Risk factors for urinary, fecal, or dual incontinence in the Nurses' Health Study

To estimate the prevalence of urinary incontinence, fecal incontinence, and dual incontinence in a large cohort of older women and compare risk factors across the three conditions.

These cross-sectional analyses used data from the Nurses' Health Study. The 2008 questionnaire, mailed to 96,480 surviving participants aged 62-87 years, included two separate items on the prevalence of urinary and fecal incontinence. A response of leakage at least once per month defined incontinence for both urine and stool. Dual incontinence was defined by responses at this frequency for both conditions. Using a polytomous logistic regression model, we assessed each risk factor for prevalence of urinary, fecal, and dual incontinence.

The survey was completed by 64,396 women. Thirty-eight percent had urinary incontinence alone, 4% had fecal incontinence alone, and 7% had dual incontinence. Age older than 80 years compared with age younger than 70 years was associated most strongly with dual incontinence (odds ratio [OR] 2.49, 95% confidence interval [CI] 2.28-2.73) followed by depression (OR 2.28, 95% CI 2.13-2.43), neurologic disease (OR 1.84, 95% CI 1.65-2.07), functional limitations (OR 1.86, 95% CI 1.71-2.02), multiparity (OR 1.66, 95% CI 1.41-1.94), and heavier fetal birth weight (OR 1.24, 95% CI 1.10-1.41). Obesity was associated only with urinary incontinence (OR 1.99, 95% CI 1.90-2.08) and type 2 diabetes mellitus was a stronger risk factor for fecal than urinary incontinence (OR 1.43, 95% CI 1.28-1.59). Black race was associated with a reduced risk of all types of incontinence, especially dual incontinence (OR 0.30, 95% CI 0.21-0.44).

In this large cohort, dual incontinence was primarily associated with advanced age, decompensating medical conditions, depression, and multiparity.

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