Overactive bladder increases with menopause
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Researchers found a significant association between the menopausal status of women aged 45 to 54 years and overactive bladder, according to a study published in Menopause.
Kazue Nagai, PhD, of the Gunma University School of Health Sciences in Gunma, Japan, and colleagues also found strong associations between high BMI and parous status with stress urinary incontinence (SUI), although SUI symptoms may become less frequent following menopause.
The researchers analyzed data from 12,198 women who participated in a cross-sectional survey as part of the Japan Nurses’ Health Study. The mean age was 46.5 years (± 8.1 years; range, 27-82 years), and the mean BMI was 22.1 kg/m2 (± 3.1 kg/m2; range, 12.9-44.6 kg/m2). Also, 29.3% (n = 3,573) of the participants were postmenopausal.
The questionnaire asked how much influence urinary problems have had on the participants’ daily lives, as well as whether symptoms have affected their daily lives, in addition to specific questions about what those symptoms were.
According to the survey, 4.9% reported frequent urination, 12.9% reported waking up to urinate, 2.7% reported weak urine streams, 6% reported a sudden need to urinate with difficulty waiting, 5.4% reported an inability to wait and then experiencing urine leakage, 16% reported urine leakage while coughing or moving and 1.6% reported other symptoms.
The prevalence of overactive bladder (OAB), which was 9.5% (n = 1,154), increased with age, especially at age 45 to 49 years. Also, there was a positive association between OAB and age 45 to 54 years (OR for ages 45-49 years = 1.58; 95% CI, 1.06-2.37 and OR for ages 50-54 years = 1.64; 95% CI, 1.06-2.52) compared to those aged younger than 35 years.
The prevalence of SUI, defined as any involuntary loss of urine on effort or physical exertion, was 13.9% (n = 1,699). Also, the prevalence of SUI was higher with a peak at 18.2% from age 50 to 54 years before declining to 13.7% from age 55 to 59 years.
Mixed urinary incontinence (MUI), defined as SUI and urgency urinary incontinence or the involuntary loss of urine associated with urgency, saw a prevalence of 2.1% (n = 253) that increased with age.
Overall, the prevalence of OAB-wet (OAB with urinary urgency and incontinence), OAB-dry (OAB with urinary urgency but without urinary incontinence), SUI and MUI were 5.4%, 4.1%, 13.9% and 2.1%, respectively.
Additionally, 19.3% of participants reported urinary incontinence in the previous month due to OAB-wet or SUI. The researchers also found an association between risk for OAB and BMI of 23 kg/m2 or higher. Postmenopausal women tend to have more OAB symptoms than premenopausal women in the perimenopausal period as well.
Perspective
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This study from the Japan Nurses’ Health Study shows that a significant percentage of middle-aged women are experiencing urinary incontinence (33.8% of women aged 50 to 54 years), with SUI being the most common type reported by women in that age group (present in 18.2%). This is fairly consistent with my clinical experience and with other studies taking into account potential differences in the study populations.
The quality-of-life burden associated with urinary incontinence is substantial and includes avoidance of social situations and even impact on intimate relationships in part due to concerns about leaking urine during sex. The economic impact is also significant and estimated in the tens of billions annually in the United States.
Given that about 1 in 3 midlife women are dealing with this issue, clinicians should be asking about urinary incontinence routinely and working with their patients to develop management strategies. These may include weight loss, pelvic floor strengthening exercises, use of pessaries, dietary modification, treatment of constipation, managing fluid intake, timed voiding and use of medications in some cases.
Treatment of urinary symptoms was not investigated in this study, though, nor was the effect of hormone therapy considered given that few women in the study cohort were receiving hormone therapy.
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