Nearly one in four older women report incontinence

San Francisco-Urinary incontinence remains a common medical condition in older women, even in those who rate their health as "good" or "excellent." Nearly 12% of elderly women experience stress, urge, or other form of incontinence, according to findings from an analysis of the Health, Aging, and Body Composition study published in Obstetrics & Gynecology (2004; 104:301-7). The condition is more prevalent in Caucasian women than in African-Americans, the study found.

Results of the longitudinal cohort study also show that stress and urge incontinence are associated with different risk factors, thus suggesting varying causes and prevention strategies for the two incontinence types, said the study's lead author, Rebecca A. Jackson, MD.

"Urinary incontinence can have a significant negative impact on the lives of elderly women, yet the risk factors remain poorly defined. Identifying factors that might precede incontinence and those that are a result of it will help to target risk reduction strategies and therapy," said Dr. Jackson, medical director of the Women's Health Center, San Francisco General Hospital.

Study participants underwent physical examination and testing of physical functioning. Medical and reproductive histories and demographic information were also obtained. Although 84% of the women described their health as "good" or "excellent," 64% reported arthritis, 55% reported hypertension, and 20% reported or were diagnosed with diabetes.

The participants were asked to characterize any incontinence they've experienced as either stress (leakage associated with activity); urge (leakage associated with the urge to void); or other (leakage unrelated to stress or urge). Frequency was assessed by the following question: "In the past 12 months, how often have you leaked urine?"

The researchers found that, overall, 9.6% of the women reported daily incontinence; 11.6% reported weekly incontinence; and 24% reported less than weekly incontinence in the previous 12 months.

Of women reporting weekly incontinence, 42% described urge incontinence as the predominant type, whereas 40% described mainly stress incontinence. Almost twice as many Caucasians reported weekly incontinence than African-Americans (27% vs. 14%, respectively; p <.001), a finding similar to that of other epidemiologic studies (Obstet Gynecol 1997; 90:983-9; Obstet Gynecol 1999; 94:66-70).

"Although ours was one of the largest studies to examine racial differences, we still don't know why incontinence occurs less often in African-Americans than Caucasians," Dr. Jackson said. "One theory is that African-American women have greater pelvic floor muscle mass and strength, which prevents incontinence despite higher rates of obesity and diabetes. Another theory is the possible underreporting of incontinence by African-Americans."

Additional risk factors Using multivariate analysis, the researchers also compared women with at least weekly incontinence with those who reported no incontinence in the previous year. Caucasian women had a three-times greater risk of urge incontinence and a four-times greater risk of stress incontinence than did African-American women.

Furthermore, arthritis and current oral estrogen use were associated with a 1.5- to 2-fold greater risk of both incontinence types.

Insulin-dependent diabetes, symptoms of depression, and decreased lower-extremity physical performance score were associated with urge but not stress incontinence, and chronic obstructive pulmonary disease and increased body mass index were associated with stress but not urge incontinence. No relationship was found between previous childbirth and either incontinence type, but a weak relationship was noted between hysterectomy (p<.07) and stress incontinence (p<.05).