. Pregnant women with UI (n=80) were compared with continent pregnant women (n=80; control group) in terms of scores on the Incontinence Consultation Questionnaire-Short Form (ICIQ-SF) and the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2) scale. Gynaecological examination was performed, and pelvic organ prolapse was diagnosed using the Pelvic Organ Prolapse Quantification system. UI was classified as stress UI (SUI), urge UI (UUI) or mixed UI (MUI). Results The total PRAQ-R2 score was significantly higher in all pregnant women with UI, as well as the UI subgroups, compared with the control group [mean±standard deviation; 21.77±8.1 (UI), 19.39±6 (SUI), 20.13±7.2 (UUI) and 28.1±9.5 (MUI) vs 15.76±5.9 (control group); p<0.0001, p=0.002, p=0.012 and p<0.0001, respectively). Significant positive correlation was found between the total ICIQ-SF and total PRAQ-R2 scores (r=0.533; p<0.0001). The score for the fear of giving birth domain in PRAQ-R2 was higher in women with SUI and MUI compared with the control group (9.5±4 and 11.1±2.6 vs 5.43±2.4; p<0.0001). Concern about own appearance was greater in the UUI and MUI groups compared with the control group (9.68±4.5 and 7.8±3.1 vs 4.85±2.3; p<0.0001). Conclusion To the authors’ knowledge, this is the first study to report the impact of the presence and severity of UI on pregnancy-related anxiety. The current findings show that anxiety may be an important psychosocial consequence of UI in pregnancy. This may lead to a clinical approach focusing on both the physical and psychological well-being of pregnant women with UI.
Article
Aims To review studies on the comorbid psychological symptoms and disorders in patients with lower urinary tract disorders (LUTD) over the life‐span, to analyse how they contribute toward the aetiology of LUTD and to discuss optimal service implementation. Materials and Methods A review of relevant literature was conducted and presented during the ICI‐RS meeting in 2018. Open questions and future directions were discussed. Results On the basis of current research, there is overwhelming evidence in all age groups that psychological comorbidities are more common in patients with LUTD. Vice versa, patients with psychiatric disorders have higher rates of LUTD. The types of LUTDs and psychiatric disorders are heterogeneous. Complex aetiological models best explain specific associations of comorbidity. Irrespective of aetiology, it is advisable to address both urological and psychological issues in patients of all age groups with LUTD. Conclusions Psychological symptoms and disorders play a decisive role in the development of LUTD in all age groups and need to be considered in the assessment and treatment of LUTD.
Article
Objective: To evaluate the association between overactive bladder syndrome (OBS) and depression among older women. Methods: One hundred sixty-nine older women answered 2 questionnaires: the Overactive Bladder (OAB-V8) and the Yesavage Geriatric Depression Scale. Results: One hundred twenty-nine participants (76.3%) had symptoms of OBS (OAB-V8 ≥ 8 points). Among those with OBS, 42.6% exhibited mild or severe depression. A significant correlation was found between OBS and depression ( r = 0.354; P = .001). Conclusions: A high prevalence rate of OBS was found in older women and a large portion of these women exhibited symptoms of mild and severe depression.
Article
Full-text available
Clinical impression suggests that many cases of detrusor instability are psychosomatic. We evaluated 63 women with urinary incontinence and 27 continent controls using the Minnesota Multiphasic Personality Inventory, Uplift and Hassle Scales, and a structured questionnaire screening sexual dysfunction. All incontinent women underwent diagnostic urodynamic studies including uroflowmetry, subtracted water cystometry with provocation, and urethral closure pressure profilometry. Thirty-five women had genuine stress incontinence and 28 had detrusor instability, including nine with mixed incontinence. No differences in psychological test results were noted between the detrusor-instability and genuine-stress-incontinence groups. On the Minnesota Multiphasic Personality Inventory, subjects with detrusor instability scored significantly higher than controls on the hypochondriasis (P = .006), depression (P = .01), and hysteria (P = .0009) scales. Compared with continent controls, the detrusor-instability group reported a lower frequency of uplifts (P less than .05) and a greater intensity of hassles (P less than .05). Both incontinent groups reported more sexual dysfunction than did controls. We conclude that many women with urinary incontinence have abnormal psychological and sexual test results reflecting moodiness, feelings of helplessness and sadness, pessimism, general hypochondriasis/somatization, and sexual dysfunction. These abnormalities appear to be associated with urinary incontinence in general rather than with specific diseases of the urinary tract.
