Psychological morbidity and female urinary incontinence

doi:10.1016/j.bpobgyn.2006.12.002

Best Practice & Research Clinical Obstetrics & Gynaecology

Volume 21, Issue 2, April 2007, Pages 321-329

https://doi.org/10.1016/j.bpobgyn.2006.12.002 Get rights and content

Female urinary incontinence is a common yet distressing condition. It affects women of all ages, but is especially common in the elderly. Its prevalence ranges from 15 to 55%, depending on age and population studied. Despite the ubiquity of female urinary incontinence, many incontinent women do not voice their suffering, and urinary incontinence has therefore been dubbed ‘the silent epidemic’. The physical impact and social isolation associated with urinary incontinence lead to impairment of quality of life and psychological well-being. It is the aim of this review to discuss the epidemiology and psychological impact of urinary incontinence. The recognition and management of incontinence-related psychological morbidity are also explored.

Section snippets

Epidemiology

Urinary incontinence is a common disorder affecting millions of women. Many incontinent women do not voice their suffering, and therefore urinary incontinence has been dubbed ‘the silent epidemic’.²⁰ Urinary incontinence can occur at any age, but is more common in older women²¹, and is estimated to affect 20–40% of adult women or 11–80% of the elderly21, 22, 23, 24, 25, depending on age, the health-care setting where the study was performed, and the definition of urinary incontinence used. The

Urinary incontinence and quality of life

One major effect of urinary incontinence on the patients is deterioration in quality of life. In a prevalence study of incontinence in the community, Brocklehurst found that 34% of women felt that their lifestyles had been considerably affected by their incontinence.³³ Regardless of the type of instruments used to measure impact on quality of life, there is a consensus in the literature that incontinence affects quality of life, causing social isolation and lifestyle restriction.³⁴ The types of

Psychological morbidity and urinary symptoms

Among women with urinary incontinence, there is also a reported high prevalence of psychological co-morbidity. A large population study in Helsinki, Finland, reported that major depression was associated with objective health problems such as poor vision, urinary incontinence, or Parkinson's disease. Depression was common in the elderly suffering from urinary incontinence, with an odds ratio as high as 4.5 (95%CI 2.3–8.8).¹⁸ This is different from healthy elderly people living in the community,

Neuropharmacopathology

Urinary symptoms and psychological morbidity may have a common aetiology. Neuropharmacological evidence indicates that some forms of depression are associated with reduced serotogenic function48, 49, which may influence bladder emptying.⁵⁰ Descending serotonin axons from the brain synapse on visceral afferents, interneurons and preganglionics in the thoracolumbar and sacral spinal cord that participate in voiding. The actions of serotonin are complex and are mediated by many different

Management of psychological morbidity associated with urinary incontinence

Although the relationship between urinary incontinence and psychological morbidity is well established, there is relatively little discussion about the specific management of these psychological problems. However, treatment of the urinary incontinence with symptomatic improvement has been shown to improve patients' quality of life and psychological morbidity.

Fonda et al showed that conservative treatment of patients aged ≥60 significantly improved quality-of-life measures at 4 and 12 months

Recognition of psychological morbidity

Psychological assessment is not part of the routine assessment of incontinent patients. Although the International Continence Society strongly suggested the inclusion of quality-of-life data in clinical trials of continence care⁶¹, there is no general consensus that routine psychological assessment should be done. This is probably due to the practical difficulty for clinicians looking after incontinent patients, as many will not have sufficient training to make such assessments. Although

Conclusion

Urinary incontinence is prevalent and can have significant impact on both the physical and mental health of patients. Psychological morbidity is likely to be due to the impact of incontinence on quality of life, although there may be a small neuropharmacological contribution. Improvement in psychological health is probably highly associated with patient satisfaction with treatment and outcome of incontinence treatment. Successful treatment of incontinent patients therefore requires the

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Cited by (67)

