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Objectives: To assess the proportion of women who visit their doctor because of urinary incontinence and investigate factors associated with help-seeking., Design: Postal invitation, questionnaire covering many health topics including urinary incontinence, received at a screening station., Setting: The Norwegian EPINCONT Study is part of a large cross-sectional population-based survey performed in the county of Nord-Trøndelag during the period 1995-97., Subjects: 6625 women (out of 27,936 participating women), 20 years or older, categorised as incontinent according to their answers to the questionnaire., Results: 26% of the incontinent women had seen a doctor for their incontinence. Increasing age, impact, severity and duration were all significantly associated with consultation rate, as were urge and mixed types compared with stress incontinence, and having visited any doctor during the previous 12 months. Fifty percent of the women with significant incontinence (moderate/severe incontinence perceived as troublesome) had seen a doctor because of their incontinence., Conclusions: Only a fourth of the women with any incontinence, and half of the women with significant incontinence had consulted a doctor. Older age and high impact of the symptoms were the factors most strongly associated with help-seeking.

Objectives: The aim was to assess the prevalence of any urinary leakage in an unselected female population in Norway, and to estimate the prevalence of significant incontinence., Methods: The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995-97. Everyone aged 20 years or more was invited. 27,936 (80%) of 34,755 community-dwelling women answered a questionnaire. A validated severity index was used to assess severity., Results: Twenty-five percent of the participating women had urinary leakage. Nearly 7% had significant incontinence, defined as moderate or severe incontinence that was experienced as bothersome. The prevalence of incontinence increased with increasing age. Half of the incontinence was of stress type, 11% had urge and 36% mixed incontinence., Conclusions: Urinary leakage is highly prevalent. Seven percent have significant incontinence and should be regarded as potential patients.

Background: Several reports have been published showing that women with urinary incontinence (UI) can be taken care of and treated satisfactorily in general practice., Aim: To find out whether the treatment of women with UI in general practice is effective also in the long term., Method: One hundred and five women with UI who consulted their general practitioner (GP) were examined and treated according to a treatment protocol. Treatment options were pelvic floor exercises, electrical stimulation, oestrogen supplements, bladder training, and protective pads. Three to six years after inclusion, all women received a postal questionnaire to evaluate the long-term effectiveness of treatment. Women who had been referred to a specialist were excluded., Results: Eighty out of 82 eligible patients answered the questionnaire after a mean follow-up period of 56 months. Twenty-seven per cent were continent, 26% much better, 23% a little better, 21% unchanged, and 3% were worse compared with before the treatment. The median score on a 100 mm visual analogue scale was 16 compared with 31 before treatment, and the percentage of women that were 'much' or 'a great deal' bothered by UI was reduced from 35% to 12%. The percentage of women with severe UI was reduced from 59% to 30%, and the number of women using pads was reduced from 62% to 39%., Conclusion: This study confirms that management of female UI in general practice is effective also in the long term.

The aim of this study was to provide valid data on the demography, medical history and clinical findings among adult women presenting with urinary incontinence to general practitioners. In a rural community in Norway, all women > 20 years who consulted their general practitioner for urinary incontinence during a 3 year period were included in a prospective study. A thorough medical history and both a general and focused clinical examination were undertaken. Gynecological examination, stress provocation test, and 48 h frequency/volume chart and pad weighing test were also performed. 105 women were included (4.4% of women > 20 years in the total population). Mean age was 57 years, 64% were postmenopausal. A lot of comorbidity was reported. Duration of incontinence was > 5 years in 49%. By a severity index, 64% were classified as severe, 28% as moderate and 8% as having slight incontinence. 59% were using protective pads or garments. Mean leakage per 24 h was 31 g. 38% had significant genital prolapse. Contractility of the pelvic floor muscles was weak in 28%. Diagnostic classification revealed 50% stress incontinence, 10% urge and 40% mixed incontinence. 42% of the patients were a great deal or much bothered by their incontinence. Patients with stress incontinence were less bothered than others. Women presenting with urinary incontinence at a primary care level are prevalent, and often have significant incontinence. It is a challenge for the general practitioners to investigate and treat these patients optimally.

