Mental Health Woes Prevalent in Women With Urinary Incontinence

Women with urinary incontinence are significantly more likely to have mental health problems than women without incontinence, results of a large survey suggest.

In a nationwide survey in Portugal that included 10,038 women, among participants who reported having urinary incontinence, there was a significantly higher number of cases of depression, as well as more mental health consultations, problems concentrating, and feelings of guilt or worthlessness than among women without incontinence, reported Pedro Ramos, MD, from Centro Hospitalar Universitário São João, in Porto, Portugal.

"Clinicians should be aware of this association in order to have a high level of suspicion of mental health status when assessing women with urinary incontinence, and therefore to treat them effectively," he said in a narrated electronic poster presented during the European Association of Urology 2021 Annual Meeting (EAU 2021).

"The high levels of depression and low self-worth in women who reported having incontinence are very concerning," said lead author Margarida Manso, MD. "Urinary incontinence can be treated, and although there are some potential side effects from treatment, for some women, these may be preferable to the mental health impacts of the condition."

Christopher Chapple, MD, from Sheffield Teaching Hospitals NHS Foundation Trust, in the United Kingdom, who was not involved in the study, commented that "urinary incontinence is an extremely important clinical condition which is often not recognized by doctors until patients have been suffering for some time. It has a devastating impact on anyone affected by it ― predominantly women but also some men.

"It is important that patients with urinary incontinence are identified at an early stage after it develops and investigated and treated appropriately," he added.

Nationwide Survey Details

Manso and colleagues analyzed data from a population-based health survey that included a representative sample of 10,038 Portuguese women aged 18 years and older. Those with self-reported symptoms of urinary incontinence in the previous 12 months were classified as having incontinence.

Among participants with and among those without incontinence, the investigators compared the prevalence of depression and other mental health conditions, the number of mental health consultations, and addictive behaviors, specifically, smoking and alcohol use.

The data were adjusted for age, education level, and body mass index.

Notably, they found that the nationwide prevalence of urinary incontinence among women was 9.9%. In contrast, the estimated prevalence of urinary incontinence among women in the United States is 55%, according to members of the Symptoms of Lower Urinary Tract Dysfunction Research Network.

Manso and colleagues found that among women with urinary incontinence, the adjusted prevalence ratio of depression diagnoses was higher (1.66; 95% CI, 1.43 – 1.92), as was the use of mental health consultations (1.41; 95% CI, 1.03 – 1.93).

In addition, among women with incontinence, the prevalence ratio was higher with regard to self-reported poor health status (1.65; 95% CI, 1.46 – 1.88), difficulty in concentrating (1.58; 95% CI, 1.38 – 1.82), and a feeling of worthlessness or guilt within the past 2 weeks (1.49; 95% CI, 1.33 – 1.67).

"Surprisingly, there was no difference in terms of addictive behavior, especially [current] smoking," Ramos said.

"We believe the conversation between patients and their urologists needs to change," Manso said. "Clinicians should be asking patients about their mental health when discussing treatments, because treating their physical challenges could help with the psychological cost of the condition.

"Personally, I will be emphasizing this more with my patients and trying to understand better the mental burden of living with incontinence," she said.

The study was internally funded. The authors and Chapple have disclosed no relevant financial relationships.

European Association of Urology 2021 Annual Meeting (EAU 2021): Abstract PO0093. Presented July 8, 2021.

Neil Osterweil, an award-winning medical journalist, is a long-standing and frequent contributor to Medscape.

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