Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.
Am J Obstet Gynecol. 2018 May;218(5):502.e1-502.e8. doi: 10.1016/j.ajog.2018.01.045. Epub 2018 Feb 6.
Symptoms of urinary incontinence are commonly perceived to vary over time; yet, there is limited quantitative evidence regarding the natural history of urinary incontinence, especially over the long term.
We sought to delineate the course of urinary incontinence symptoms over time, using 2 large cohorts of middle-aged and older women, with data collected over 10 years.
We studied 9376 women from the Nurses' Health Study, age 56-81 years at baseline, and 7491 women from the Nurses' Health Study II, age 39-56 years, with incident urinary incontinence in 2002 through 2003. Urinary incontinence severity was measured by the Sandvik severity index. We tracked persistence, progression, remission, and improvement of symptoms over 10 years. We also examined risk factors for urinary incontinence progression using logistic regression models.
Among women age 39-56 years, 39% had slight, 45% had moderate, and 17% had severe urinary incontinence at onset. Among women age 56-81 years, 34% had slight, 45% had moderate, and 21% had severe urinary incontinence at onset. Across ages, most women reported persistence or progression of symptoms over follow-up; few (3-11%) reported remission. However, younger women and women with less severe urinary incontinence at onset were more likely to report remission or improvement of symptoms. We found that increasing age was associated with higher odds of progression only among older women (age 75-81 vs 56-60 years; odds ratio, 1.84; 95% confidence interval, 1.51-2.25). Among all women, higher body mass index was strongly associated with progression (younger women: odds ratio, 2.37; 95% confidence interval, 2.00-2.81; body mass index ≥30 vs <25 kg/m; older women: odds ratio, 1.93; 95% confidence interval, 1.62-2.22). Additionally, greater physical activity was associated with lower odds of progression to severe urinary incontinence (younger women: odds ratio, 0.86; 95% confidence interval, 0.71-1.03; highest vs lowest quartile of activity; older women: odds ratio, 0.68; 95% confidence interval, 0.59-0.80).
Most women with incident urinary incontinence continued to experience symptoms over 10 years; few had complete remission. Identification of risk factors for urinary incontinence progression, such as body mass index and physical activity, could be important for reducing symptoms over time.
尿失禁症状通常被认为会随时间变化；然而，关于尿失禁的自然病程，特别是长期病程，定量证据有限。
我们旨在通过两项大型中年和老年女性队列研究，利用 10 年的数据来描绘尿失禁症状随时间的变化过程。
我们研究了护士健康研究中的 9376 名年龄在 56-81 岁的女性，基线时年龄为 56-81 岁，以及护士健康研究 II 中的 7491 名年龄在 39-56 岁的女性，这些女性在 2002 年至 2003 年间出现了新发尿失禁。尿失禁严重程度通过 Sandvik 严重指数测量。我们追踪了 10 年内症状的持续、进展、缓解和改善情况。我们还使用逻辑回归模型检查了尿失禁进展的危险因素。
在 39-56 岁的女性中，39%有轻度、45%有中度、17%有重度尿失禁；在 56-81 岁的女性中，34%有轻度、45%有中度、21%有重度尿失禁。在所有年龄段中，大多数女性报告在随访过程中症状持续或进展；很少有（3-11%）报告缓解。然而，年轻女性和尿失禁起始程度较轻的女性更有可能报告症状缓解或改善。我们发现，只有年龄较大的女性（75-81 岁与 56-60 岁相比；比值比，1.84；95%置信区间，1.51-2.25）的增龄与进展的几率较高有关。在所有女性中，较高的体重指数与进展密切相关（年轻女性：比值比，2.37；95%置信区间，2.00-2.81；体重指数≥30 与<25kg/m；年龄较大的女性：比值比，1.93；95%置信区间，1.62-2.22）。此外，较高的身体活动与进展为严重尿失禁的几率降低相关（年轻女性：比值比，0.86；95%置信区间，0.71-1.03；活动量最高与最低四分位数相比；年龄较大的女性：比值比，0.68；95%置信区间，0.59-0.80）。
大多数新发尿失禁的女性在 10 年内仍持续出现症状，很少有完全缓解。确定尿失禁进展的危险因素，如体重指数和身体活动，可能对随时间减轻症状很重要。