Background and Objectives: Patient vignettes are often used for investigating the performance of physicians. The purpose of this study was to assess the criterion validity of vignettes., Methods: A random sample of incontinent women were interviewed, and vignettes depicting their cases were later presented to their own physicians. Questionnaires sent to the physicians included open questions about what drug treatment the doctor would give and a checklist (cueing items) for indicating other possible actions. Analysis compared actions taken with vignette patients and actual actions taken with the real patients., Results: Thirty-two general practitioners and 32 patients were included in the study. When cueing items were provided, the physicians claimed more actions with vignettes than were actually performed. Mean difference was 1.9 actions per case (95% confidence interval 1.3 to 2.4). No such difference was found for the open question. When cues were provided, the likelihood ratio for reporting a vignette action in comparison with actually performing the action with a similar real patient was 2.8 (2.2 to 3.5), and Kappa .39. When no cues were provided, the likelihood ratio was 5.1 (2.6 to 10), and Kappa .45. Total number of actions with vignettes and real patients correlated significantly (r = .65, P < .001)., Conclusions: Responses to vignettes with cueing items overestimate real performance. The agreement may be better when no cues are offered. The method may have acceptable validity for group comparisons.

The objective was to study explanatory factors for help-seeking among incontinent women, and what was the outcome of the treatment. A questionnaire was mailed to all 2366 women aged 20 or over in the rural community of Rissa, Norway. Women confirming incontinence gave information about duration, precipitating factors, frequency, amount of leakage, and impact. Questions about doctor consultation or planned consultation, treatment and results were included. Women with incontinence which had resolved without treatment were also recorded. A total of 77% answered the questionnaire. Twenty per cent of women with incontinence (n = 535) had consulted a doctor, 18% had planned to consult. Increasing age and duration, and urge/mixed type of incontinence were determinative factors for doctor consultation, while increasing severity and impact were determinative for planned consultation. Drugs, exercises, pads, and electrostimulation were all important treatment options: 21% were cured, 40% much better after treatment. Of all the women, 8% reported that they had been incontinent in the past, and only 18% of these had consulted a doctor.

Study Objective: The aim was to validate a simple severity index of female urinary incontinence for subsequent use in an epidemiological survey., Design: The index was created by multiplying the reported frequency (four levels) by the amount of leakage (two levels). The resulting index value (1-8) was further categorised into slight (1-2), moderate (3-4), and severe (6-8). It was validated against a 48 hour "pad weighing" test. Thereafter, an anonymous postal questionnaire survey was performed and the index was used to assess the severity of the leakage. A question about the impact of incontinence was also included., Setting: The outpatient clinic of the Department of Gynaecology and Obstetrics, Trondheim University Hospital and the rural community of Rissa, Norway., Participants: Altogether 116 incontinent women referred to the clinic by their GP and all 2366 adult women living in Rissa., Results: The difference in median pad weights between moderate and slight incontinence was 9g/24h (95% confidence interval 0-27). The corresponding difference between severe and moderate incontinence was 17g/24h (95% CI 5-30). In the epidemiological survey 29.4% reported urinary incontinence (response rate 77%). The prevalence tended to be highest in middle life and old age. Forty six per cent were classified as slight, 27% moderate, and 27% severe. There was a strong correlation between severity and impact (R = 0.59, p < 0.001)., Conclusion: The severity index may be a useful tool for assessing the severity of female urinary incontinence in epidemiological surveys. It is confirmed that urinary incontinence is very prevalent in adult women, but most should not be regarded as potential patients.

One hundred and eighty-seven Norwegian women with urinary incontinence (UI) were interviewed after having responded to a marketing campaign for incontinence aids. Nineteen per cent stated that UI was a negligible problem. Urge incontinence was associated with more mental distress, practical inconveniences, and social restrictions than stress incontinence. Young women were more handicapped by stress incontinence than old women. Severe incontinence was associated with more mental distress and practical inconveniences than slight incontinence. A wide variety of control measures was used, the most popular being absorbent products. Only four had not used any control measure. Fifty-seven per cent had mentioned their UI-problem with a doctor. The consultation rate increased with the severity and duration of UI. Only 36% were satisfied with the outcome of the consultation.