Article
Full-text available
To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence. Population-based cohort with a 1-year follow-up. General community. A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews. At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living. At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (chi 2 = 119.8; P < .001) as the number of predisposing factors increased from zero to one to two at least three. Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.
Article
Full-text available
To investigate the prevalence and lifetime risk factors for urinary incontinence in middle aged women. Nationally representative birth cohort study with prospective data on childhood enuresis, measured adult height and weight, childbearing histories and measures of socioeconomic status updated at regular contacts, and measures of menopausal status, symptomatology and health care in midlife. England, Scotland and Wales. General population sample of 1333 women aged 48 years. Fifty per cent reported symptoms of stress incontinence and 22% reported symptoms of urge incontinence in the previous year. Eight per cent had severe symptoms. Women who at age 6 years had wet in the day or several nights a week were more likely to suffer severe incontinence and report urge symptoms but occasional bedwetting was not associated with an increased risk in adult life. Those who were older at the birth of their children and who had vaginal deliveries had an excess risk of stress symptoms. Heavier adult body weight was also a risk factor for these symptoms and for severe incontinence. Postmenopausal women were less likely to report stress symptoms. These risk factors remained significant after taking account of the increased reporting of incontinence among women with high levels of general symptomatology and general practitioner visits, and of stress symptoms among better educated women. Urinary incontinence is a common problem among middle aged women. This is the first prospective study of a general population sample to support the postulated link between childhood enuresis and adult incontinence. Child-bearing has long term adverse effects, particularly for older mothers. Overweight is a common risk factor.
Article
A symptom index for benign prostatic hyperplasia (BPH) was developed and validated by a multidisciplinary measurement committee of the American Urological Association (AUA). Validation studies were conducted involving a total of 210 BPH patients and 108 control subjects. The final AUA symptom index includes 7 questions covering frequency, nocturia, weak urinary stream, hesitancy, intermittence, incomplete emptying and urgency. On revalidation, the index was internally consistent (Cronbach’s α = 0.86) and the score generated had excellent test-retest reliability (r = 0.92). Scores were highly correlated with subjects’ global ratings of the magnitude of their urinary problem (r = 0.65 to 0.72) and powerfully discriminated between BPH and control subjects (receiver operating characteristic area 0.85). Finally, the index was sensitive to change, with preoperative scores decreasing from a mean of 17.6 to 7.1 by 4 weeks after prostatectomy (p <0.001). The AUA symptom index is clinically sensible, reliable, valid and responsive. It is practical for use in practice and for inclusion in research protocols.
Article
Urinary incontinence, which is defined by the International Continence Society as 'a condition in which involuntary loss of urine is a social and/or a hygienic problem and is objectively demonstrable', is observed approximately in 25% of the women. It is known that urinary incontinence is caused by urethral sphincteric incompetence (anatomic stress incontinence) and/or involuntary detrusor contraction (detrusor instability) in more than 95% of the patients. Detrusor instability is a clinical condition, characterized by involuntary and uninhibited contractions which evolves spontaneously or by provocation in the storage phase of the patients who have no neurologic problem. Anatomic stress incontinence is a urinary leakage, which occurs when intravesical pressure exceeds the maximal urethral pressure during stress, without having any detrusor contractions. Patients must be completely evaluated urogynecologically, as differential diagnosis of the type of incontinences which have entirely different pathophysiology and treatment methods is very important. Using a stepped urogynecologic evaluating protocol acquires the correct diagnosis in a short and cheap way, by preventing unnecessary tests. It is possible to diagnose the type of the incontinence and perform the appropriate treatment by this protocol in 85-90% of the patients, without using complicated urodynamic tests.
