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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.
... 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. ...
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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.
... A study conducted by Zorn et al. (1999) found that 42 percent of adults (men and women) with UUI or MUI reported depression compared to 14 percent of adults with SUI. Perry et al. (2006) indicated that anxiety was both a consequence and a risk for UUI while depression only appeared to be a consequence. Also, having UUI was a predictor of anxiety and depression while SUI was not. ...
... The literature has indicated that having a UI creates suffering due to its negative impact on the individual's social life (Lee, 2009;Miu et al., 2010). Women with UI reported higher levels of anxiety and depression than the general population (Fultz and Herzog, 2001;Perry et al., 2006) as well as poorer physical and emotional health (Yu et al., 2003). Therefore, suffering may function as a mediator in the relationship between psychological morbidity and QoL. ...
... Psychological morbidity, in this sample, was not a significant predictor of QoL. Some studies have found a relationship between these two variables (Fultz and Herzog 2001;Perry et al., 2006;Yu et al., 2003). Although in this study psychological morbility and QoL were also correlated, psychological morbidity was not a predictor of Qol, probably due to the modest psychological morbidity presented in the sample. ...
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This article analyzed how sexual satisfaction, suffering, severity and impact of urinary incontinence, and psychological morbidity affected women’s quality of life and whether suffering mediated the relationship between psychological morbidity and quality of life. The study included 80 women diagnosed with urinary incontinence receiving rehabilitation treatment. Regression analysis showed that sexual satisfaction, suffering, and urinary incontinence severity and impact predicted quality of life and that suffering mediated the relationship between psychological morbidity and quality of life. The findings suggest that interventions should be tailored according to the suffering reported by women and the impact of the urinary incontinence on the couple’s sexual relationship.
... Finally, 54 articles met the inclusion criteria and presented data on 632 605 participants, of whom 29 844 had a positive depression F I G U R E 1 Selection of studies in the meta-analysis on the prevalence of depression and anxiety in pelvic floor dysfunction. Most of them were conducted in the USA, [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] followed by Europe [41][42][43][44][45][46][47][48][49][50][51] and Asia, 52-58 among others. All of the studies used validated instruments to assess anxiety and depression being the most frequently used the hospital anxiety and depression scale (HADS-11) 35,45,49,50,55,[59][60][61][62][63] and patient health questionnaire (PHQ -9). ...
... Most of them were conducted in the USA, [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] followed by Europe [41][42][43][44][45][46][47][48][49][50][51] and Asia, 52-58 among others. All of the studies used validated instruments to assess anxiety and depression being the most frequently used the hospital anxiety and depression scale (HADS-11) 35,45,49,50,55,[59][60][61][62][63] and patient health questionnaire (PHQ -9). 24,25,27,29,33,34,41,42,53,64,65 The HADS is a 14-item self-report measure of anxiety and depression in nonpsychiatric outpatients. ...
