Urinary incontinence in women linked to poorer mental health

Survey data showed that women with urinary incontinence experienced depression and low self-worth more than those who do not have the condition.

Margarida Manso, a urologist from São João University Hospitalar Center in Portugal, presented the results at this year’s European Association for Urology Congress. Based on the findings, Manso encouraged physicians to ask women with the condition about their mental health.

Researchers of a 2019 study estimated that the prevalence of urinary incontinence ranges from 25% to 45%, and will likely increase in the future. They also noted that the condition usually occurs around menopause.

Manso’s population-based survey consisted of 10,038 Portuguese women.

Margarida Manso

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

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

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

Those with urinary incontinence had a higher prevalence of depression diagnosis (adjusted prevalence ratio = 1.66; 95% CI, 1.43-1.92) and more often utilized mental health services (adjusted prevalence ratio = 1.41; 95% CI, 1.03-1.93), according to Manso. Women with urinary incontinence were also more likely to report “feeling bad” (adjusted prevalence ratio = 1.65; 95% CI, 1.46-1.88), problems concentrating (adjusted prevalence ratio =1.58; 95% CI, 1.38-1.82) and feeling worthlessness or guilt during the 2 weeks before taking the survey (adjusted prevalence ratio = 1.49; 95% CI, 1.33-1.67).

Manso said the findings suggest that the conversation between women with urinary incontinence and physicians should be modified.

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

Patients whose urinary incontinence is identified at an early stage stand a good chance of experiencing quality-of-life improvement and successful treatment, Christopher Reginald Chapple BSc, MD, FRCS, FEBU, a consulting urological surgeon at Sheffield Teaching Hospitals National Health Services Foundation Trust in the United Kingdom and secretary general of the European Association of Urology, said in a press release.

Christopher Reginald Chapple

In an interview with Healio Primary Care, he said clinicians should be aware of guidelines from the European Association of Urology on proper assessment and treatment of urinary incontinence, which recommend to:

• acknowledge that overactive bladder is a non‐specific diagnosis;
• provide patients with proper supplies to manage the condition;
• take a “careful” patient history and examination that includes a urine analysis and ensuring the patient is not experiencing retention;
• utilize a bladder voiding diary with all patients to assess the extent of their condition; and
• advise patients receiving anticholinergics for their urinary incontinence that this medication may be titratable and that the “alternative first‐line therapy”— mirabegron — is only contraindicated in patients whose BP is 180/110 mm Hg or higher.

A combination of both these therapies may also help a patient’s urinary incontinence if neither treatment helps on its own, Chapple said.

References:

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

European Association of Urology. Women with incontinence suffer poorer mental health, says new research. 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 health disease - a population-based study. Presented at: Annual European Association on Urology Congress; July 8-12, 2021 (virtual meeting).

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