Objective: To evaluate rates of subjective and objective cure, treatment satisfaction, pain, and the correlation between cure and body mass index (BMI), at 10 and 20 years after tension-free vaginal tape (TVT) surgery., Design: Retrospective cohort study., Setting: Multicentre study including 19 units in Norway., Population: Women undergoing TVT surgery for stress urinary incontinence (SUI) during 2001-2006 (20-year cohort) and 2011-2012 (10-year cohort)., Methods: The Norwegian Female Incontinence Registry was used to identify women eligible for the study, who answered validated questionnaires about urinary incontinence, pain and satisfaction., Main Outcome Measures: Subjective cure of SUI (with stress index of <3, range 0-12), objective cure (<3 g on stress test) and persisting pain and satisfaction after TVT (scored on a five-point Likert scale)., Results: In total, 1210 of 1903 (64%) patients responded. The subjective cure rate was 68% after 10 years, versus 59% after 20 years, and did not significantly differ after adjusting for age, BMI, parity and preoperative stress index (adjusted OR 1.27, 95% CI 0.82-1.94). The objective cure rate was 100% versus 93% (P < 0.001), with 89% versus 76% reporting subjective satisfaction (P < 0.001), and with 4.7% versus 2.7% reporting persisting pain (P < 0.001), after 10 versus 20 years, respectively. Women in obesity classes I and II, compared with women of normal weight, had an increased risk of not being subjectively cured (crude OR 2.02, 95% CI 1.42-2.90; OR 2.95, 95% CI 1.60-5.46, respectively)., Conclusions: Tension-free vaginal tape (TVT) provided high rates of subjective and objective cure at 10 and 20 years after surgery, with no significant difference between the two cohorts. Although 3%-5% of women experienced persisting pain, most women were satisfied with TVT surgery. Obesity was associated with a lower cure rate., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To evaluate rates of subjective and objective cure, treatment satisfaction, pain, and the correlation between cure and body mass index (BMI), at 10 and 20 years after tension‐free vaginal tape (TVT) surgery. Design: Retrospective cohort study. Setting: Multicentre study including 19 units in Norway. Population: Women undergoing TVT surgery for stress urinary incontinence (SUI) during 2001–2006 (20‐year cohort) and 2011–2012 (10‐year cohort). Methods: The Norwegian Female Incontinence Registry was used to identify women eligible for the study, who answered validated questionnaires about urinary incontinence, pain and satisfaction. Main outcome measures: Subjective cure of SUI (with stress index of <3, range 0–12), objective cure (<3 g on stress test) and persisting pain and satisfaction after TVT (scored on a five‐point Likert scale). Results: In total, 1210 of 1903 (64%) patients responded. The subjective cure rate was 68% after 10 years, versus 59% after 20 years, and did not significantly differ after adjusting for age, BMI, parity and preoperative stress index (adjusted OR 1.27, 95% CI 0.82–1.94). The objective cure rate was 100% versus 93% (P < 0.001), with 89% versus 76% reporting subjective satisfaction (P < 0.001), and with 4.7% versus 2.7% reporting persisting pain (P < 0.001), after 10 versus 20 years, respectively. Women in obesity classes I and II, compared with women of normal weight, had an increased risk of not being subjectively cured (crude OR 2.02, 95% CI 1.42–2.90; OR 2.95, 95% CI 1.60–5.46, respectively). Conclusions: Tension‐free vaginal tape (TVT) provided high rates of subjective and objective cure at 10 and 20 years after surgery, with no significant difference between the two cohorts. Although 3%–5% of women experienced persisting pain, most women were satisfied with TVT surgery. Obesity was associated with a lower cure rate. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor disorders are common and associated with impaired sexual function in women. Aim: To assess women with pelvic floor disorders and describe factors associated with not being sexually active and those associated with sexual function in sexually active women. Methods: A cross-sectional study was conducted that included nonpregnant women with symptoms of pelvic floor disorders who were referred to the urogynecologic and surgical outpatient clinic at 2 Norwegian university hospitals: St Olavs Hospital, Trondheim University Hospital, and the University Hospital of Northern Norway, Tromsø. Women answered a questionnaire anonymously. Outcomes: Pelvic Organ Prolapse Incontinence Sexual Questionnaire–IUGA Revised. Results: Of 157 respondents, 111 (71%) reported being sexually active (with or without a partner), and 46 (29%) reported not being sexually active. As compared with sexually active women, not sexually active women were older (mean ± SD, 60.2 ± 13.3 vs 51 ± 12.1 years; P < .001), more were menopausal (78% vs 47%, P = .001), and more had symptom debut <1 year (31% vs 9%, P < .001). They reported more distress related to pelvic floor disorders, especially pelvic organ prolapse. In a multivariate logistic regression analysis, menopausal women and women with symptom debut <1 year were 4 times more likely to be not sexually active than premenopausal women (odds ratio, 4.0; 95% CI, 1.7-9.2) and women with symptom debut ≥1 year (odds ratio, 4.0; 95% CI, 1.5-10.7). In sexually active women, colorectal-anal distress was negatively associated with 5 of 6 domains of sexual function: arousal/orgasm (ß = –0.36; 95% CI, –0.02 to –0.005), partner related (ß = –0.28; 95% CI, –0.01 to –0.002), condition specific (ß = –0.39; 95% CI, –0.002 to –0.009), global quality (ß = –0.23; 95% CI, –0.02 to –0.002), and condition impact (ß = –0.34; 95% CI, –0.02 to –0.006). Clinical Implications: Health care professionals should discuss sexual function in patients with pelvic floor disorders, especially menopausal women and women with colorectal-anal symptoms. Strengths and Limitations: The study used condition-specific measures and recruited women from 2 university hospitals with wide range of age. Limitations include the small sample size and wide confidence intervals. The number of women who considered themselves not sexually active was low, and item nonresponse levels among these women where somewhat high. Of 625 eligible women, 200 (32%) answered the questionnaire. Sexual health and sexual function are still surrounded with taboo, and some women were probably not comfortable answering the questions. Conclusion: Menopausal women and women with recent onset of symptoms of pelvic floor disorders are more likely to be sexually inactive, and colorectal-anal symptoms have the most negative impact on sexual function in sexually active women. [ABSTRACT FROM AUTHOR]

