Abstract
Objectives:
Although urinary incontinence (UI) becomes more prevalent as women age, little is known about outcomes of UI in midlife women. Our aim was to determine effects of UI (stress and urge) on mood (depressed mood, anxiety), perceptions of self (self esteem, mastery, perceived health), attitudes toward midlife (attitudes toward aging, menopause), and consequences for daily living (interference with relationships and work, sexual desire, physical activity, awakening at night, social support, stress), taking into account the effects of aging.
Methods:
A subset of Seattle Midlife Women’s Health Study participants (n=299 with up to 2206 observations) provided data during the late reproductive, early, and late menopausal transition stages and early postmenopause, including menstrual calendars, annual health questionnaire since 1990, and symptom diaries. Multilevel modeling (R program) was used to test models accounting for UI outcomes.
Results:
Stress UI and UUI were significantly associated with lower self esteem (p. .01 & p <.001, respectively) and mastery (p <.001, SUI & UUI) with age included in the models as a measure of time. UI effects on mood symptoms, attitudes toward aging and menopause, perceived health and consequences for daily life were not significant (p >.05).
Conclusions:
UI during the menopausal transition and early postmenopause appears to affect perceptions of self, but not mood, attitudes toward midlife, or consequences for daily life in this midlife population. Appropriate therapies for UI during midlife may promote higher levels of self esteem and a greater sense of mastery by older women.
Keywords: stress urinary incontinence, urge urinary incontinence, menopausal transition, interference with daily living, mood, self-perceptions, attitudes toward midlife and menopause
With the aging of the population, investigators and clinicians have devoted increased effort to understanding the factors associated with urinary incontinence. Pressed by increasing health care costs linked to the aging population, researchers have emphasized understanding the causes and more recently the consequences of urinary incontinence.1–3 To date research on midlife women has been limited to investigations of the prevalence of urinary incontinence in large, population based studies such as the Study of Women and Health Across the Nation and the Women’s Health Initiative.4–7 Recent efforts to understand the consequences of incontinence for midlife women have revealed them to be multidimensional and complex.
Among the consequences of incontinence are reports of mood changes. Women report mental and emotional health consequences, including anxiety and depression.8–13 In addition, women link health changes14 and use of health services to various types of incontinence.15–17
Perceptions of oneself may change as a consequence of urinary incontinence. Self esteem and women’s sense of control or mastery may be challenged with increasing episodes of incontinence and increasing severity.8,9
Experience of incontinence during midlife may be related to how a woman views her own aging as well as her attitudes toward menopause. Superimposing the experience of incontinence on other experiences related to the menopausal transition, such as irregularity of menses, and unpredictable and uncontrollable symptoms such as hot flashes, may contribute to negative attitudes about this part of the lifespan.8,9,11
Urinary incontinence also may interfere with multiple aspects of daily living. Among these are interference with relationships at home and at work, limitations on physical activity and effects on sexual desire, interference with sleep, stress, and social support .18
Work challenges, including absenteeism and productivity problems occur in conjunction with urinary incontinence and overactive bladder.11,15,19,20 Economic consequences may include lost opportunity costs related to earnings as well as the dollar cost for hygiene products and health care.21 Women identify bother and burden as consequences of incontinence for them and their families.13,17,21–23 Women’s challenges related to incontinence also involve sexual activity and intimate relationships .10,12,14
Although investigators have begun to study UI among midlife women with the intention of discovering etiologic and therapeutic factors, including attention to the menopausal transition and menopause-related factor 4–6, to date they have devoted little attention to the consequences of UI. Therefore, the objectives of these analyses were to determine the effects of stress and urge incontinence on: mood (depressed mood, anxiety), self perceptions (self esteem, mastery, perceived health), attitudes toward midlife (attitudes toward aging, menopause), and consequences for daily living (interference with relationships and work, sexual desire, physical activity, sleep, stress and social support), taking into account effects of aging.
Methods
Design and Sampling
The data for these analyses are part of the Seattle Midlife Women’s Health Study (SMWHS), a large longitudinal study of the menopausal transition and early postmenopause. Women (N=508) were recruited between 1990 and 1992 when most had not yet begun, or were in the early stages of, the transition to menopause.24 All women were between the ages of 35 and 55, had an intact uterus and at least one ovary, reported at least one menstrual period in the prior 12 months and were not pregnant or lactating. After completing an initial in-person interview administered by a trained registered nurse interviewer, 390 women agreed to provide data annually by questionnaire, daily menstrual calendar, and health diary; 367 women completed at least one diary. At the end of 5 years, 243 women were still eligible (not yet 5 years PM; at least one intact ovary) and agreed to continue to participate for an additional 5 years.