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Background Female pelvic floor dysfunction (PFD) is a common condition affecting the emotional well‐being of women. Objective To estimate the prevalence of depressive and anxiety symptoms in women with PFD. Search Strategy, Selection Criteria, Data Collection and Analysis Following prospective registration (PROSPERO CRD42022362095) we conducted a search of three electronic databases (PubMed, Web of Science and Scopus) from inception to April 2023 without language restriction to capture studies reporting the prevalence of depression/anxiety among women with PFD (chronic pelvic pain [CPP], urinary incontinence [UI], pelvic organ prolapse [POP], and/or fecal incontinence [FI]). Only studies with validated tools were included. Data extraction and study quality assessment were performed by two independent reviewers. Stratifying by type of PFD, rates of depression and anxiety were pooled using random effects model computing 95% confidence interval (CI) and assessing heterogeneity using the I² statistic. Funnel plots were used to detect potential reporting biases and small‐study effects. Main Results The search yielded 767 articles, from which 54 studies containing 632 605 women were included. All the studies were high quality. The prevalence of depression was: CPP 26.8% (95% CI: 19.2–34.4, I² = 98.7%; 12 studies, 4798 participants with 491 cases; Egger's P value = 0.009); UI 26.3% (95% CI: 19.4–33.2, I² = 99.9%; 26 studies, a total of 346 114 participants with 25 050 cases; Egger's P value = 0.944); POP 34.9% (95% CI: 24.3–45.6, I² = 68%; three studies, 297 participants with 104 cases; Egger's P value = 0.973); and FI 25.3% (95% CI: 0.68–49.9, I² = 99.7%; six studies, 14 663 participants with 1773 cases; Egger's P value = 0.780). The prevalence of anxiety was: CPP 29.5% (95% CI: 16.3–42.7, I² = 97.7%; nine studies, 2483 participants with 349 cases; Egger's P value = 0.001); UI 46.91% (95% CI: 39.1–54.6, I² = 99.6%; 11 studies, 198 491 participants with 40 058 cases; Egger's P value = 0.337); and POP 28% (95% CI: 13.6–42.4, I² = 89%; three studies with 355 participants with 90 cases; Egger's P value = 0.306). Conclusion The prevalence of mental health illness was variable in the different types of PFDs. This meta‐analysis helps quantify the burden of depression and anxiety in PFD and will help inform the policies regarding screening of emotional well‐being by healthcare professionals engaged in care of women with PFD.
... The majority of research focused on investigating the relationship between depression and the subsequent occurrence of UI. Despite extensive empirical investigations in this area, mixed findings were found (Felde et al., 2017;Perry et al., 2006). On the other hand, although the significant association between depression and frailty has been corroborated by cross-sectional studies (Soysal et al., 2017), inconsistent findings on predicting role of depression on frailty were found in longitudinal studies (Da Mata et al., 2021;Prina et al., 2019). ...
... Available studies often used baseline depression to predict the occurrence of UI (Felde et al., 2017;Melville et al., 2009;Mishra et al., 2015), but ignored that depression was not a time-invariant variable (Perry et al., 2006). Morrisroe et al. (2014) addressed this methodological pitfall and reported the significant predicting role of change in depression on incident UI at 1-year follow-up among older adults in the community. ...
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Aims To explore the co‐occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways. Design A secondary analysis of a 1‐year three‐wave panel data collected from older nursing home residents in China. Methods Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co‐occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism. Results A total of 348 older adults were included in this study, and 55.7% were women. The co‐occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1‐year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant. Conclusion The co‐occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co‐occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement. Implications for the Profession and/or Patient Care The phenomenon of urinary incontinence and frailty co‐occurrence should be given extreme emphasis. Although statistically significant findings on the roles of depression and activity engagement were not inferred, this study provides multiple possibilities for future studies to test and depict a clear picture of this co‐occurrence. Impact What problem did the study address? This study was designed to test the roles of depression and activity engagement in predicting the incidence of urinary incontinence and frailty, and the mediating roles in linking frailty to urinary incontinence incidence. What were the main findings? Despite the methodological pitfalls in literature have been addressed, neither depression nor activity engagement would significantly predict the incidence of urinary incontinence and frailty in older adults. Their mediating roles in linking frailty to urinary incontinence incidence were also not significant. Where and on whom will the research have an impact? Our findings add important pieces of evidence to promote researchers’ understanding and provide an important basis for untangling the puzzle of urinary incontinence and frailty co‐occurrence. Reporting Method The report of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines. Patient or Public Contribution No patient or public contribution.
... 16 In females, OAB has shown a larger negative impact on overall quality of life, specifically on anxiety, depression, sleep, and shame as well as difficulties with their social life and sexual relationships. [17][18][19][20][21] Anxiety has been found to precede OAB symptoms or to be a complication of OAB. 19 One study revealed an increase in OAB symptoms in patients with underlying anxiety compared with patients with no history of anxiety. ...