Article
We examined the relationship between urinary incontinence and psychological distress in a sample of community-dwelling older adults. The data are from a probability sample of Washtenaw County, Michigan residents ages 60 years and older, who were interviewed in 1983 and 1984. A total of 747 women and 431 men were included in the analyses. Experiencing urinary incontinence, particularly in a severe form, was weakly related to depression, negative affect, and low life satisfaction. These relationships are partly explained by the fact that incontinent respondents are less healthy than are continent respondents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
OBJECTIVE: To estimate the prevalence of urinary incontinence and to assess care-seeking behavior for urinary symptoms among community-dwelling people. DESIGN: A community-based cross-sectional study. SETTING: Randomly selected men and women from Olmsted County, Minnesota. PARTICIPANTS: Two cohorts, one comprised of both men (n = 778) and women (n = 762) 50 years of age or older and a second comprised of men aged 40 years or older (n = 2150). MEASUREMENTS: Participants completed questionnaires assessing urinary incontinence in the previous 12 months, the number of days leaked, the amount leaked, and healthcare-seeking measures for urinary symptoms. RESULTS: In the first cohort, the prevalence of incontinence was 24% in men and 49% in women; 29% of men and 13% of women with incontinence had sought care for urinary symptoms. Urinary incontinence was more strongly associated with care-seeking measures for urinary symptoms in men (Odds Ratio (OR) = 4.3, 95% Confidence Interval (CI) = 2.4, 8.0) than in women (OR = 2.1, 95% CI = 1.2, 3.9). Moderate or severe urinary incontinence was associated significantly with care-seeking for urinary symptoms (OR = 10.5, 95% CI = 5.6, 19.8). In the second cohort, the prevalence of urinary incontinence was 17.3%; 8.5% of men with incontinence had sought care for urinary symptoms. Men with incontinence were 1.2 times (95% CI = .8, 1.9) as likely to seek care for urinary symptoms as men without incontinence. CONCLUSION: Our findings indicate that although urinary incontinence is relatively common in the community, care-seeking for urinary symptoms among persons with urinary incontinence is low, particularly among women, for whom the prevalence exceeds 40% between the ages of 50 and 70 years. These findings suggest that strategies to promote care-seeking for incontinence need to be investigated and employed in the community.
Article
In an epidemiological health survey, 515 45-year-old women were interviewed about urological problems, particularly incontinence. A pelvic examination was also conducted on 509 of the women. Twenty-two per cent or 114 women stated that they experienced incontinence, which took the form of stress incontinence in 75%, urge incontinence in 11 % and a mixture of the two in 14%. Only 14 women, 3% of all the women interviewed, desired medical treatment for incontinence. In the incontinent women, the pelvic examination significantly more often revealed a cystocele, uterine prolapse or impaired function of the levator muscles. No correlation was found between an enlarged uterus and incontinence. In 211 women with one or more of these findings at the gynaecological examination, the frequency of incontinence was 35%; in 298 women with no pathological findings, the frequency was 15%. The frequency of urinary incontinence was not increased in women with higher panty or in postmenopausal women.
Article
Background. The aim was to study urinary incontinence (UI) and nocturia in a female population: prevalence, effect on well-being, wish for treatment and result of treatment in primary health care. Methods. A postal questionnaire was sent to all women aged 20-59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well-being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor. Results. Of the included 641 women. 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%). 12 of whom were also incontinent. Self-assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well-being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type. Conclusions. Urinary incontinence and nocturia affect well-being in a negative way. Well-being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it; only about a quarter of incontinent women, or 6-7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.
