Elsevier

European Urology

Volume 55, Issue 4, April 2009, Pages 783-791
European Urology

Platinum Priority – Female Urology – Incontinence
Editorial by Hann-Chorng Kuo on pp. 792–793 of this issue
A Longitudinal Population-based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Women

https://doi.org/10.1016/j.eururo.2009.01.007Get rights and content

Abstract

Background

Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies.

Objective

To describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression.

Design, setting, and participants

A longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged ≥20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n = 2911), and available for reassessment in 2007 (n = 1408).

Methods

A self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire.

Results and limitations

In 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p < 0.001), and 3% (p < 0.05), respectively, from 1991 to 2007. The incidence of UI and OAB were 21% and 20%, respectively, and the corresponding remission rates were 34% and 43%, respectively. Women with OAB symptoms were classified as OAB dry or OAB wet, depending on the presence or absence of concomitant UI. The prevalence of OAB dry did not differ between the two assessment occasions (11% and 10%, respectively), but the prevalence of OAB wet increased from 6% to 16% (p < 0.001).

Conclusions

UI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms were considerable.

Introduction

Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life (QoL) [1], [2], [3], [4]. There has been a growing interest in these symptoms in recent years as a consequence of the increased awareness of the human and social implications for the individual sufferer.

The reported prevalence of UI among women varies widely in different studies due to the use of different definitions, to the heterogeneity of different study populations, and to population sampling procedures. Large cross-sectional population-based samples, however, have shown that the prevalence of female UI ranges from approximately 20% in young adults to 50% in older women [5], [6], [7]. In recent years, several epidemiologic studies have been conducted to better understand the prevalence and the impact of OAB and other LUTS. The estimated prevalence of OAB is approximately 17% in both men and women, whereas the frequency of other problems related to bladder control vary according to symptom and severity [4], [7], [8], [9], [10].

LUTS are not static but dynamic, and many factors may contribute to incidence, progression, or remission. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups. The mean annual incidence of UI seems to range from 1% to 9%, while estimates of remission vary from 4% to 30% [1], [11], [12], [13], [14]. Presently, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies [8], [15], [16].

In 1991, we initiated a longitudinal population-based study composed of women aged ≥20 yr residing in Gothenburg, Sweden, regarding the prevalence of UI and other LUTS. The aim of the present study was to assess the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to reveal possible regression or progression in the same participant.

Section snippets

Participants

In 1991, a prospective longitudinal study was initiated to assess LUTS in a random sample of women from an urban Swedish population [17]. Every fourth woman (n = 2911) was randomly selected from the total population of women aged ≥20 yr residing in the Central District of Gothenburg (n = 11 644) who were listed in the Swedish National Population Register. The women were invited by letter to complete a questionnaire regarding UI and other LUTS (eg, urgency, frequency, and nocturia). The women's QoL

Results

In 2007, the questionnaire was returned by 1081 of the 1408 women still available for reassessment (response rate: 77%).

Discussion

In this 16-yr follow-up of 1081 women randomly selected from the general population, changes in the prevalence of UI, OAB, and other LUTS were assessed over time. To our knowledge, this is the first population-based long-term longitudinal study determining the natural course of LUTS in women aged ≥20 yr. There was a marked overall increase in the prevalence of UI, urgency, OAB, and nocturia from 1991 to 2007. The cumulative incidences of UI, urgency, and OAB were 21%, 20%, and 20%,

Conclusions

UI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms, however, were considerable.

References (22)

  • D.E. Irwin et al.

    Impact of overactive bladder symptoms on employment, social interactions and emotional well-being in six European countries

    BJU Int

    (2006)
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