... [17][18][19][20][21] Anxiety has been found to precede OAB symptoms or to be a complication of OAB. 19 One study revealed an increase in OAB symptoms in patients with underlying anxiety compared with patients with no history of anxiety. 18 Whether depression, anxiety, sleep disturbance, and perceived stress increase OAB symptoms or vice versa is an ongoing debate. ...
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).
... 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.
... 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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Abstract 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
... In both the novel Short Form Cues survey and Long Form Cues survey, a variety of mood symptoms were associated with elevated urgency including being worried, stressed, or anxious. Multiple studies show an association with mood and voiding dysfunction [28]. Anxiety and urinary symptoms including frequency and urgency have been shown to interact and influence one another; patients with OAB and anxiety have reported increased severity of symptoms and worse quality of life [29,30]. ...
... Res. Public Health 2024, 21, 40 2 of 10 with the development of affective disorders [11,12,[19][20][21]. However, the relationship between postpartum depressive symptoms and LUTSs is unclear. ...
Article
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Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04–1.11) and perceived stress (AOR 1.12, 95% CI 1.04–1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88–0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98–0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95–0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.
... If you enlarge the focus also on anxiety, Choi, Lam, Chin [28] found that 17.7% of subjects with lower urinary tract symptoms (LUTS) reported depressive symptoms, 24,3% anxiety symptoms and 9,6% stress symptoms. In a random sample of women aged 40 years or more a significant proportion of women with urge incontinence reported symptoms of anxiety (56.6%) and depression (37.6%) [29]. Beyond the different prevalence rates of depressive disorder, what is even more important is the degree of association, which is found between depression and incontinence: in some studies it is more or less weak and in others moderate [21,24,26]. ...
Article
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The urinary incontinence syndrome is a common disease, whose etiology is still unclear. The survey of psychological variables generally highlights a poverty quality of life, depressive features, and difficulties in sexual life. The goal of this pilot study-sample of 97 women with urinary incontinence-is to give these patients a more complex picture, evaluating aspects of pain (depression and other mental illness indicators, alexithymia, sex life), but also investigating if there are good aspects in their life which act as counterweight. It 's so emerged as the patients lead a healthy life and have generally good relations, it is a good couple relationship, both good relationships with parents and have different interests in life. In particular, the women with self-interest are not depressed and have no traits of alexithymia. It is so important in clinical practice to not take for granted the presence of a psychological suffering and rather encourage patients to cultivate self-interests.
... Тот факт, что на сексуальную функцию человека оказывает влияние огромное количество факторов [6], еще больше усложняет задачу. Давно установлена сильная связь между показателями физического и психического здоровья у пациенток с несостоятельностью тазового дна [7][8][9]. В частности, уровень сексуальной активности положительно коррелирует с восприятием пациенткой образа собственного тела и удовлетворенностью им [10]. Так, опущение или выпадение органов малого таза ассоциировано с такими депрессивными чувствами, как потеря привлекательности и снижение уровня уверенности в себе. ...
Article
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The sexual activity of patients before and after the treatment of pelvic organ prolapse (POP) largely determines their quality of life and satisfaction with the intervention. This review analyzes current data on the nature of changes in sexual function in various pelvic organ prolapse correction methods. Particular attention is paid to a comparative assessment of the effect of available surgical techniques with abdominal and vaginal access on the risk of de novo dyspareunia. Based on the results of clinical studies and systematic reviews, the most optimal ways of correcting POP have been established; tools for assessing their effectiveness in routine clinical practice have been proposed; the importance of an interdisciplinary approach to the treatment of POP with the involvement of medical psychologists has been noted due to the significant role of emotional and behavioral factors in sexual dysfunction.
... (5) . In a British survey (2006), incontinence was estimated to be over twice as prevalent in women (14%) as in men (6.6%) (6) . While in Egypt, the prevalence of UI was 54.8% which is higher when compared to other reports (7) . ...
... 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.
... 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.
... 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). ...
... 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.
... 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]. ...
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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
... 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. ...
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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.
... 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. ...
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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.
... 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. ...
