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Urinary Incontinence and Diabetes in Postmenopausal Women

¹ Northwest Health Services Research and Development Program, VA Puget Sound, Seattle, Washington
² Department of Medicine, University of Washington, Seattle, Washington
³ Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington
⁴ Department of Epidemiology, University of Washington, Seattle, Washington
⁵ Epidemiologic Research and Information Center, VA Puget Sound, Seattle, Washington

Address correspondence and reprint requests to Sara L. Jackson, MD, MPH, University of Washington, Department of Medicine, VA Puget Sound, 1825 N. 52nd St., Seattle, WA 98103. E-mail: sljack{at}u.washington.edu

OBJECTIVE—This study evaluates diabetes characteristics and other risk factors for urinary incontinence among community-dwelling postmenopausal women.

RESEARCH DESIGN AND METHODS—We performed a cross-sectional analysis of a population-based study of 1,017 postmenopausal women (218 with diabetes), aged 55–75 years, enrolled from a health maintenance organization. Outcomes included any incontinence and severe incontinence in the prior month.

RESULTS—Overall, 60% of women had any incontinence in the prior month and 8% had severe incontinence. Parity and postvoid residual bladder volume were not associated with incontinence. Oral estrogen and vaginal estrogen use were positively associated with a report of any incontinence but not severe incontinence. A history of urinary tract infection (UTI) and measures of general health were associated with both outcomes. Women with diabetes reported disproportionately more severe incontinence, difficulty controlling urination, mixed (stress and urge) incontinence, use of pads, inability to completely empty the bladder, being unaware of leakage, and discomfort with urination (P 0.06). Diabetes duration, treatment type, peripheral neuropathy, and retinopathy were significantly associated with severe incontinence in multiple regression models adjusted for age, education, and history of UTI (P = 0.01–0.06); however, additional adjustment for BMI diminished the strength of association (P = 0.17–0.52).

CONCLUSIONS—Urinary incontinence is highly prevalent among postmenopausal women. Women with diabetes are more likely to experience severe and symptomatic urinary incontinence. UTI history is a major risk factor, postvoid residual bladder volume plays no demonstrable role, and BMI confounds the relationship between diabetes and incontinence among healthy postmenopausal women.

Abbreviations: GHC, Group Health Cooperative • SF-36, 36-item short-form health survey • UTI, urinary tract infection

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