Relationship between depression, anxiety, and attendance at pelvic-floor muscle training sessions
2023, Physiotherapy (United Kingdom)
Psychological comorbidities are associated with non-attendance for pelvic-floor muscle training (PFMT) appointments and non-engagement with ongoing treatment. However, little direct work has examined the precise relationship between these variables.
A prospective observational study of consecutively referred women patients with Pelvic-floor Dysfunction. Patients were assessed at intake for age, BMI, pelvic symptoms (measured by the Queensland Pelvic Symptom Scale), and anxiety and depression (measured by the Hospital Anxiety and Depression Scales).
A women’s health physiotherapy outpatient unit of a metropolitan hospital.
433 consecutively-referred women with pelvic-floor dysfunction (PFD).
Six sessions of PFMT, lasting over a period of 6 months.
Attendance at PFMT sessions was the outcome, and was related to intake patient age, BMI, pelvic symptoms, as well as anxiety and depression.
Psychological symptoms of depression and anxiety predicted attendance at PFMT sessions, over and above physical symptoms. Depression was the key predictor of non-attendance, with anxiety having a more complex relationship with attendance. There were few differences between these psychological variables and the different types of PFD, or between type of PFD and PFMT attendance.
The findings add to the literature suggesting that consideration of patients’ psychological state is important when designing treatment-regimes.
- •
  In this report, we looked at the impact of depression and anxiety of patients with pelvic-floor dysfunction on their attendance at pelvic-floor muscle training sessions.
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  We found depression negatively impacted patients’ ability to engage with treatment.
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  We suggest offering psychological support to patients to help them engage more fully with their treatment, and potentially prevent future surgery.
Change in depression predicts change in bladder symptoms for women with urinary incontinence undergoing pelvic-floor muscle training
2023, European Journal of Obstetrics and Gynecology and Reproductive Biology
To examine the relationship between depression and bladder symptoms, especially the impact of change in depression on changes in bladder symptoms, for women with urge and stress urinary incontinence undergoing a course of PFMT.
106 adult females with pelvic-floor dysfunction (PFD), consecutively referred to an outpatient pelvic-floor muscle training (PFMT) programme for either urge, stress, or mixed incontinence, participated in a prospective observational study. Participants reported subjective views of their pelvic floor problems (Queensland), and their levels of depression (HADS_D), and data relating to age and BMI were collected. The trial was registered on clinicaltrials.gov (NCT02549157).
There was a positive relationship between depression and bladder symptoms at intake. Levels of initial depression significantly predicted levels of bladder symptoms at completion of PFMT, and ability to complete the PFMT programme. Change in depression significantly predicted change in bladder symptoms, over and above intake patient characteristics and symptoms.
These data imply a multidisciplinary focus, including psychological input, for PFD may be a highly effective strategy for its management.
Urinary incontinence status changes and depressive symptoms among middle-aged and older women: Using data from a survey of the Korean Longitudinal Study of Aging
2021, Journal of Affective Disorders
Citation Excerpt :
In contrast, other studies have shown no association between depression and UI (Melville et al., 2009; Thom et al., 1997). However, related studies have reported that UI limits social behaviors (Yip and Cardozo, 2007), negatively affects physical activity (Brocklehurst, 1993), and even contributes to work disability (Hung et al., 2014). One of the main findings of our study is the effect of the change in UI status over time.
Urinary incontinence (UI) affects 200 million people worldwide and is a common problem in middle-aged and older women. The symptoms of UI in women are known to have a variety of effects on their health. Therefore, this study aimed to identify the effects of changes in UI status on depressive symptoms and identify determinants of the progression of UI among South Korean women 45 years old and above.
Data were collected from the Korean Longitudinal Study of Aging from 2012 to 2016. Participants were categorized into five groups by the results of a prior panel survey on UI status: “Recovered,” “Better,” “Same,” “Worse,” and “No symptoms of urinary incontinence.” We used the generalized estimating equation model and performed subgroup analyses based on age, working status, household income, perceived health status, and the number of chronic medical conditions.
A total of 3,957 middle-aged and older women were included in the analysis. Those with a change to “worse” UI status (β: 0.408, P=0.005) had higher depressive symptom scores than those who reported “no symptoms of UI.” Conversely, those with a “better” (β: -0.271, P=0.0131) or “recovered” (β: -0.518, P=0.0020) UI status had lower depressive symptom scores than those with “no symptom of UI”. Younger women and those with a “better” or “recovered” status showed a tendency of having fewer depressive symptoms. Older women and those with a “worse” status showed a tendency of having more depressive symptoms.
The cause of UI could not be evaluated. Changes in UI status were evaluated based on self-reported data.
This study showed that a change in UI status is associated with depression in middle-aged and older Korean women. It is important to consider UI management to relieve depressive symptoms.
A Review of the Effects of Physical Therapy on Self-Esteem in Postpartum Women With Lumbopelvic Dysfunction
2019, Journal of Obstetrics and Gynaecology Canada
Citation Excerpt :
PT is a profession dedicated to improving quality of life (QOL) by enhancing or restoring the function of multiple body systems.14 By improving lumbopelvic dysfunction, PT is likely to have a positive impact on self-esteem, perception of symptoms, and satisfaction with treatment and contribute to an overall perceived improvement in QOL.15–17 The objective of this review was to determine the impact of PT for lumbopelvic dysfunction on self-esteem in postpartum women.