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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.
... 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. ...
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Urinary incontinence (UI) and depression are prevalent conditions affecting millions globally and are significantly associated with various demographic, health, and socio-economic factors. This study examines the trends and associations of UI and depression over a 14-year period using nationwide data. We analyzed data from the Turkish Health Studies Surveys conducted in seven years between 2008 and 2022, including 125,279 participants aged 15 and older, excluding those with incomplete key health data. Variables included chronic conditions, BMI, depression severity (assessed by PHQ-8), socio-economic status, and lifestyle factors. Univariable and multivariable logistic regression models were used to investigate associations between UI and various risk factors over time. The prevalence of UI and depression fluctuated over the 14-years, with a significant increase observed in 2014. Multivariate analysis confirmed a strong and consistent association between UI and depression across genders and age groups, even after adjusting for confounders. Higher depression severity increased the odds of experiencing UI. Age, multiple comorbidities, higher BMI, and lower socio-economic status were associated with an increased likelihood of UI. Obesity was a significant risk factor for UI in females but not in males. Urban living and higher education levels were inversely associated with UI. The simultaneous rise in UI and depression in 2014 may be linked to socio-economic changes during that period. The findings suggest a robust link between UI and depression, influenced by a complex interplay of health, demographic, and socio-economic factors, needing prospective studies to further investigate the causal pathway of these associations.
Article
Lower urinary tract symptoms (LUTS) are defined as symptoms related to the lower urinary tract or referred from similarly innervated anatomy. No specific criteria are used to precisely define LUTS owing to its multiorgan involvement instead of organ-centric (urethra and bladder). In the past decade, the prevalence of LUTS dramatically increased owing to low health care seeking behaviors. Initially, patients with LUTS seemed to not actively look for medical opinions because of cultural or ethnic barriers. Raising awareness of the significance of medical opinions may contribute to increasing health care seeking behaviors for LUTS. In addition to the association between LUTS and mental illness, a temporal relationship exists, that is, LUTS may cause mental illness and vice versa. This bidirectional correlation relationship was demonstrated by a nationwide observational study. The impacts of LUTS vary among different age groups. Older adults have higher LUTS prevalence, whereas younger ones with LUTS have higher risks of developing anxiety and depression. Similarly, the impacts of LUTS differ between men and women. Women have higher LUTS prevalence; however, men with LUTS have higher risks of developing anxiety and depression. In conclusion, significant association and temporal bidirectional relationship exist between LUTS and mental health. Our findings suggested that patients with LUTS also receive mental illness–related health care; similarly, patients with mental illness may have risks of developing subsequent LUTS.
Article
Introduction This study aims to assess the presence of overactive bladder syndrome (OAB), academic stress, and their impact on quality of life (QoL) of healthy university students. Methods A cross-sectional study recruited university students from different academic streams, between January 2021 to December 2021. Demographics, overactive bladder-validated 8 questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB) questionnaire, and Perception of Academic Stress (PAS) scale were collected. The correlation between the variables was assessed using the Social Sciences Statistical Package (SPSS) version 21. Results Three hundred and 89 people met the inclusion criteria. There were 241 (62%) females, and 248 (63.8%) of the students were under the age of 22. Four academic streams were included: Engineering 96 (24.7%), Humanities 121 (31.1%), Medicine 85 (21.8%) and Nursing 87 (22.4%). OAB was found among 103 (26%) students. The mean OAB-V8 score was 5.8 ± 6.6. The mean PAS scale was 53.9 ± 9.4. The mean ICIQ-OAB score was 1.5 (0–9). Male gender 62 (60%), smoking 42 (40.8%), academic stream (Humanity 40 (38.8%)) and year (third and fourth-year students 34 (33%) and 33 (32%), respectively) have a statistically significant positive correlation with OAB ( p < 0.001). Humanity stream (mean rank 169.2) and junior students (first and second years with mean rank of 174 and 177), respectively, had high level of academic stress and low PAS scale. There is a weak but statistically significant inverse correlation between OAB and the PAS scale ( r = −0.211) ( p < 0.001). Conclusion OAB is prevalent among healthy university students and is directly related to academic stress. Both OAB and academic stress have impact on quality of life. We hope this study will help to raise awareness of OAB among university students to early identify and treat such a condition, avoiding unnecessary bother among healthy university students.
