Hypothesis / aims of study
Some risk factors have been reported to influence the development of urinary incontinence. Prior hysterectomy, age, obstetric trauma, and obesity are discussed risk factors for the development of urinary incontinence. Even though a several factors are reported to be associated with urinary incontinence published data about these factors are inconsistent and comprehensive data about risk factors in different subtypes of urinary incontinence is still lacking. Hence, we aimed to identify risk factors for the development of the different types of incontinence in a hospital-based study. Of special interest was the influence of menopausal status on urinary incontinence.
Study design, materials and methods
This is a hospital-based retrospective analysis of patients who presented with urinary incontinence in the outpatient ward of our hospital. The diagnosis of urinary incontinence was based on the subjective complaints of the patients. The complaints of the patients were registered by using a modification of the long version of the ICIQ – Questionnaire.
Stress urinary Incontinence (SUI) was defined as the involuntary loss of urine when the intra-abdominal pressure was increased by coughing, sneezing, or body movement. Urgency urinary incontinence (UUI) was the fact that patients would lose urine without any control nearly immediately with the first feeling of urgency. Mixed urinary incontinence (MUI) was defined as loss of urine during coughing and sneezing associated with UUI. Data concerning menopausal status, hormone therapy, prior incontinence surgery, prior hysterectomy were assessed.
Patient characteristics are described using absolute numbers (percentage), mean ±standard deviation (SD). Associations between two qualitative variables were tested using Fisher’s exact test. All reported p-values are two sided and values of p<0.05 were considered statistically significant. As the analyses were regarded as explorative no adjustment for multiple testing was made. Statistical analyses were performed using SPSS 25 (IBM Corp., Armonk, NY, USA).
Results
In total, 620 patients with incontinence could be included in this retrospective analysis. Among those patients 13.2 % of patients presented with a stress urinary incontinence, 70.5 % a mixed urinary incontinence and 16.3 % presented with an urge urinary incontinence, respectively.
Mean age of the patients in was 62.1 years in the overall cohort. When we analyzed the age depended from the subgroups the mean age was 53.8 years in the SUI group, 62.7 years in the MUI group and 66.1 years in the UUI group, respectively. The difference between the group was statistically significant (p<0.001). About 10.8 % of the patients were nulliparous, whereas 62.2 % had 1 or 2 spontaneous deliveries and 26.9 % had 3 or more spontaneous deliveries. There was no significant correlation to the type of incontinence. When we compared pre- and postmenopausal patients the distribution of the three types of incontinence was significantly different. The proportion of patients with urge urinary incontinence was higher in the postmenopausal group whereas the proportion of stress urinary incontinence was higher in the premenopausal group (p<0.001). Overall, 50.2 % of the patients had a prior hysterectomy in medical history. In a subgroup analysis of the postmenopausal 38.5 % received a hormone replacement therapy. We asked patients when the first symptoms of incontinence began. The mean age in which complaints began was significantly lower in the SUI group (45.4 years) compared to the MUI (51.0 years) and UUI group (54.7 years) (p<0.001).
Interpretation of results
Hormone replacement therapy seems to play a minor role in the manifestation of different incontinence types in contrast to the age, which seems to have an influence on the different types of urinary incontinence. Age related changes may lead to different types of incontinence.