The sample for this current study (N=299) is a subset of the original 508 women in the parent study. To be eligible for this study each woman had to provide at least one rating of incontinence sometime during the parent study, not be taking any exogenous estrogen and be in one of the 4 reproductive aging stages (late reproductive, early MT, late MT, early PM).
Measures
Data about incontinence and outcomes were obtained through annual health questionnaires mailed to all active participants after an initial in person interview. Diary data were obtained on days 5, 6 and 7 of the menstrual cycle monthly from 1990 through 2000 and then quarterly from 2001 through 2010. Each occasion of health questionnaire and diary data was matched within 6 months of each other.
Urinary Incontinence was assessed using a series of questions addressing stress and urge urinary incontinence. The item SUI was in a list of chronic diseases women were asked every year, “Do you currently have any of the following health problems? One choice was “leaking urine when you cough or sneeze (stress incontinence)”. This was the only question asked about SUI. It was repeated annually. Another choice for this item was “leaking urine when bladder is full (urge incontinence). This was only asked at the start of the study. Beginning in the 7th year of the study (1997) more specific questions were asked yearly “In the past year, did the sight, sound, or feel of running water usually cause you to lose urine?” (Yes or No) and “Did you often have a severe sense of urgency before losing your urine?”
Outcomes of Incontinence.
Several outcomes of incontinence were examined, including: mood (depressed mood, anxiety), self perceptions (self esteem, mastery, perceived health), attitudes toward midlife (attitudes toward aging, menopause), and consequences for daily living (interference with relationships and interference with work, sexual desire, amount of exercise, awakening at night, perceived stress and social support).
Mood included depressed mood and anxiety. Depressed mood was assessed with the Center for Epidemiologic Studies-Depression scale (CES-D), a 20-item self-report measure of depressive symptoms derived from clinical criteria for major depressive disorder (MDD). Categories included positive affect, negative affect, somatic, and interpersonal symptoms.25 Women rate how often they had a specific feeling during the past week on a 4-point scale from 0 [rarely or none of the time (less than 1 day)] to 3 [most or all of the time (5–7 days). The four items of the positive affect category are worded positively and are reverse coded for computation of total score. The total CES-D score is a sum of the ratings of the 20 items, ranging from 0 to 60. A cut-off of 16 has been used to differentiate depressed from non-depressed individuals. In Radloff’s study,25 test-retest reliability correlations were .40 or above, and internal consistency reliability as measured by Cronbach’s α was .80 or above. In the SMWHS study, α was .89 −.92 across the study. The CES-D was administered annually for 22 years from 1990–2012. Anxiety was assessed using an item in the health diary in which women rated their symptom experience on a scale from 0 (not present) to 4 (extreme).
Self perception included self esteem, mastery, and perceived health. Self esteem was measured with Rosenberg’s Self Esteem Scale.26 Women rated how much they agreed with ten items about how they felt about themselves such as being a person of worth, having a number of good qualities, able to do things as well as others, having a positive attitude toward self. The items were rated on a Likert scale ranging from 1 (agree strongly) to 7 (disagree strongly). Positively worded items were reverse coded; high scores indicate a high self esteem. Cronbach’s α ranged from 0.86 to 0.92 in the SMWHS sample across the years of the study.
Mastery was measured with Pearlin and Schooler’s Mastery Scale.27 Women rated how they currently felt about seven items, such as the extent to which they felt in control of life chances or fatalistically ruled by them on a Likert scale ranging from 1 (agree strongly) to 7 (disagree strongly). Positively worded items were reverse coded; high scores indicate a stronger sense of mastery. Cronbach’s alpha ranged from 0.78 to 0.87 in the SMWHS sample across the years of the study.
Perceived health was measured in the annual health questionnaire from 1995 to the end of data collection using an item asking women to rate their current health on a scale ranging from poor (0) to excellent (10).
Attitudes toward midlife included attitudes toward menopause and attitudes toward aging. Attitudes toward menopause were assessed using the Attitudes toward Menopause Scale developed by Neugarten and associates 28 and revised by Patsdaughter.29 This 28-item Likert type scale assesses women’s attitudes toward menopause as related to negative affect, postmenopausal recovery, extent of continuity, control of symptoms, psychological losses, unpredictability, and sexuality. High scores indicate positive attitudes using a 1 to 4 scale where 1 indicated strongly agree and 4 strongly disagree. (alpha=.74-.79 across the study).