Article
Objective A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. Methods Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. Results Two conceptual models were developed—one to explain central (brain‐based) and peripheral (gut‐based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short‐chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain–gut–bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. Conclusions Depicted pathways, including brain–gut–bladder communication, have implications for research and development of novel prevention and treatment approaches.
Article
Objective: To evaluate the association between urinary incontinence and depression. An estimated 21 million adults in the United States (U.S.) reported at least one major depressive episode. Urinary incontinence has a well-described negative impact on quality of life. Methods: We included respondents aged ≥ 20 who participated in the 2017 - March 2020 National Health and Nutrition Examination Survey cycles. Our dichotomous outcomes were depression and clinical depression. The predictor variable urinary incontinence was assessed using the validated incontinence severity index. We fitted an adjusted multivariable logistic regression and performed interaction analysis for urinary incontinence and our variable of interest. Results: Among a weighted sample of 233.5 million people (unweighted 8,256), 19.9 million (8.5%) reported depression (p<0.001). The weighted population was 48.6% male, 55.2% married, and 63.4% non-Hispanic White (NHW) (all p<0.001). Moderate and severe urinary incontinence was associated with depression (aOR 2.3; 95%CI [1.5-3.3]; aOR 3.8; 95%CI [2.5-3.3]; p<0.001). No association was observed between urinary incontinence and clinical depression. Interaction analysis showed that men (aOR 3.62; 95%CI [2.13-6.15]; pint<0.001) and participants at the lowest socioeconomic status (aOR 2.2; 95%CI [1.3-3.71]; pint=0.005) with moderate/severe urinary incontinence had higher odds of depression than their continent counterparts. Conclusion: We report that urinary incontinence is an independent predictor of depression in a nationally representative survey for men and those in the lowest socioeconomic tier. The association is most prominent among men and the socioeconomically disadvantaged population. This suggests that treatment for urinary incontinence may be important tool to reduce depression in the general population.
Article
Aims: Links between emotional state and the bladder have long been recognized, as psychological comorbidity is a common feature of overactive bladder (OAB). However, how psychological factors might contribute to the development and severity of OAB remains unclear. Therefore, we sought to examine the effect of anxiety on OAB with a specific focus on bladder hypersensitivity. Methods: In a sample of 120 adult women with OAB, we compared those with at least mild anxiety (PROMIS Anxiety score ≥55) to those with lower anxiety. Analyses focused on patient-reported questionnaires assessing urinary symptom severity and quality of life, psychological stress symptoms, general somatic symptoms, and results of quantitative sensory testing (QST), including temporal summation to heat pain (TSP). TSP was used to index elevated C-fiber responsiveness (i.e., central sensitization). Results: Thirty-six (30%) women had at least mild anxiety. While there were no group differences for urinary symptom severity, more anxious women reported worse OAB-specific quality of life, greater psychological stress burden, higher stress reactivity, and greater somatic symptoms. On QST, there were no differences between anxiety groups for pain threshold (43.6 ± 3.1°C vs. 44.0 ± 3.1°C, p = 0.6) and tolerance (47.3 ± 1.5°C vs. 47.4 ± 1.6°C, p = 0.7). However, those with anxiety had significantly higher TSP than those without anxiety (6.0 ± 4.8 vs. 3.7 ± 3.9, p = 0.006), indicating greater central sensitization. Conclusions: Women with OAB and at least mild anxiety symptoms reported greater psychosocial burdens (i.e., psychological stress, stress reactivity, OAB-specific QOL) and somatic symptom severity and demonstrated greater central sensitization on QST than those without anxiety. These findings support the hypothesis that anxiety and psychological stress impact hypersensitivity mechanisms that may underlie and contribute to OAB, although further research is needed to better understand how and to what extent.
