Nonbiologic factors that impact management in women with urinary incontinence: review of the literature and findings from a National Institute of Diabetes and Digestive and Kidney Diseases workshop

Urinary incontinence (UI)-defined as a complaint of involuntary loss of urine-is common in women, with major public health, financial, and quality of life (QoL) implications. Despite the high toll of UI and the availability of effective conservative treatments, many women with UI do not seek care.

Those who do often continue to experience symptoms. Improving UI treatment may require a comprehensive approach to urology research, including a broad set of potentially influential factors beyond biologic.

To explore the effects of nonbiologic factors (NBF) on UI management and treatment response, the National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop for clinical and psychosocial researchers. Participants proposed a UI treatment pathway: recognizing the problem, willingness to seek treatment, access to care, receiving quality treatment, engaging in self-management, and adhering to chosen treatments; discussed potential NBFs that may affect the pathway; and identified areas for future research. After the meeting, a rapid literature review was conducted to assess the current state of research on NBFs in women with UI.

Participants identified several patient-level NBFs that may influence the UI management pathway, including QoL and perceived bother; stigma, shame, and embarrassment; knowledge and perceptions; social determinants of health; cultural and language characteristics; personal characteristics and skills; and physical abilities. Additionally, participants acknowledged that provider- and system-level factors also play a role and likely interact with patient-level factors.

NBFs that potentially affect the UI management pathway are not well understood, and a comprehensive, interdisciplinary approach to research is needed to understand and appropriately support effective UI treatment.

Go “Beyond the Abstract” - Read an article commentary written by the authors

International urogynecology journal. 2017 Jul 03 [Epub ahead of print]

Jenna M Norton, Jennifer L Dodson, Diane K Newman, Rebecca G Rogers, Andrea D Fairman, Helen L Coons, Robert A Star, Tamara G Bavendam

Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Blvd, Office 6081, MSC 5458, Bethesda, MD, 20892-5458, USA., Department of Urology, Johns Hopkins University, Baltimore, MD, USA., Division of Urology, University of Pennsylvania, Philadelphia, PA, USA., Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA., Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA., Health Psychology Solutions, Denver, CO, USA., Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Blvd, Office 6081, MSC 5458, Bethesda, MD, 20892-5458, USA. .

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