Attitudes toward aging were assessed using a 20 item scale developed by Patsdaughter.29 Women rated each item on a 1 to 4 scale where 1 indicated strongly agree and 4 strongly disagree. High scores reflect positive attitudes toward aging (alpha=.74-.80 across the study).
Consequences for daily living were measured with indicators of interference with work and relationships, both of which were assessed in the health diaries by asking the following questions: How much did the way you feel today interfere with your work or school? With your relationships? Women responded by rating interference on a scale where 0 indicated not at all and 6 indicated a lot.
Other measures of consequences for daily living were level of sexual desire, amount of exercise, awakening at night, perceived stress and social support. Sexual desire was assessed in the diary by asking women to respond to the item: Rate how much you felt sexual desire: 0=not at all, 1=minimally, 2=mildly, 3=moderately, and 4=very much. The reference period for sexual desire ratings was the past 24 hours. Physical activity was measured in the health diary using the question: how many total minutes of non-work related exercise did you do today? (walking, running, biking, swimming, aerobics, sports, work out, gardening, yard work). Awakening at night was assessed by an item in the health diary that asked women to rate their experience on a scale from 0 (not present) to 4 (extreme). Social support was measured with a six-item inventory covering ways that people provide support (being able to talk to someone about very personal and private matters, depend on people to lend or give $50, get important advice from others, receive time and energy from others to help take care of something, and get together with people for fun and relaxation). These areas were adapted from the Arizona Social Support Inventory by Barrera.30 Instead of eliciting numbers of people in each area who might and actually did provide each type of support, this adapted version asks about current support availability for each area rated from 0 (not at all) to 3 (quite a bit). Cronbach`s α for internal consistency reliability ranged from 0.73 to 0.86 across the study. Perceived stress was assessed in the annual health questionnaire with a question “Overall, how do you rate your current level of stress?” Women rated this item from 1 (not at all stressful) to 10 (extremely stressful). Brantley, Waggoner, Jones, & Rappaport31 found that a global stress rating and the sum of stress ratings across multiple dimensions correlated significantly (r=.35, p<.01).
Analysis
Mixed effects modeling using the R library 32–35 was used to investigate the relationships between age as a measure of time and urinary incontinence (stress and urge) to each of the outcomes. A random intercept/random slope model was used. This model postulated that overall levels of the outcome could differ from woman to woman (random intercept; (B1) and the levels of outcome could change with age from woman to woman (random slope; B2). For each of the outcomes given in Tables 2 and 3 age was centered at the mean value to aid in interpretability. Thus, the value of the slope (B2) is the amount of change in the outcome variable (SUI or UUI) for each year of age beyond the mean age for the sample across all the years of the study. Each type of incontinence as a covariate was then modeled to test the effect on each outcome measure. The covariate effect (B3; effect of either SUI or UUI on the outcome) is reported as either an increase or decrease of the outcome variable in the presence of either SUI or UUI and the significance level. A p-value of .05 was used as the criterion for significance.
TABLE 2.
Random-effects models with age (47.5 y) and SUI as predictors (yes, 817; no, 1,432)
| Outcomes | β1 (intercept; group mean) | β2 (slope; age), mean (P) | β3 (covariate; SUI), mean (P) | Women, n | Observations, n |
|---|---|---|---|---|---|
| Mood | |||||
| Depressed mood (CES-D) | 10.60 | –0.13 (<0.001) | 0.56 (0.24) | 298 | 2,206 |
| Anxiety (0−4) | 0.93 | 0.03 (<0.001) | –0.08 (0.12) | 291 | 1,884 |
| Self-perception | |||||
| Self-esteem (1−7) | 5.75 | 0.006 (0.27) | –0.19 (0.01) | 296 | 1,362 |
| Mastery (1−7) | 5.45 | 0.001 (0.83) | –0.20 (0.004) | 296 | 1,382 |
| Perceived health (0−10) | 7.34 | –0.05 (<0.001) | –0.14 (0.22) | 190 | 1,434 |
| Attitudes toward midlife | |||||
| Attitudes toward aging (1−4) | 3.00 | –0.001 (0.77) | –0.01 (0.67) | 289 | 898 |
| Attitudes toward menopause (1−4) | 2.59 | 0.02 (<0.001) | 0.01 (0.60) | 289 | 801 |
| Consequences for daily living | |||||
| Perceived stress (0−10) | 5.69 | –0.04 (0.02) | –0.02 (0.89) | 180 | 1,284 |
| Awakening at night (0−4) | 1.04 | 0.02 (0.01) | 0.13 (0.15) | 142 | 886 |
| Social support (0−3) | 2.20 | 0.001(0.71) | –0.01 (0.70) | 174 | 1,064 |
| Exercise (min/d) | 23.10 | 0.29 (0.12) | –1.95 (0.30) | 288 | 1,475 |
| Sexual desire (1−4) | 1.84 | 0.01 (0.01) | 0.04 (0.42) | 293 | 1,988 |
| Interference with relationships (1−6) | 1.55 | –0.03 (<0.001) | 0.03 (0.63) | 163 | 931 |
| Interference with work (1−6) | 1.51 | –0.01 (0.06) | 0.04 (0.59) | 158 | 879 |
β1, β2, β3 are the fixed effects (group averages) for the intercept (overall mean level), slope (outcome change each year), and covariate (outcome change with urge urinary incontinence present).
