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Predictors of Urinary Incontinence in a Prospective Cohort of Postmenopausal Women

From the ¹Northwest Health Services Research and Development Program, Veterans Administration Puget Sound; ²Department of Medicine, University of Washington; ³Center for Health Studies, Group Health Cooperative of Puget Sound; ⁴Department of Epidemiology, University of Washington; and ⁵Epidemiologic Research and Information Center, Veterans Administration Puget Sound, Seattle, Washington.

OBJECTIVE: To prospectively assess risk factors associated with occurrence of urinary incontinence among postmenopausal women.

METHODS: We followed up 1,017 postmenopausal health maintenance organization enrollees, aged 55 to 75 years, for 2 years. The primary outcome measures were any urinary incontinence and severe incontinence reported at 12- or 24-month follow-up visits.

RESULTS: Baseline prevalence of any amount or frequency of urinary incontinence in the past year was 66%. Among the 345 women without incontinence at baseline, 65 (19%) at 1 year and 66 (19%) at 2 years reported any incontinence. Ninety-two of 672 (14%) and 96 of 672 (14%) women with incontinence at baseline reported no incontinence at years 1 and 2. In an adjusted multiple logistic regression model, independent predictors of any incontinence included white race (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1–2.6), vaginal estrogen cream (OR 2.0, CI 1.1–3.7), vaginal dryness (OR 1.6, CI 1.2–2.2), vaginal discharge (OR 1.5, CI 1.0–2.2), 6 or more lifetime urinary tract infections (OR 1.8, CI 1.2–2.6), and diabetic peripheral neuropathy (OR 1.7, CI 1.0–3.1). In adjusted models, predictors of severe incontinence were history of hysterectomy (OR 1.8, CI 1.1–2.7) and any vaginal symptom (OR 1.7, CI 1.0–2.8).

CONCLUSION: A substantial proportion of incontinence-free postmenopausal women developed urinary incontinence during 2 years of follow-up. Because vaginal symptoms are associated with urinary incontinence, their relationship with other risk factors, including vaginal Escherichia coli colonization and vaginal estrogen cream use, warrant additional study. Similarly, diabetic peripheral neuropathy and hysterectomy associations suggest areas for future investigation.

LEVEL OF EVIDENCE: II-2

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