By Marilynn Larkin
NEW YORK (Reuters Health) – Many women don’t seek treatment for urinary incontinence (UI) for reasons that could be addressed if health care providers asked about the condition, researchers say.
To better understand the reasons women give for not seeking UI treatment, Dr. Elaine Waetjen of the University of California Davis School of Medicine, Sacramento, and colleagues analyzed questionnaire data collected from 1995 to 2005 in the Study of Women’s Health Across the Nation (SWAN), a multicenter, multiracial/ethnic, and multidisciplinary longitudinal study of women ages 40 to 55 at baseline.
The researchers focused on the women’s first 9 (mostly annual) healthcare provider visits at six of the seven participating centers. Covariates included type, frequency and duration of urinary incontinence; self-reported race/ethnicity; annual household income; level of difficulty paying for basics; educational level; psychosocial factors such as depression and anxiety; social support systems; and physical factors such as self-assessed health and healthcare utilization.
As reported online July 31 in Menopause, of the 1,339 women reporting UI, 814 (61.0%) said they did not seek treatment for the condition, most often for these reasons: "UI not bad enough" (73%); "UI is a normal part of aging" (53%); and "healthcare provider never asked" (55%).
Women reporting daily UI had higher odds of reporting beliefs about UI causes (adjusted odds ratio, 3.16) and motivational barriers (aOR, 2.36), compared with women who said they had UI less than monthly.
Women with mixed types of UI had lower odds of reporting multiple reasons for not seeking treatment, compared with women who had stress-only or urge-only UI (aOR, 0.78).
African American women were least likely to report any of the reasons for not seeking treatment, whereas women with higher depressive symptom scores were more likely to report beliefs about UI causes (e.g., aging or childbirth) and motivational barriers (e.g., embarrassment) as reasons for not seeking treatment.
African American race (aOR, 0.52) and increasing age (aOR, 0.91) were associated with lower odds of reporting that a healthcare provider never asked about UI.
Nevertheless, the authors state, “In all of our models, for each category of reasons women reported for not seeking UI treatment, interactions between socioeconomic factors (race, level of education, and difficulty paying for basics) and UI frequency and duration were not significant.”
Dr. Waetjen told Reuters Health, “Given these results, healthcare providers could have a bigger impact in helping women with incontinence.”
“First, we suggest that incontinence should be a topic of discussion with midlife and older women during well-woman and other preventive health visits,” she said by email. “Inquiring about whether a woman has a problem with incontinence not only gives her an opportunity to have her problem addressed, but it also gives the clinician the opportunity to educate and dispel erroneous beliefs about incontinence.”
Are women aware of the non-surgical and medication treatment options for UI? “We did not evaluate this in our study,” Dr. Waetjen said. “However, as a clinician who sees patients with this problem, I can say that most women are not aware of options such as pelvic floor physical therapy or pessaries.”
Dr. Kimberly Ferrante of NYU Langone Health in New York City told Reuters Health the findings reflect her own experience. “Patients will often say that they feel urinary incontinence is a normal part of aging. I try to reinforce to them that while it may be common, it is not normal.”
“If they come to see me for another indication such as recurrent urinary tract infections and have answered yes on my questionnaire about urinary incontinence, they will often say that their incontinence is not bad enough to want treatment,” she said by email. “However when I discuss with them the options for treatment, they are often surprised that simple behavioral changes can help them.”
Dr. Ferrante concluded, “I agree with the author’s conclusions that there are interventions we can make from a public health standpoint to better educate our patients and offer treatments to those who might otherwise not bring up their incontinence by simply asking the question.”