Article
Objective. —To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence.Design. —Population-based cohort with a 1-year follow-up.Setting. —General community.Participants. —A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews.Main Outcome Measures. —At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living.Results. —At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (X2=119.8; P<.001) as the number of predisposing factors increased from zero to one to two to at least three.Conclusions. —Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.(JAMA. 1995;273:1348-1353)
Article
Detrusor instability is a common cause of urinary incontinence in women. Symptoms are those of urgency and urge incontinence produced by an inability to inhibit the bladder from contracting at inappropriate times. The exact aetiology in the vast majority of cases remains unknown. Treatment is often unsatisfactory. It has been proposed that ‘idiopathic’ detrusor instability is a psychosomatic disorder. Support for this view comes from clinical evidence, the results of psychological questionnaire studies and the results of behavioural treatments, e.g. bladder drill and biofeedback. The effect of hypnosis on patients with detrusor instability has been assessed both subjectively and objectively on urodynamic testing. The short-term results are good but once formal treatment has been stopped the relapse rate is high as evidenced by the results of two years. It is suggested that if hypnosis is to be effective for the condition then formal treatment should be continued indefinitely.
Article
The first four reports of the Standardisation Committee of the International Continence Society dealt with the nomenclature relating to urinary incontinence, procedures related to the evaluation of urine storage (cystometry, urethral closure pressure profile), units of measurement (Bates et al., 1976), procedures related to the evaluation of micturition (flow rate, pressure measurement), symbols (Bates et al., 1977), procedures related to the evaluation of micturition: pressure flow relationship, residual urine (Bates et al., 1980) and neuromuscular dysfunction of the lower urinary tract (Bates et al., 1981). The fifth report has remained an internal document of the Society and deals with the quantification of urine leakage. This report deals with recommendations on terminology related to neurophysiological investigations of the lower urinary tract with particular reference to electromyography, nerve pathway studies and sensory testing. These standards are proposed to facilitate comparison of results by investigators who use these investigations. It is recommended that the acknowledgement of these standards in written publications be indicated by a footnote to the section “Methods and Materials” or its equivalent: “Methods, definitions and units conform to the standards proposed by the International Continence Society except where specifically noted.”
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Chapter
The major problem defining the changes in lower urinary tract function associated with age, especially in humans, has been that of ascribing causation. Studies in aged humans have been typified by a lack of age-matched controls and it is only recently that to an extent this has been rectified. Since the first edition of this book there has been considerable advance in the understanding of observed changes and this chapter will illustrate what is currently understood about age-related changes in lower urinary tract function, drawing upon human data.
Article
A symptom index for benign prostatic hyperplasia (BPH) was developed and validated by a multidisciplinary measurement committee of the American Urological Association (AUA). Validation studies were conducted involving a total of 210 BPH patients and 108 control subjects. The final AUA symptom index includes 7 questions covering frequency, nocturia, weak urinary stream, hesitancy, intermittence, incomplete emptying and urgency. On revalidation, the index was internally consistent (Cronbach's alpha = 0.86) and the score generated had excellent test-retest reliability (r = 0.92). Scores were highly correlated with subjects' global ratings of the magnitude of their urinary problem (r = 0.65 to 0.72) and powerfully discriminated between BPH and control subjects (receiver operating characteristic area 0.85). Finally, the index was sensitive to change, with preoperative scores decreasing from a mean of 17.6 to 7.1 by 4 weeks after prostatectomy (p < 0.001). The AUA symptom index is clinically sensible, reliable, valid and responsive. It is practical for use in practice and for inclusion in research protocols.
Article
The aim of this study was to determine whether urge incontinence was associated with a higher prevalence of psychological symptoms than other types of incontinence. The psychological aspects of 110 women presenting with urinary incontinence in general practice were assessed by means of standardised questionnaires and medical history‐taking. The results showed no difference in psychological characteristics between patients with urge incontinence and those with other types of incontinence. These findings were contrary to the conclusions of almost all other studies based on populations selected for specialist care. It was concluded that in general practice the psychological approach to urinary incontinence depends more on the individual needs of the patient than specifically on the type of incontinence.
