Despite significantly hampering the quality of life for millions of individuals, urinary incontinence frequently remains shrouded in secrecy and shame. Combat the confusion for those suffering, heighten your own knowledge, and help bring the condition out into the open, with NIHR’s snapshot of exciting research.
The Sexual Health Impact
One of the major negative effects of urinary incontinence which has fallen under the public’s conversational radar has been its intrusion into the sexual health of individuals experiencing the condition. Hoping to bring the extent of this impact to light, a comprehensive BJU International study was conducted, which incorporated information from 3,805 individuals in the English Longitudinal Study of Ageing; a population-representative panel survey of ageing, retirement, and health in middle-aged and older men and women living in England.
In the subsequent findings, women with urinary incontinence reported declines in sexual activity and arousal over the last year, and they expressed increased concern about their frequency of sexual activity and ability to become sexually aroused. Conversely, men with urinary incontinence reported declines in sexual desire, increased erectile and orgasm difficulties, and concern about these sexual functions.
‘Our findings highlight strong links between urinary incontinence and a number of negative outcomes regarding sexual health. Both urinary incontinence and later-life sexuality remain taboo subjects in society and are likely to be under-reported as co-existing health problems,’ commented lead author, Dr David Lee, of Manchester Metropolitan University.
‘Given the relatively high occurrence of incontinence, particularly among women, healthcare professionals should be aware of the potential impacts on quality of life and wellbeing, and recognise that sexual activity and satisfaction are key factors in this equation.’
The Risk Factors
Speculation has long been rife regarding the factors which underscore the development of urinary incontinence – and who might be at risk. Offering enlightenment was a large representative British population of individuals in their late 60s, in which the prevalence of urinary incontinence was 15 per cent in men and 54 per cent in women. In the BJU International analysis, urgency urinary incontinence (UUI) was the most common subtype in men, while there were similar proportions of UUI and stress urinary incontinence in women. Additionally, female sex, previous stroke or transient ischaemic attack diagnosis, and increased BMI were risk factors for UUI, while hypertension was a risk factor in men only.
Remarking on the incidence-centred findings, lead author, Dr Alex Tsui, of University College London, said, ‘Although higher BMI was known to contribute to UUI, our findings suggest this may be related to vascular risk factors, in addition to the mechanical contributions of increased body mass. Our results also seem to support more severe UUI symptoms to be a distinct disease entity from milder UUI.’
The Genetic Connection?
Despite the widespread acceptance that genetic or heritable factors are known to contribute to a number of urinary incontinence cases, until recently there has been limited knowledge relating to the identity of the genetic variants associated with the condition. To help bolster our insights and simultaneously assist us in bringing the best course of action to patients, a genome-wide association study was carried out in just under 9,000 women from three groups in Finland and the UK, with the team confirming their findings in six further studies. Analysis of the study data yielded a risk locus for urinary incontinence close to the endothelin gene, known to be involved in the ability of the bladder to contract.
As the number of identified risk variants for urinary incontinence grows, there will be potential to introduce genetic screening for the condition, and improve advice to pregnant women about the likely risks of incontinence in order that they may make an informed choice about delivery method.
Professor Joris Veltman, Director of the Institute of Genetic Medicine at Newcastle University, further explained, ‘This work reveals the first links between urinary incontinence and genetic factors. It provides important insight into the biological mechanisms for incontinence and suggests the potential of identifying women at risk.’
Smashing the Taboo
The day-to-day struggle of urinary incontinence and the necessity of taking action on it on a wider scale was particularly highlighted last year when 10 organisations, including Alzheimer’s Society, Age UK, Marie Curie and Parkinson’s UK, held a workshop to discuss the common problems and potential solutions with patients, carers, researchers and health and social care professionals.
The resulting report details the daily impact of incontinence on older people and people living with long-term health conditions and terminal illnesses like dementia, Parkinson’s, cancer, urinary and gastric issues. And the report authors have thus been calling for the evaluation of the economic impact of incontinence, more dedicated services to support people affected, better training for health and care professionals, and investment in research with a focus on non-drug and non-surgical interventions that allow people affected to take control of their own needs.
Lesley Carter, Clinical Lead at Age UK, warned, ‘Incontinence can have a big impact on an older person’s quality of life, their wellbeing and independence. Too often, people are left to manage alone because they feel too embarrassed to seek help, or when they do, adequate support is not available.
‘We urgently need to break the taboo around incontinence, and invest in dedicated services and training for staff to support people to manage incontinence effectively and remain independent. As our population ages, more and more people will be likely to experience incontinence and as a society, we must act now to end the stigma.’