σ1, σ2, σε are the random effects (variability) for the intercept, slope, and residual error.
SUI, stress urinary incontinence; CES-D, Center for Epidemiologic Studies-Depression Scale.
TABLE 3.
Random-effects models with age (47.5 y) and UUI as predictors (yes, 318; no, 1,745)
| Outcomes | β1 (intercept; group mean) | β2 (slope; age), mean (P) | β3 (covariate; UUI), mean (P) | Women, n | Observations, n |
|---|---|---|---|---|---|
| Mood | |||||
| Depressed mood (CES-D) | 10.54 | –0.13 (0.002) | 1.12 (0.06) | 296 | 2,048 |
| Anxiety (0−4) | 0.87 | 0.03 (<0.001) | 0.09 (0.17) | 291 | 1,740 |
| Self-perception | |||||
| Self-esteem (1−7) | 5.76 | 0.009 (0.10) | –0.31 (<0.001) | 296 | 1,277 |
| Mastery (1−7) | 5.44 | 0.004 (0.54) | –0.36 (<0.001) | 296 | 1,263 |
| Perceived health (0−10) | 7.28 | –0.05 (<0.001) | –0.20 (0.17) | 186 | 1,410 |
| Attitudes toward midlife | |||||
| Attitudes toward aging (1−4) | 3.01 | –0.001 (0.57) | –0.04 (0.14) | 290 | 868 |
| Attitudes toward menopause (1−4) | 2.60 | 0.01 (<0.001) | –0.03 (0.18) | 289 | 860 |
| Consequences for daily living | |||||
| Perceived stress (0−10) | 5.69 | –0.04 (0.02) | 0.12 (0.53) | 180 | 1,283 |
| Awakening at night (0−4) | 1.11 | 0.02 (0.12) | 0.19 (0.12) | 133 | 827 |
| Social support (0−3) | 2.20 | 0.003 (0.28) | –0.06 (0.15) | 174 | 978 |
| Exercise (min/d) | 22.47 | 0.28 (0.16) | 1.16 (0.65) | 198 | 1,807 |
| Sexual desire (1−4) | 1.85 | 0.01 (0.01) | 0.03 (0.57) | 290 | 1,368 |
| Interference with relationships (1−6) | 1.54 | –0.02 (<0.001) | 0.14 (0.44) | 292 | 1,844 |
| Interference with work (1−6) | 1.52 | –0.01 (0.11) | 0.07 (0.48) | 163 | 846 |
β1, β2, β3 are the fixed effects (group averages) for the intercept (overall mean level), slope (outcome change each year), and covariate (outcome change with UUI present).
σ1, σ2, σε are the random effects (variability) for the intercept, slope, and residual error.
UUI, urge urinary incontinence; CES-D, Center for Epidemiologic Studies-Depression Scale.
Results
At entry to the SMWHS in 1990–1992, the original sample of 508 women had a mean age of 41.7, with 77% white, 11.4% black, and 8.5% Asian American or Pacific Islander, reflecting approximately the proportions of each racial/ethnic group in the underlying population at that time. These women had a mean education of 15.6 years, with a range from completion of tenth grade to completion of a graduate degree. The majority was married or partnered (68.5%) and employed (86.2%).
As seen in Table 1, the subset of women who were eligible to participate in these analyses was similar to those not eligible for inclusion with respect to age, employment status, and marital status. Those with eligible data were better educated, more likely to be white, and have a lower BMI than those not in the analyses. For the analyses the number of observations across the study for SUI were 817 Yes and 1432 No; for UUI 318 Yes and 1745 No.