Article
1. Although a range of factors can contribute to urinary incontinence in long-term care residents, it is more closely associated with a decline in both cognitive and functional status. 2. Although all subjects had to be cognitively impaired to participate in the study, the incontinent group had a significantly lower mean score on the mental status examination than did the continent group. 3. Incontinent subjects were more dependent in activities of daily living and took significantly longer to carry out functional tasks specifically related to toileting. 4. Urinary incontinence was strongly associated with a history of urinary tract infections, positive urine cultures, epididymitis, hematuria, and fecal incontinence. Medical diagnosis, medications, and affective status were not associated with the problem.
Article
In summary, we conclude that current evidence supports cognitive therapy as a promising approach to the treatment of anxiety. However, definitive conclusions regarding its efficacy must await large-scale, well-conducted, controlled trials that address the methodological shortcomings previously addressed. Furthermore, although there are many components to Beck's version of cognitive therapy, the critical ingredients are not known at this time. Despite the absence of data regarding this issue, we believe that future trials of cognitive therapy should include the following as core components: (a) identifying and modifying idiosyncratic anxiety-related beliefs, (b) using behavioral experiments to test those beliefs, and (c) utilizing well-trained therapists to administer treatment. This would provide a solid foundation from which to evaluate how cognitive therapy might add to the effectiveness of current behavioral treatments for anxiety disorders. In addition, studies comparing treatment effectiveness of cognitive therapy, behavior therapy, and pharmacotherapy for anxiety would ideally include dropout rates, relapse rates, and generalization of changes made over time. The advantages of cognitive therapy approaches may not be evident in the short run because cognitive therapy may provide clients with a method for handling future environmental or internal stresses that might make this treatment approach more effective in the long-term amelioration of anxiety disorders.
Article
The mental state of 211 women attending a urodynamic clinic was assessed using questionnaires. Patients with genuine stress incontinence had scores comparable with other patients with longstanding physical complaints. Patients with sensory urgency were more anxious than those with genuine stress incontinence. Patients with detrusor instability were as anxious as patients with sensory urgency and in addition had higher scores on the hysteria scale. A subset of patients (roughly a quarter of the total) was identified, comprising members of all three diagnostic groups, for whom urinary symptoms rendered life intolerable. These patients were as anxious, depressed, and phobic as psychiatric inpatients, emphasising the serious psychological morbidity experienced by patients with urinary symptoms. Fifty patients with detrusor instability or sensory urgency entered a randomised trial comparing psychotherapy, bladder drill, and propantheline. The psychotherapy group significantly improved on measures of urgency, incontinence, and nocturia, though not on frequency. Bladder training was an effective treatment for frequency and patients became less anxious and depressed. There was a modest improvement in frequency of micturition in patients given propantheline. Frequency may be a learnt disorder which responds to the direct symptom oriented approach of bladder training. Patients with urgency and nocturia predominating might derive more benefit from psychotherapy.
Article
The prevalence of urinary incontinence in women aged 18 years and over was investigated by carrying out a telephone interview of 851 women randomly selected from the Dunedin electoral register. Two hundred and sixty seven (31%) of the women interviewed had some degree of incontinence in the preceding 12 months and 142 (17%) had had regular incontinence (two or more episodes of leakage per month). Daily incontinence occurred in approximately 5% of the women sampled with 2.3% being incontinent more than once per day or being continually incontinent. Only one third of those with regular incontinence had sought medical help for their problem. The commonest reasons for this were that either the incontinence was not seen as abnormal (81%) or there was a low expectation of benefit from treatment (10%). Thus there needs to be improved awareness that incontinence is treatable and that medical and surgical treatment options are available.