This study sought to determine the impact of physical therapy for lumbopelvic dysfunction on self-esteem in postpartum women. Systematic searches were carried out in CINAHL, Embase, PsycINFO, Medline (OVID), Cochrane, and Web of Science by a health sciences librarian using various combinations of subject headings and key words. A dual review process was used first to assess titles and abstracts and then to examine the full text. Conflicts were resolved through discussion or a third reviewer as needed. Dual data extraction was completed using a standardized collection form. Pairs of reviewers met to discuss conflicts. Data quality was assessed using the Cochrane Collaboration's Risk of Bias Tool, the Joanna Briggs Critical Appraisal Tool, and the Critical Appraisal Skills Programme Checklist. Thirteen articles were included in the review. None of the articles assessed self-esteem specifically; however, each article assessed aspects of self-esteem (self-concept, self-efficacy, self-worth, depression, quality of life, general well-being, or physical function). All articles reported improvements in the selected outcome measures compared with baseline; two studies that compared two different physical therapy interventions found no significant differences between the interventions. To our knowledge, there is no literature explicitly evaluating self-esteem in postpartum women following physical therapy intervention for lumbopelvic dysfunction. Low self-esteem is shown to predict depression and anxiety; therefore, interventions that increase self-esteem may be useful in reducing the risk of depression.
Cette étude avait pour but de déterminer l'effet de la physiothérapie pour dysfonction lombo-pelvienne sur l'estime de soi des femmes en période postpartum. Un bibliothécaire en sciences de la santé a mené des recherches systématiques dans CINAHL, Embase, PsycINFO, Medline (par l'interface OVID), Cochrane et Web of Science à l'aide de diverses combinaisons de vedettes-matière et de mots-clés. Deux évaluateurs ont examiné, dans un premier temps, les titres et les résumés des articles et, dans un deuxième temps, les textes entiers. Tout désaccord a été réglé par des discussions ou par l'intervention d'un troisième évaluateur, au besoin. Les évaluateurs ont extrait séparément les données au moyen d'une fiche de collecte uniformisée, puis se sont réunis pour discuter des divergences. La qualité des données a été évaluée avec l'outil d’évaluation du risque de biais de la Collaboration Cochrane, l'outil d’évaluation critique de l'Institut Joanna Briggs et la liste de vérification du programme de développement des compétences en évaluation critique. Au total, 13 articles ont été retenus. Aucun de ces articles n’évaluait précisément l'estime de soi, mais chacun d'entre eux en évaluait des aspects (concept de soi, sentiment d'autoefficacité, sentiment de sa propre valeur, dépression, qualité de vie, bien-être général, fonctionnement physique). Tous les articles ont fait état d'améliorations dans ces aspects. Deux articles comparant deux physiothérapies n'ont constaté aucune différence significative entre les traitements. À notre connaissance, il n'existe aucune recherche évaluant explicitement l'estime de soi des femmes après une physiothérapie pour dysfonction lombo-pelvienne en période postpartum. Il a été montré qu'une faible estime de soi est un facteur prédictif de dépression et d'anxiété; les interventions visant à la renforcer peuvent donc être utiles pour réduire le risque de dépression.
Adherence to pelvic floor muscle training in women with urinary incontinence. Systematic review of the literature
2019, Fisioterapia
La incontinencia urinaria femenina es un problema de salud de elevada prevalencia, costes sociales y económicos. El entrenamiento muscular del suelo pélvico es el tratamiento conservador más utilizado en mujeres con cualquier tipo de incontinencia urinaria, pero requiere de la adhesión a dichos programas de entrenamiento. Sin embargo, los estudios publicados hasta la fecha alertan de la falta de adherencia a estos programas, identificándose como una barrera para el proceso de recuperación.
El objetivo de este trabajo es describir la adherencia al entrenamiento muscular del suelo pélvico en las mujeres con incontinencia urinaria.
Se realizó una revisión bibliográfica en las bases de datos PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, La biblioteca Cochrane Plus, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science y Scopus, completándose con una estrategia de búsqueda manual. Los artículos incluidos fueron ensayos controlados aleatorizados o análisis secundarios de los mismos, publicados entre 2007 y 2018. La evaluación de la calidad metodológica se realizó con la escala PEDro, realizándose la implementación de las normas PRISMA.
Siete artículos se incluyeron en esta revisión. Las tasas de adherencia variaron entre el 92 y el 53,55% en el corto plazo y entre el 80 y el 38,1% en el seguimiento. Los sistemas de medición se basaron en diarios, cuestionarios y datos recogidos por los fisioterapeutas. La falta de homogeneidad en los estudios supone una limitación para un metaanálisis válido.
Las tasas de adherencia del entrenamiento muscular del suelo pélvico en incontinencia urinaria femenina son bajas, siendo necesarias acciones que puedan homogeneizar los sistemas de medición y las estrategias de mejora de la adherencia terapéutica.
Female urinary incontinence is a health problem of high prevalence, social and economic costs. Training of the pelvic floor muscles is the most used conservative treatment in women with any type of urinary incontinence, but requires adherence to these programs. However, studies published to date warn of the lack of adherence to these programs, identifying this as a barrier to the recovery process.
The objective of this work is to describe the adherence to pelvic floor muscle training in women with urinary incontinence.
A bibliographic review was made in the databases PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, The Cochrane Plus library, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science and Scopus, completing with a manual search strategy. The articles included were randomised controlled trials, or secondary analyses of these, published between 2007 and 2018. The evaluation of the methodological quality was carried out using the PEDro scale, with the implementation of the PRISMA standards.
Seven articles were included in this review. Adherence rates varied between 92% and 53.55% in the short term, and between 80% and 38.1% in the follow-up. The measurement systems were based on diaries, questionnaires, and data collected by the physiotherapists. The lack of homogeneity in the studies is a limitation for a valid meta-analysis.
The adherence rates of pelvic floor muscle training in female patients with urinary incontinence are low, and actions are needed to standardise measurement systems, as well as strategies to improve therapeutic adherence.
The Impact of Extracorporeal Magnetic Stimulation as Addition to Mirabegron in Overactive Bladder Treatment in Women: A Single-Centre Randomized Sham-Controlled Study
2024, Journal of Clinical Medicine

