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Understanding the epidemiology (distribution and determinants) of urinary incontinence (UI), as well as its natural history is a very important issue. In this article, we discuss prevalence, incidence, natural history, and the variations that may be related to race and ethnicity. We focus on epidemiologic population comprising community-dwelling women who are not institutionalized. Our review clearly shows that there is a lack of advanced epidemiologic analyses. Variables that better characterize UI include frequency measure, quantity of urine loss, duration, type, and severity. These factors should be incorporated into basic study design so that more advanced and informative analyses may be conducted.

Objectives. To assess, by means of a survey, the impact of the symptoms of overactive bladder (urinary frequency, urgency, and urge incontinence) on the quality of life in a community-based sample of the U.S. population. Methods. A telephone survey was conducted in the United States among an age and sex-stratified sample of 4896 noninstitutionalized adults 18 years of age and older. From the responses to the telephone survey, a total of 483 individuals with symptoms of overactive bladder and 191 controls completed a mailed follow-up questionnaire to assess their quality of life using the Medical Outcomes Study Short-Form 20. Results. After adjustment for age, sex, and the use of medical care, the greatest differences in the quality-of-life scores between the patients with incontinent overactive bladders and the controls were in the health perception (17.6 points; P

Although diuretics have been implicated as a cause oJ urinary incontinence, no evidence has been presented prior to this report to confirm such a relationship. Our epidemiologic survey oJ 1,956 respondents sixty years of age and older in Washtenaw County, Michigan, revealed 24.6 percent oJ men and 36.9 percent oJ women were current users oJ a diuretic medication. Comparisons between users and non-users of diuretics and continence and in- continence status revealed no significant diJJerence in the prevalence Of incon- tinence in either gender. However, when male respondents who had cystomet- ric examinations were analyzed, it was found that diuretic users who have uninhibited detrusor contractions (UDC) had a significantly higher prevalence of urinary incontinence (85.7%) when compared with non-users with UDC (25 %) (p = 0.009)/Among men who did not have UDC, use or non-use of diuretics showed a similar relationship but did not reach statistical significance (p = O. 085). There were too Jew female respondents with UDC to make mean- ingful analysis in this group.

Most urodynamic tests currently in use in the evaluation of female urinary incontinence have not been applied to a community-based sample to determine their specificity. In this study of a random sample of noninstitutionalized elderly, 258 self-reported continent and 198 self-reported incontinent women sixty years and older, who participated in a household survey, underwent a clinic evaluation (history, physical examination, and urinalysis); of these, 67 continent and 100 incontinent female respondents underwent urodynamic testing. The uroflowmetry, cystometry, and supine static urethral pressure profilometry (UPP) findings did not differ significantly between continent and incontinent subjects (whether based on a self-report or a clinician's diagnosis of urinary continence status). Standing static and dynamic UPP and lateral eystography showed significant differences between self-reported continent and incontinent respondents. The provocative stress test significantly distinguishes continence from incontinence, and stress incontinence from other types. The sensitivity of the provocative stress test was 39.5 percent, whereas its specificity is 98.5 percent. Urodynamic testing including uroflow study, static UPP, and lateral eystography should not be used as a screening test but rather selectively as a confirmatory test, and to determine the therapeutic approach, and to assess the outcome of therapy.

A probability sample of noninstitutionalized elderly people in Washtenaw County,Michigan was interviewed to determine the relationship between urinary incontinence and various health conditions. The results show that between both male and female respondents physical mobility problems specific neurologic symptoms, lower urinary tract problems, bowel problems, respiratory problems, and history of genital surgery are more prevalent among those who are incontinent than among those who are continent. Additional factors associated with incontinence in females are: history of parent and sibling incontinence, incontinence either during pregnancy or postpartum hearing problems, use of female hormones, and vaginal infections. Incontinence among males is associated with vision problems and a history of and symptoms of cardiovascular disease These findings suggest urinary incontinence is part of a complex and multifactorial problem. Further studies are needed to confirm and explain these findings.

A 4.7 percent surgey rate to correct urine loss conditions was found by a large scale survey of sixty-year and older non-institutionalized women in a Michigan county. The initial post- operative results reported by the respondents were 74 percent complete continence and 23 percent partial relief. The long-term self-reported outcomes (two years or more post-surgery) were an abso- lute continence rate of 39 percent and 17 percent with mild incontinence (the median time since surgery was 12 years), whereas the short term (4-23 months, mean 7.1 months) absolute continence rate was 71 percent. The characteristics of the incontinence respondent who had previous surgery showed 70 percent having mixed stress-urge type of incontinence and 66 percent losing urine almost weekly or daily. Bladder emptying symptoms were reported by 30.4 percent of the continent pre- viously-operated respondents compared with 13.0 percent of the incontinent previously-operated respondents. All continent respondents and 84 percent of the incontinent respondents believed that physicians can help people with a urine loss condition.