Article
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Purpose: Substantive evidence supports a role of chronic stress in the development, maintenance, and even enhancement of functional bladder disorders such as interstitial cystitis/bladder pain syndrome (IC/BPS). Increased urinary frequency and bladder hyperalgesia have been reported in rodents exposed to a chronic stress paradigm. Here, we utilized a water avoidance stress (WAS) model in rodents to investigate the effect of chronic stress on vascular perfusion and angiogenesis. Methods: Female Wistar-Kyoto rats were exposed to WAS for 10 consecutive days. Bladder neck tissues were analyzed by western immunoblot for vascular endothelial growth factor (VEGF) and nerve growth factor precursor (proNGF). Vascular perfusion was assessed by fluorescent microangiography followed by Hypoxyprobe testing to identify regions of tissue hypoxia. Results: The expression of VEGF and proNGF in the bladder neck mucosa was significantly higher in the WAS rats than in the controls. There was a trend toward increased vascular perfusion, but without a statistically significant difference from the control group. The WAS rats displayed a 1.6-fold increase in perfusion. Additionally, a greater abundance of vessels was observed in the WAS rats, most notably in the microvasculature. Conclusion: These findings show that chronic psychological stress induces factors that can lead to increased microvasculature formation, especially around the bladder neck, the region that contains most nociceptive bladder afferents. These findings may indicate a link between angiogenesis and other inflammatory factors that contribute to structural changes and pain in IC/BPS.
Article
Objective To investigate the association of urinary incontinence with depressive symptoms, and to explore the mediating effect of functional limitations on this association. Methods This cross-sectional study included 7039 adults aged 50 and over from the English Longitudinal Study of Aging (Wave 8). Urinary incontinence was defined as whether the participants experienced urinary incontinence in the past 12 months. Depressive symptoms were assessed based on the Center for Epidemiologic Studies-Depression Scale. Functional limitations included disability of activities of daily living, instrumental activities of daily living, mobility and large muscle groups limitation of the participants. Logistic regression based on Karlson/Holm/Breen (KHB) method was applied to estimate the association of urinary incontinence with depressive symptoms and explore the mediating effect of functional limitations. Results Urinary incontinence was significantly associated with increased risk of depressive symptoms after controlling covariates (odds ratio = 1.75, 95 % confidence interval: 1.45–2.11). Functional limitations explained 36.96 % of this association. Conclusion Urinary incontinence might be associated with an increased risk of depressive symptoms among middle-aged and older adults and functional limitations partially mediate this association. Improving physically functional capacity might play an important role in preventing and managing depressive symptoms in elderly people with urinary incontinence.
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
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
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
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
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
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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.
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 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
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.
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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
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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
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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
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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
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.
Article
Urinary incontinence is a common and highly embarrassing condition among females of all age groups and has been the subject of several epidemiological studies in the past. From an extensive literature search covering the time period from 1954 to 1995, 48 epidemiological studies and several other publications dealing with prevalence and natural history of female incontinence were reviewed. Meta-analysis of reported data was performed in respect of incontinence definitions, investigation methods, home country of survey and age groups. Available data are nonhomogenous and difficult to compare because of differences in definitions of incontinence, target populations and study design in different investigations. By grouping the studies by similarities in the above criteria and analysing the results for each group of studies, an attempt was made to understand the great variation of reported results. Differences in prevalence of incontinence were identified for all examined aspects and for distinct ethnic populations. The little information that exists on the incidence, spontaneous remission rates and risk factors were used to elucidate the natural history of female incontinence. A generally accepted definition of incontinence is highly desirable and should comprise aspects of severity and demonstrability of the condition, bother factor and impact on quality of life. Furthermore, basic requirements for epidemiological surveys of incontinence such as validation of questionnaire results need to be defined and standardised to establish a sensible basis for useful epidemiological studies in the future.