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248 - PREVALENCE OF URINARY INCONTINENCE SYMPTOMS: LOOKING BEYOND STRESS & URGENCY URINARY INCONTINENCE

248

PREVALENCE OF URINARY INCONTINENCE SYMPTOMS: LOOKING BEYOND STRESS & URGENCY URINARY INCONTINENCE

BOTROS, N. DALALO, S. IYER, S. LOZO, S. BOTROS, J. TOMEZSKO, R. GOLDBERG, A. GAFNI-KANE, P. K. SAND;
NorthShore Univ. Hlth.System, Skokie, IL.

Introduction: Urinary incontinence (UI) is a common condition in women. In the United States alone, UI affects 16% of non-pregnant women over the age of 201. Among women between the ages of 25 and 84, 15% have complaints of stress urinary incontinence (SUI), and 13% have complaints of urgency urinary incontinence (UUI)2. Many patients present with complex UI complaints, including insensible urine loss, post-micturition dribbling, nocturnal enuresis, or coital incontinence, as described by the International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology of urinary incontinence3. More women are wearing incontinence pads, increasing the difficulty in determining etiology and severity of UI and differentiating it from perspiration. To date, no study has described the prevalence of each symptom in a urogynecology patient population.
Objective: The objective of this study is to define the true prevalence of UI symptoms beyond SUI and UUI among women presenting with complaints of UI in a tertiary referral center.
Methods: This is a retrospective cross-sectional review of patients who presented to one provider in the Division of Urogynecology with complaints of UI between January, 2014 and August, 2016. 432 patients were included based on the complaint of UI at their first visit. The following symptoms of UI and number of leakage episodes per week were routinely asked and recorded: SUI, UUI, insensible urine loss, nocturnal enuresis, post-micturition dribbling, and coital incontinence. Patients with multiple symptoms were included in each category they complained of. The data was obtained by 3 methods including manual chart review, search by ICD 9/10 codes, and search by completion of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). If there was a discrepancy between the different methods, the manual chart review was used as the most accurate record.
Results: The mean patient age was 61, BMI 29 kg/m2, and parity was 2. The prevalence of the each subtype of UI and number of leakage episodes per week is shown in Figure 1. The most common UI complaint was UUI, followed by SUI, post-micturition dribbling, and nocturnal enuresis. Coital incontinence was the least common symptom recorded. Mixed incontinence (both SUI and UUI) was seen in 56.4% of patients, and 230 (53%) complained of either post-micturition dribbling, insensible urine loss or nocturnal enuresis. Women who complained of complex types of urinary incontinence were more likely to also have mixed incontinence complaints as follows: 69% of those with insensible urine loss also had SUI and UUI, 69% of those with post-micturition dribbling, 74% with nocturnal enuresis, and 85% with coital incontinence, further characterizing the complexity of these symptoms.
Conclusions: Urinary incontinence in women is complex and may be characterized by several different subtypes. Not assessing for post-micturition dribbling, nocturnal enuresis and insensible urine loss would lead to missing 52% of the weekly leakage episodes. Further evaluation in such patients may be warranted to establish an accurate diagnosis prior to treatment.
References:

  1. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ; Pelvic Floor Disorders Network. Prevalence of Symptomatic Pelvic Floor Disorders in US Women. JAMA. 2008;300(11):1311-1316.
  2. Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008 Mar;111(3):678-85.
  3. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN; International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20.