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• W2021432016 abstract "Urinary incontinence is a common problem in women and usually manifests as stress incontinence, urgency incontinence, or both (Wu et al. Obstet Gynecol 2014;123:141–8). Most caregivers assume that urinary incontinence, as with many other chronic diseases, increases in incidence and severity with age without significant rates of remission. This large 18-year longitudinal cohort study by Legendre and co-workers of middle-aged French working women gives a more precise picture of the natural history of urinary incontinence and adds to our knowledge of this subject. Most studies on the epidemiology of urinary incontinence are vexed with how to define ‘urinary incontinence’ and this study is no different. Saying ‘yes’ to ‘Do you have trouble holding your urine?’ defined the condition, but answering this question says nothing about if and how much of a bother it was to each woman. Nonetheless, this definition has been used before and likely captures most women with problematic incontinence. The longitudinal nature of this study allowed the authors to better clarify the temporal relations and directions of risk factors for female incontinence. The overall annual incidence rate for all women was 3.3%. As expected, having one or more child, gaining weight, and going through menopause, as well as depression, impaired quality of life (QoL), and social isolation, increased the probability of becoming incontinent. The annual remission rate for urinary incontinence was 6.2%. Interestingly, once a woman developed incontinence, persistence (lack of remission) was more likely with advancing age and weight gain. The only modifiable factor here is weight gain and this effect is modest (HR = 0.99; 95% CI 0.98–0.99); thus it appears to be difficult for a woman to induce a substantive remission of her incontinence with lifestyle changes alone (without other behavioral, medical or surgical treatment). Reaching menopause during follow-up paradoxically was also associated with a higher probability of incontinence remission. The findings about the effects of parity, aging and weight gain are not new nor are they surprising. The associations of psychological and behavioural disorders such as depressive symptoms and impaired health-related QoL (Quality of Life; social isolation and energy dimensions) are also not new. However, the direction of effect is: most assume that the depressive and impaired QoL symptoms follow the incontinence (as with many other chronic disabilities), but the authors contend that the psychological and social abnormalities precede the incontinence, and propose some physiologic mechanisms to explain this effect. Future research into this association and issues of causation are clearly needed. The various effects on a woman of menopause and hormone replacement are complex and remain poorly understood. Menopause appears to increase both the incidence of urinary incontinence and its probability of remission. The authors wonder if this paradox might be explained by different proportions of stress and urge incontinence in the women as they age and achieve menopause. Likewise, as most menopausal women in this cohort apparently took hormone replacement therapy (HRT), the controversial roles of various types of HRT on urinary incontinence cannot be clarified here. More and better research is needed on this important topic. In conclusion, urinary incontinence is a common problem that can progress and regress in a woman's lifetime. Advancing age and parity are probably the strongest risk factors for developing urinary incontinence. Control of weight gain and avoidance or treatment of some mood disorders might help a woman decrease her chance of becoming incontinent or promote its regression. Ethicon – consultant." @default.
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• W2021432016 title "Urinary incontinence in women comes and goes, and reasons remain elusive" @default.
• W2021432016 doi "https://doi.org/10.1111/1471-0528.13231" @default.
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