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11Psychological morbidity and female urinary incontinence

Section snippets

Epidemiology

Urinary incontinence and quality of life

Psychological morbidity and urinary symptoms

Neuropharmacopathology

Management of psychological morbidity associated with urinary incontinence

Recognition of psychological morbidity

Conclusion

Best Pract Res Clin Obstet Gynaecol

Int J Gynaecol Obstet

Soc Sci Med

J Urol

Obstet Gynecol

Maturitas

Psychosomatics

J Psychosom Res

Urology

Obstet Gynecol

Eur J Obstet Gynecol Reprod Biol

Prog Neuropsychopharmacol Biol Psychiatry

J Urol

Urology

J Clin Epidemiol

The aging lower urinary tract

J Urol

Urinary incontinence in women

Lancet

The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery

BJOG

Current opinion on the classification and definition of genital tract prolapse

Curr Opin Obstet Gynecol

Editorial comment: Advances in female stress urinary incontinence: mid-urethral slings

BJOG

Pharmacotherapy for neurogenic detrusor overactivity

Am J Phys Med Rehabil

Overactive bladder in the elderly: a guide to pharmacological management

Drugs Aging

Laparoscopic colposuspension for urinary incontinence in women

Cochrane Database Syst Rev

Open retropubic colposuspension for urinary incontinence in women

Cochrane Database Syst Rev

Traditional suburethral sling operations for urinary incontinence in women

Cochrane Database Syst Rev

Overactive bladder: epidemiology and social impact

Curr Opin Obstet Gynecol

Stress urinary incontinence in active elderly women

South Med J

Pelvic floor dysfunction: a conceptual framework for collaborative patient-centred care

J Adv Nurs

The impact of urinary incontinence on quality of life of the elderly

Am J Manag Care

Major depression in the elderly: A population study in Helsinki

Int Psychogeriatr

11
Psychological morbidity and female urinary incontinence