Urinary incontinence in women linked to poor mental health

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Disclosures: Healio Primary Care was unable to confirm relevant financial information at the time of publication.

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Survey data showed that women with urinary incontinence suffered from depression and low self-esteem more than those who did not.

Margarida manso, a urologist from the University Hospital of São João in Portugal, presented the results at this year’s European Urological Association congress. Based on the results, Manso encouraged doctors to ask women with the disease about their mental health.

Data indicates that women with urinary incontinence suffered more from depression and low self-esteem than those who did not.
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Researchers in a 2019 study estimated that the prevalence of urinary incontinence ranges from 25% to 45%, and is likely to increase in the future. They also noted that the condition usually occurs around menopause.

Manso’s demographic survey covered 10,038 Portuguese women.

Margarida manso

“The sample included adult women of different ages, some of whom were healthy and others with a range of comorbidities,” Manso told Healio Primary Care.

She made mental health comparisons between respondents with self-reported symptoms of urinary continence and those without the condition.

Overall, 9.9% of women had urinary incontinence, according to Manso. The prevalence increased to 40.8% in women aged 75 to 85.

People with urinary incontinence had a higher prevalence of diagnosed with depression (adjusted prevalence ratio = 1.66; 95% CI, 1.43-1.92) and used mental health services more often (ratio adjusted prevalence = 1.41; 95% CI 1.03-1.93), according to Manso. Women with urinary incontinence were also more likely to report ‘feeling unwell’ (adjusted prevalence ratio = 1.65; 95% CI, 1.46-1.88), problems concentrating (prevalence ratio adjusted = 1.58; 95% CI 1.38-1.82) and a feeling of worthlessness or guilt in the 2 weeks preceding the survey (adjusted prevalence ratio = 1.49; 95% CI : 1.33-1.67).

Manso said the results suggest the conversation between women with urinary incontinence and doctors should be changed.

“There are no fixed questions to ask clinicians,” she said. “Doctors need to be on the lookout for signs of depression and low self-esteem in their patients. We trust their individual judgment to ask the right questions if they suspect something to worry about. “

Patients whose urinary incontinence is identified at an early stage have a good chance of benefiting from an improvement in quality of life and successful treatment, Christophe Réginald Chapple BSc, MD, FRCS, FEBU, a consultant urological surgeon at the Sheffield Teaching Hospitals National Health Services Foundation Trust in the UK and secretary general of the European Urological Association, said in a press release.

Christophe Reginald Chapple

In an interview with Healio Primary Care, he said clinicians should be aware of the European Urological Association’s guidelines on the proper assessment and treatment of urinary incontinence, which recommends:

  • recognize that overactive bladder is a non-specific diagnosis;
  • provide patients with appropriate supplies to manage the disease;
  • take a history and “careful” examination of the patient which includes urinalysis and ensure that the patient is not suffering from retention;
  • use a bladder urination diary with all patients to assess the extent of their condition; and
  • advise patients receiving anticholinergics for their urinary incontinence that this drug may be titratable and that the “alternative first-line treatment” – mirabegron – is only contraindicated in patients with BP 180/110 mm Hg or more.

A combination of these two therapies can also help a patient’s urinary incontinence if no treatment alone helps, Chapple said.

The references:

European Association of Urology. Guideline on urinary incontinence. https://uroweb.org/guideline/urinary-incontinence/. Accessed July 15, 2021.

European Association of Urology. Women with incontinence suffer from poorer mental health, a new study finds. https://www.eurekalert.org/pub_releases/2021-07/eaou-wwi070621.php. Accessed July 15, 2021.

Manso M, et al. AM-21: The impact of female urinary incontinence on mental illness – a population-based study. Presented at: Annual Congress of the European Urological Association; July 8-12, 2021 (virtual meeting).

Milsom I, Gyhagen M. Climacteric. 2019; doi: 10.1080 / 13697137.2018.1543263.

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