Article
We examined the relationship between urinary incontinence and psychological distress in a sample of community-dwelling older adults. The data are from a probability sample of Washtenaw County, Michigan residents ages 60 years and older, who were interviewed in 1983 and 1984. A total of 747 women and 541 men were included in the analyses. Experiencing urinary incontinence, particularly in a severe form, was weakly related to depression, negative affect, and low life satisfaction. These relationships are partly explained by the fact that incontinent respondents are less healthy than are continent respondents.
Article
In an epidemiological health survey, 515 45-year-old women were interviewed about urological problems, particularly incontinence. A pelvic examination was also conducted on 509 of the women. Twenty-two per cent or 114 women stated that they experienced incontinence, which took the form of stress incontinence in 75%, urge incontinence in 11% and a mixture of the two in 14%. Only 14 women, 3% of all the women interviewed, desired medical treatment for incontinence. In the incontinent women, the pelvic examination significantly more often revealed a cystocele, uterine prolapse or impaired function of the levator muscles. No correlation was found between an enlarged uterus and incontinence. In 211 women with one or more of these findings at the gynaecological examination, the frequency of incontinence was 35%; in 298 women with no pathological findings, the frequency was 15%. The frequency of urinary incontinence was not increased in women with higher parity or in postmenopausal women.
Article
Psychological tests were completed by 57 incontinent women with idiopathic detrusor instability, and compared with those of 22 women with genuine stress incontinence (an anatomical disorder) and published norms. The previously reported findings of hysterical personality traits, situational stresses and sexual dysfunction in patients with detrusor instability were not confirmed. Higher scores for anxiety, neuroticism, hostility, and depression were found in patients with detrusor instability than in controls. These findings, known associations of psychosomatic disorders, lend further support to the view that idiopathic detrusor instability is a psychosomatic disorder.
Article
A 20-yr-old male presenting a 2-yr history of excessive urinary urgency and frequency was treated with a three-phase behavioral intervention. Progressive urinary retention training was first suggested to decrease urinary frequency and increase functional bladder capacity (phase one). The patient was not able to comply with the instructions, showing a phobic fear of accidents and an over-valued consideration of the social consequences of incontinence. Systematic desensitization, in vivo desensitization and cognitive restructuring were implemented in phase two. The patient was then able to comply with the progressive urinary retention training (phase three) and completely overcame his problem. Gains were maintained at 6 and 12-month follow-ups. The results suggest that progressive urinary retention training alone is effective both at the behavioral and physiological levels, but its application is facilitated by a consideration and modification of the patient's subjective attitude towards excessive micturition frequency and its feared consequences.
Article
A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
The goal of this study was to estimate the prevalence and correlates of difficulty holding urine among a population of community-dwelling older people. Population-based cross-sectional study. A population census identified all residents aged 65 years and older residing in East Boston, Massachusetts, in 1982. Data collected via in-home interviews were used to estimate the prevalence of difficulty holding urine and to provide information regarding potential correlates of urinary difficulty. Of the 3809 study participants (85% response rate), 28% reported having "difficulty holding urine until they can get to a toilet" at least some of the time, and 8% reported difficulty "most" or "all of the time." Difficulty was associated with age and sex; 44% of women and 34% of men reported some difficulty (P < .001), and 9% of women and 6% of men (P < .001) reported difficulty most or all of the time. For respondents aged 65 to 74 years, 40% reported some difficulty, compared with 47% of those aged 85 and older (Ptrend < .001); difficulty most or all of the time was reported by 6% of those aged 65 to 74 and 12% of those aged 85 and older (Ptrend < .001). Difficulty holding urine was associated with important health and functional measures including depression, stroke, chronic cough, night awakening, fecal incontinence, problems with activities of daily living, decreased frequency and ease in getting out of the house, and poor self-perception of health. Difficulty holding urine is a prevalent condition among older people living in the community and is associated highly with a number of health conditions and functional problems.