TABLE 1.
Characteristics of eligible and ineligible women, at the start of study (1990–1991), in the mixed-effects modeling analyses of urinary incontinence outcomes
| Characteristic | Eligible women (n = 298) | Ineligible women (n = 210) | P |
|---|---|---|---|
| Age, mean (SD), y | 41.5 (4.3) | 42.0 (5.0) | 0.21a |
| Years of education, mean (SD) | 15.9 (2.8) | 15.3 (3.1) | 0.05a |
| Body mass index, mean (SD), kg/m2 | 25.2 (5.4) | 27.3 (7.2) | <0.001a |
| Currently employed, n (%) | |||
| Yes | 257 (86.2) | 181 (86.2) | 0.54b |
| No | 41 (13.8) | 29 (13.8) | |
| Race/ethnicity, n (%) | |||
| African American | 21 (7.0) | 37 (17.6) | 0.001b |
| Asian /Pacific Islander | 28 (9.4) | 15 (7.1) | |
| White | 243 (81.5) | 148 (70.5) | |
| Other (Hispanic, mixed) | 6 (2.0) | 10 (4.8) | |
| Marital status, n (%) | |||
| Married/partnered | 211 (70.8) | 137 (65.2) | 0.21b |
| Divorced/widowed/not partnered | 65 (21.8) | 60 (28.6) | |
| Never married/partnered | 22 (7.4) | 13 (6.2) |
Independent t-test
χ test
Using random intercept/random slope multilevel models with age centered at the overall mean of 47.5 years, the effects of SUI on mood, self perception, attitudes toward midlife and consequences for daily living were analyzed. SUI had significant negative effects on self perception as indicated by self esteem and mastery (see Table 2). The mean self esteem score at age 47.5 for all women in the sample was 5.75 (SD= .78). For women with SUI there was a significant (p=.01) decrease in self esteem of .19 units compared to those without SUI. The mean mastery score at age 47.5 for all women in the sample was 5.45 (SD= .78). For women with SUI there was a significant (p=.004) decrease in mastery of .20 compared to those without SUI. SUI did not significantly change perceived health or any of the indicators of mood, attitudes toward midlife or consequences for daily living.
As seen in Table 2, age affected many of the outcomes studied. Age alone was associated with a significant change in mood: there was a mean decrease in depressed mood of .13 per year (p<.001) (1.3 units per decade) and a slight mean increase in anxiety of .03 per year (p<.001) (.3 units per decade). Perceived health had a significant age effect with a decrease of .05 per year (p<.001) (.5 units per decade). Other significant age effects were attitudes toward menopause (.02 unit increase per year, p<.001), perceived stress (.04 unit decrease per year, p.02), awakening at night (.02 unit increase per year, p.01), level of sexual desire (.01 unit increase per year, p.01), interference with relationships (.03 unit decrease per year, p<.001) and interference with work (.01 unit decrease per year, p.01). There were no significant age effects for attitudes toward aging, social support and amount of exercise per day.
When the effects of UUI were analyzed on these same measures, there were significant negative effects on self esteem and mastery, as with SUI but with greater effect (see Table 3). The mean self esteem score at age 47.5 for all women in the sample was 5.76 (SD= .78). For women with UUI there was a significant (p=.01) decrease in self esteem of .31 units compared to those without UUI. The mean mastery score at age 47.5 for all women in the sample was 5.44 (SD= .78). For women with UUI there was a significant (p=<.001) decrease in mastery of .36 compared to those without UUI. UUI did not significantly change perceived health or any of the indicators of mood, attitudes toward midlife or consequences for daily living. However, UUI was marginally associated with an increase in depressed mood (CESD scores) of 1.12 units (p=.06) compared to those without UUI. Also age alone had effects very similar to the SUI sample for change in mood, perceived health, attitudes toward menopause, perceived stress, sexual desire and interference with relationships (see Table 3). Unlike the SUI sample, for the UUI sample, age did not have a significant effect on awakening at night and interference with work. There were also no significant effects of age on self esteem and mastery, attitudes toward aging, social support and amount of exercise per day.
Discussion
Examination of the consequences of SUI and UUI revealed no differential significant effects of the type of incontinence on outcomes. Stress or urinary incontinence were significantly associated with lower self esteem and mastery, but not associated with mood, perceived health, attitudes toward midlife or consequences of daily life. UUI was associated marginally with increased depressed mood, meriting further study.
