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Epidemiology - Urinary Incontinence

Urinary Incontinence - Epidemiology

Background: There is a large variation in the estimated prevalence of urinary incontinence (UI), even after taking into account differences in definitions, epidemiological methodology and demographic characteristics. However, recent prospective studies have provided much data on the incidence of UI and the natural history of urinary incontinence.  

Urinary incontinence is most common in women.
One in four women over the age of 18 experience episodes of leaking urine involuntarily.
The consequences of UI lead to serious morbidity, including falls and fractures, urinary tract infections, skin breakdown including pressure ulcers, and admission to nursing homes.
UI is not a tremendously progressive condition.

Urinary Incontinence - Definition

  • Urinary incontinence is a common condition in which there is involuntary leakage of urine.
  • There are different causes and types of urinary incontinence.
  • stress incontinence, in which small amounts of urine leak from the bladder during moving, such as when exercising or sneezing.
  • Urge incontinence results in the leakage of large amounts of urine and may occur together with stress incontinence. This is called mixed incontinence.
  • Urinary Incontinence - Symptoms
  • Symptoms of urinary incontinence include sudden urges to urinate and leakage of urine.
  • Urinary incontinence can lead to frequent "accidents" that negatively affect quality of life as bladder leaking is disruptive to the normal activities of daily living.
  • Although it is important to rule out serious underlying or associated conditions, invasive testing is rarely required before initiating treatment with conservative measures.

Risk Factors in Women 

  • Pregnancy and vaginal delivery are significant risk factors, but decrease in  importance with age.
  • Diabetes mellitus is a risk factor in most studies. Research also suggests that oral estrogen and body mass index are important modifiable risk factors for UI. 
  • Pelvic organ prolapse (POP) has a prevalence of 5-10% based on the finding of a mass bulging in the vagina.
  • Childbirth carries an increased risk for POP later in life, with the risk increasing with the number of children.
  • Several studies suggest hysterectomy and other pelvic surgery increase the risk of POP. Further research is needed.

Risk Factors in Men:

  • Risk factors for UI in men include increasing age, lower urinary tract symptoms (LUTS), infections, functional and cognitive impairment, neurological disorders and prostatectomy.

Overactive Bladder (OAB) 

  • The prevalence of OAB in adult males varies from 10% to 26% and in adult females from 8% to 42%. 
  • It increases with age and often occurs with other LUTS.

  • see Overactive Bladder symptoms for more (add link)

Overall Incidence:

  • The annual incidence rates of UI in women ranges from 2% to 11%, with the highest incidence occurring during pregnancy.
  • Rates of complete remission of UI range from 0% to 13%, with the highest remission rate after pregnancy.
  • The annual incidence rates of OAB range from 4% to 6%, while annual remission rates of OAB range from 2% to 3%.
  • The annual incidence of prolapse surgery ranges from 0.16% to 0.2%.
  • The estimated life-time cumulative risk for prolapse surgery is estimated to be 7-11%.

Prevalence and incidence of Urinary Incontinence (UI) in the United States:

• Prevalence of Urinary Incontinence: 13 million adults (NIDDK); 1 in 10 over 65 (NWHIC) and a rate of about 1 in 20 or 4.78% or 13 million people in USA.
• Twice as common in women as men in the US (NIDDK, NIH)
• The Agency for Health Care Policy and Research (AHCPR) cites studies indicating that one in four women ages 30 to 59 has experienced urinary incontinence.
• Estimated 35% of women over 65 had urinary incontinence in the US 2001.
• 22% of adults over 65 with urinary incontinence were men in the US 1988-1994.
• 30-50% of institutionalized adults over 65 in the USA 2001.
• Older adults of both sexes commonly have urinary incontinence.

Cost of UI in USA

  • Costs for Urinary Incontinence: $16.3 billion in the USA 2001.
  • AHCPR estimates that the annual costs for caring for people with UI is $16.4 billion:
  • $11.2 billion is spent in the community and
  • $5.2 billion is spent in nursing homes.
  • This money is spent on management measures, such as pads and diapers, rather than on treatment.
  • The median out-of-pocket costs to women with weekly or more UI were $186/year (2005 dollars), but those with severe UI spent $372/year and those with very severe UI spent $1148/year.

References:

  • Abrams P, Cardozo L, Wein A, Khoury S. 4th International Consultation on Incontinence. Paris, July 5-8, 2008. Publication due in the course of 2009.
  • Abrams P, Cardozo L, Fall M, et al: The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21(2):167-178.
  • Huggins, M, Bhatia, N Ostergard, D. Current Opinion in Obstetrics & Gynecology 2003;15(5): 419-427.
  • Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006;50(6):1306-14.
  • Wennberg AL, Molander U, Fall M, Edlund C, Peeker R, Milsom I. A Longitudinal Population-based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Women. Eur Urol 2009, Jan.
  • What Your Female Patients Want to Know About Bladder Control: NIDDK)
  • (Annual Direct Cost of Urinary Incontinence, Obstetrics and Gynecology, 2001, NIDDK).