Article
It has been suggested that regular clinics might improve the management of urinary incontinence in general practice. A study was undertaken to determine the prevalence of urinary incontinence among women in one general practice and the feasibility of using a health promotion clinic in its management. Questionnaires were sent to a 10% sample of women aged 20 years and over on the practice register. Pregnant women were excluded. Of 384 questionnaires sent to eligible women, 314 were completed correctly (82%). The overall reported prevalence of urinary incontinence was 53%; 8% of these women had urge incontinence, 46% had stress incontinence and 43% had mixed incontinence. Incontinence was positively correlated with parity and with gynaecological operation other than hysterectomy and repair of prolapse but not with perineal suturing after childbirth, delivery of a baby weighing 9 lb (4.1 kg) or more or mode of delivery. Twenty seven out of 78 incontinent women (35%) who completed a second questionnaire admitted to worrying about their incontinence but only 10 (13%) had consulted their doctor about the problem. The main reason given for not consulting was that incontinence was a minor inconvenience only. The 167 incontinent women were offered an appointment at a women's clinic but only 13 attended. Of these, 10 were entered into a 12 week treatment trial. Various treatments were offered, such as the women being taught bladder training and pelvic floor exercises. One woman was lost to follow up, and for eight out of nine women their continence had improved, both subjectively and objectively. Urinary incontinence in women is a common problem. It can be successfully diagnosed and treated in general practice but low attendance makes the health promotion clinic setting an inefficient means of achieving this.
Article
To determine the prevalence, incidence, and remission rates of urinary incontinence in a large group of older women over a 6-year time span and to assess factors associated with incontinence incidence and remission. Longitudinal cohort study. Two rural counties in Iowa. 2025 women aged 65 years or older residing in rural Iowa, enrolled in the Iowa 65+ Rural Health Study of EPESE (Establishment of Populations for Epidemiologic Studies of the Elderly) were interviewed in person annually for 6 years; specific responses to queries about urinary incontinence were given at baseline, 3-, and 6-year intervals. Conditional multivariate logistic regression analysis was done to assess the relationship between incontinence symptoms and various factors previously found to be related to incontinence. The baseline prevalence of urge incontinence was 36.3%, and of stress incontinence it was 40.3%. For urge incontinence, the 3-year incidence and remission rates between the third and sixth years were 28.5% and 22.1%, respectively. For stress incontinence, the 3-year incidence and remission rates between years 3 and 6 were 28.6% and 25.1%, respectively. Seventy-six percent and 84% of women who reported no urge or stress incontinence, respectively, at the baseline interview were continent at both follow-up interviews. The only significant factors related to changes in incontinence status were age, which was associated with an increased incidence of urge incontinence (OR 1.11, P = .017, 95% CI 1.019-1.203), and improvement in activities of daily living, which was associated with a increased remission of urge incontinence (OR 0.50, P = .015, 95% CI 0.28-0.9) In some older women, urinary incontinence is a dynamic state, with women moving back and forth along a continuum between continence and incontinence. These results are tempered by limitations of the study, which include its questionnaire design and lack of ability to detect potential treatment effect.
Article
This nursing study about women with urinary incontinence was designed to explore (1) the incidence of depression in women with urinary incontinence, (2) the correlation between mastery and depression and/or self-esteem and depression in women with urinary incontinence, and (3) depression as a mediating factor in the quality of life (QOL) in these women. This study found a higher incidence of depression in women with urinary incontinence compared with the general population. Correlational and multiple regression analyses both revealed strong and significant relationships between the independent variables of mastery and self-esteem and the dependent variable of depression. Depression did not emerge as a mediator in QOL. When mastery, depression, and self-esteem were considered together, mastery was the only predictor with a direct effect on QOL in women with urinary incontinence. Nursing interventions aimed at increasing women's sense of mastery may be effective in decreasing depression and improving the QOL.