The authors evaluated data from the Reproductive Risks of Incontinence Study at Kaiser Permanente. This is a diverse, community-based cohort in Northern California where long-term enrollees are sampled by age and race. History of interpersonal violence exposures as well as current symptoms of post traumatic stress disorder (PTSD) were evaluated by questionnaires from 2008-2012. Urinary symptoms were also evaluated by questionnaire to assess type of incontinence and frequency of incontinence. The association between trauma exposure and PTSD symptoms with urinary incontinence (stress and urgency) and nocturia were then evaluated using a multivariable adjusted logistic regression model. The multivariate model adjusted for factors of age, race, education, BMI, parity, menopausal status, pelvic surgery, and medications.
Nearly 2,000 subjects were analyzed, 27% of which had a history of at least one interpersonal trauma and 23% of which had clinically-significant PTSD. The mean age was 61 years, and the group was racially and ethnically diverse. On multivariate analysis, women with a history of physical interpersonal violence were more likely to have nocturia. Those with a history of emotional interpersonal violence were more likely to show all types of incontinence as well as nocturia. Those with a history of sexual assault did not demonstrate any increased risk of urinary symptoms. Finally, subjects with PTSD were more likely to report any incontinence, stress incontinence, urgency incontinence, and nocturia.
The authors conclude that a history of physical or emotional abuse as well as PTSD are under-recognized risk factors for lower urinary tract symptoms such as incontinence and nocturia. This is a very important study that highlights psychological factors that may influence the treatment of pelvic floor dysfunction in women. Urologists who treat female pelvic floor dysfunction develop close relationships with patients, and in turn, are likely to uncover history of interpersonal trauma and abuse. Although the effect of these factors on the treatment of lower urinary tract dysfunction is uncertain, clinicians should certainly be aware of patients’ history of trauma, especially those with a history of emotional interpersonal violence and PTSD.
Presented by: Alison Huang, MD Associate Professor, General Internal Medicine, University of California San Francisco
Written by: Dena Moskowitz, MD; Assistant Professor of Clinical Urology, University of California Irvine; @demoskowitz at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
Reference:
- Lai HH, Rawal A, Shen B, Vetter J. The Relationship Between Anxiety and Overactive Bladder or Urinary Incontinence Symptoms in the Clinical Population. Urology. 2016;98:50-57. doi:10.1016/j.urology.2016.07.013