Effects of UI on self esteem and sense of mastery are consistent with the nature of women’s experience of SUI that may involve managing unpredictable events, such as a sneeze or cough, that may lead to involuntary loss of urine. Clearly, these experiences are beyond women’s control, and may threaten perceptions of control or mastery and diminish one’s sense of self esteem or self-worth. Likewise, UUI produces a sense of urgency that may be associated with worrying about urine loss and access to toileting facilities. In turn, these experiences may contribute to a lack of perceived control or mastery over one’s body as well as diminished self-esteem. For women with UUI, these experiences may, in time, become associated with negative mood and begin to influence social functioning and engagement. Coyne and associates 20 found that women with UUI had significantly worse health-related quality of life than those with SUI and suggested that women with SUI could adapt their lifestyles more readily to managing a cough or sneeze by using techniques such as the “knack” maneuver 37 or avoiding heavy lifting or exercise. Those experiencing UUI are less likely to be able to control their incontinence and may find themselves in a cycle of loss of control leading to depressed mood, reinforced by continuing incontinence.9,13 More study is needed about the association between UUI and mood.
These findings point to important consequences of urinary incontinence in general that compromise how women think of themselves and their bodies and are informed by theory about embodiment and women’s health. Embodiment refers to the intertwining of body and mind, enabling reciprocity between a person and the external world. The body constitutes a material self and thus the self is never separate from its own materiality.38 Women experiencing urinary incontinence may redefine themselves in ways that reflect lack of control. As their bodies lack the ability to control or contain urine, women redefine themselves as having lost a sense of control or mastery, appraising themselves as less worthy of esteem. For women who struggle with UUI, the declining control may become depressing. Indeed, “resigned hopelessness” is a phrase used to describe the situation of those who have lost bladder control.39 The reciprocity between a person and the external world is mediated by one’s sense of self, including the esteem one accords oneself and perceives is accorded in social interactions. Because incontinence is a highly stigmatizing condition, women living with incontinence feel devalued and may be reluctant to seek professional or lay help for their symptoms and some develop self care designed to conceal their incontinence that may include increasing social isolation. Withdrawal, heightened vigilance, and concealment efforts may characterize the lives of those who experience more severe incontinence. The recent adoption of the term overactive bladder (OAB) by the international Continence Society has signaled an effort by professional groups to address some of the stigma associated with incontinence.
Conclusions
Effects of incontinence observed in this sample of midlife women were limited to self-perceptions of self esteem and mastery, unlike those reported for older women. It may be that during midlife women experience less severe incontinence, involving only losing a few drops of urine during an episode, whereas older women may have more severe incontinence. Alternatively, midlife women with the most severe urinary incontinence may have already sought treatment for the problem, thus eliminating them from those reporting incontinence symptoms as part of this study. Women with less severe SUI or UUI may not yet experience disruption of activities of daily living, mood, attitudes toward midlife, and perceptions of their health. In addition, these data are from a subset of women participating in a longitudinal study of the menopausal transition and early postmenopause, with attendant bias related to loss of follow-up such that those with advantages of more education and lower BMI remained in the study over a longer period of time.
Limitations of this study include a lack of data on severity of incontinence and change in amount of incontinence. Another limitation is the overall age of our sample. Because UUI is reported more frequently postmenopause, and increases in prevalence after age 60 years, most of the observations of incontinence in this study occurred during the late reproductive and early menopausal transition (40% and 24% respectively) vs in the late transition or postmenopause (15% and 20 % respectively). Thus there were fewer opportunities for women to be old enough to experience UUI than SUI.
Replication of these analyses in a larger sample of midlife women studied over a longer period of time, thus providing a lifespan view of incontinence with an extended age range, and inclusion of more ethnically diverse women could enhance our understanding of the consequences of incontinence for this age group of women. Likewise, more intensive interviews with women about the nature of their experiences with incontinence could deepen our understanding of the meaning of this experience for midlife women.
Disclosures:
Data reported here were collected with support from grants from the National Institute of Nursing Research, P50-NU02323, P30-NR04001, and R01-NR0414. Data analysis for this paper was supported by a grant from Pfizer Pharmaceuticals. We acknowledge the contributions of Don Percival, PhD, who designed the analytic strategies for this paper.
Footnotes
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Conflicts of interest/financial disclosures: Dr. Woods reports board membership: Procter and Gamble.
Contributor Information
Nancy Fugate Woods, Family and Child Nursing, University of Washington.
Ellen Sullivan Mitchell, Family and Child Nursing, University of Washington.
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