Current Data

General
Chapter 5: Urinary Incontinence. In: Litwin, MS, Saigal, CS (Eds) Urologic Diseases in America. US Department of Health and Health Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, 2007; NIH Publication No. 07-5512.

The report incorporates current and retrospective data on all aspects of the epidemiology, practice patterns, costs, and impact of urologic diseases in the United States and is intended for use by public officials, nongovernment organizations, the media, academic researchers, health professionals, and the public.

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Economic Impact of UI
Wagner, T. & Hu, T. (1998). Economic Costs of Urinary Incontinence in 1995. The Journal of Urology, 160,(3), 956-957.

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Women’s Health Foundation’s Board Members Recent Published Work
Norton, P & Brubaker, L. (2006). Urinary Incontinence in Women. The Lancet. 367, (9504), 57-67.

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Urinary incontinence is common in women, but is under-reported and under-treated. Urine storage and emptying is a complex coordination between the bladder and urethra, and disturbances in the system due to childbirth, aging, or other medical conditions can lead to urinary incontinence. The two main types of incontinence in women, stress urinary incontinence and urge urinary incontinence, can be evaluated by history and simple clinical assessment available to most primary care physicians. There is a wide range of therapeutic options, but the recent proliferation of new drug treatments and surgical devices for urinary incontinence have had mixed results; direct-to-consumer advertising has increased public awareness of the problem of urinary incontinence, but many new products are being introduced without long-term assessment of their safety and efficacy.

Goldberg, R. (2003). Urinary incontinence among mothers of multiples: The protective effect of cesarean delivery. American Journal of Obstetrics and Gynecology, 188 (6), 1447-1453.

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Abstract

Objective: The purpose of this study was to assess the impact of delivery mode on the risk of urinary incontinence among women with previous multiple childbirth. Study Design: A 77-item questionnaire was administered to 733 mothers of multiples. Multivariate regression was used to control for potentially confounding variables. Results: The mean rate of stress urinary incontinence among women who were delivered by cesarean-only delivery was 39.6%, which was significantly lower than the 60.4% among women who reported previous vaginal births (P = .005). Cesarean-only delivery was associated with a markedly reduced risk (odds ratio, 0.52; P = .002) after controlling for age, parity, and body mass index by multivariate regression. Weaker associations were found for age (odds ratio, 1.08), body mass index (odds ratio, 1.06), and parity (odds ratio, 1.46). Urge incontinence was associated with parity, body mass index, and age, but not delivery mode (P = .76). Conclusion: Vaginal delivery represents a major risk factor for stress incontinence among mothers of multiples. Delivery by cesarean delivery only confers an independent protective effect. (Am J Obstet Gynecol 2003;188:1447-53.)

Effectiveness of Pelvic Muscle Exercise
Sampselle, CM, Miller, JM, Mims, BL, Delancey, JOL et al. (1998) Effect of Pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstetric & Gynecology, 91(3):406-412.

OBJECTIVE: To test the effect of pelvic muscle exercise on postpartum symptoms of stress urinary incontinence and pelvic muscle strength in primigravidas during pregnancy and postpartum. METHODS: A prospective trial randomized women into treatment (standardized instruction in pelvic muscle exercise) or control (routine care with no systematic pelvic muscle exercise instruction). Urinary incontinence symptoms were measured by questionnaire. Pelvic muscle strength was quantified by an instrumented gynecologic speculum. Time points were 20 and 35 weeks' gestation and 6 weeks, 6 months, and 12 months postpartum. RESULTS: Outcomes are reported for 46 women with vaginal or cesarean birth and for a subsample of 37 women with vaginal birth. Longitudinal analyses are reported for cases with complete data across time points. Diminished urinary incontinence symptoms were seen in the treatment group, with significant treatment effects demonstrated at 35 weeks' gestation (F [1,43] = 4.36, P = .043), 6 weeks postpartum (F [1,43] = 4.94, P = .032), and 6 months postpartum (F [1,43] = 4.29, P = .044). A repeated measures analysis of variance showed a significant interaction between time and treatment for urinary incontinence (F [4, 41] = 2.83, P = .037). A significant effect of initial pelvic muscle strength was demonstrated; ie, pelvic muscle strength at 20 weeks' gestation predicted significantly 12-months postpartum strength (F [1, 13] = 8.12, P = .014). Group differences in pelvic muscle strength were observed (the treatment group had greater strength at 6 weeks and at 6 months postpartum than did controls), but these differences were not statistically significant.

CONCLUSION: Practice of pelvic muscle exercise by primiparas results in fewer urinary incontinence symptoms during late pregnancy and postpartum.

Nygaard, Ingrid E. MD; Kreder, Karl J. MD; Lepic, Mary M. RN; Fountain, Kathleen A. RN; Rhomberg, Ann T. RN. (1996). Efficacy of pelvic floor muscle exercises in women with stress, urge, and mixed urinary incontinence. American Journal of Obstetrics & Gynecology. 174(1):120-125.

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Abstract:

OBJECTIVES: Our purpose was (1) to evaluate the efficacy on an intent-to-treat basis of a 3-month course of pelvic floor muscle exercises as first-line therapy for urinary incontinence in consecutive women seen in a tertiary care center with stress, urge, and mixed urinary incontinence and (2) to evaluate whether a specially designed audiotape improves compliance and efficacy of the exercises.

STUDY DESIGN: A prospective randomized trial was conducted with 71 women seen for treatment of urinary incontinence in two tertiary care center referral clinics (in the departments of gynecology and urology). The primary outcome measure was the number of incontinent episodes, as documented with a 3-day voiding diary. Statistical analysis included t tests and Wilcoxon signed-ranks test, as appropriate. A value of p less or equal to 0.05 was considered significant.

RESULTS: Forty-four percent of all enrollees had a greater or equal to 50% improvement in the number of incontinent episodes per day. This increased to 56% of enrollees who completed the treatment course. For all enrollees the mean number of incontinent episodes per day decreased from 2.6 to 1.7 for genuine stress incontinence, from 3.5 to 2.3 for detrusor instability, and from 3.9 to 3.2 for mixed incontinence. For enrollees who completed the 3-month course the mean number of incontinent episodes per day decreased from 2.5 to 1.4 for genuine stress incontinence, from 2.8 to 0.5 for detrusor instability, and from 3.0 to 1.7 for mixed incontinence. Six months after completing the course of exercises approximately one third of all enrollees reported that they continued to note good or excellent improvement and desired no further treatment. There was no difference in outcome measures and no difference in compliance between the women who exercised with the aid of the audiotape and those who exercised according to our usual office routine (p > 0.05).

CONCLUSIONS: One third of all participants remained improved to the patient's satisfaction 6 months after completion of a risk-free, inexpensive, simply provided therapy. Our audiotape did not improve our success rate or decrease the dropout rate. In this study the exercises were equally effective for all three urodynamic diagnoses. Inexpensive methods that could be used by primary care providers to improve the success rate of this therapy merits further attention. (AM J OBSTET GYNECOL 1996;174:120-5.)

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