Background: One in four women experience urinary incontinence. A woman's medical history, a physical examination and certain tests can guide specialists in diagnosing and offering treatment. Despite the high prevalence, little is known about women's experience of urinary incontinence assessment. Aim: To explore the experience of a group of women undergoing an assessment for urinary incontinence. Methods: Individual semi-structured interviews were conducted with 10 women who had been assessed for urinary incontinence. A thematic reflective analysis method was used. Findings: The women experienced a lot of shame and worry related to their urinary incontinence and the assessment. Having a safe relationship with the urotherapist was very important, and being given information about treatment options gave hope for a better life. Conclusion: Urinary incontinence and its assessment are associated with shame and anxiety. A good patient–urotherapist relationship is paramount and learning that treatments are available made women feel more optimistic about the future. [ABSTRACT FROM AUTHOR]

Introduction: Over the last two decades synthetic mid-urethral slings (MUS) have become established as the main surgical method for correcting stress urinary incontinence (SUI). However, transurethral injections with polyacrylamide hydrogel are gaining popularity. We used surgical codes from a national registry to explore potential differences in risk of later surgery for SUI comparing retropubic slings, obturator slings, and polyacrylamide hydrogel injections., Material and Methods: This cohort study used surgical codes from The Norwegian Patient Registry. All women recorded as having had surgery for SUI coded as retropubic sling, obturator sling, or polyacrylamide hydrogel injection from 2008 until end-of-study censoring in 2017, were included. Main outcome was time to any recorded new SUI procedure later in the study period. Unadjusted comparison between groups was done using Kaplan-Meier. A Cox regression analysis was then performed to adjust for hospital unit size and patient age at surgery., Results: The unadjusted analyses showed significant differences between the chosen index method and the risk of later SUI surgery favoring retropubic slings (p < 0.01). The proportions of patients without any recorded new SUI procedure at 1 and 5 years were 99.3% and 97.7% for retropubic MUS, 98.7% and 96.1% for obturator MUS, and 82.7% and 72.4% for polyacrylamide hydrogel injections. The majority of women having a repeat procedure for SUI after a polyacrylamide hydrogel injection underwent repeat treatment within 1 year (63%). After adjusting for age at time of surgery and hospital size, obturator slings (hazard ratio 1.8, 95% CI 1.4-2.4) and polyacrylamide hydrogel (hazard ratio 23.1, 95% CI 17.6-30.3) remained associated with a higher risk of later incontinence surgery., Conclusions: Both retropubic and obturator slings have low long-term risks of repeat incontinence surgery compared with polyacrylamide hydrogel injections. Retropubic slings were found to have superior longevity of the surgical result., (© 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Introduction: Urinary incontinence is a frequently reported condition among women with pregnancy and delivery as established risk factors. The aims of this study were to evaluate the effect of an antenatal exercise program including pelvic floor muscle training on postpartum urinary incontinence, and to explore factors associated with urinary incontinence three months postpartum., Material and Methods: This is a short-term follow-up and secondary analysis of a randomized controlled trial conducted at two Norwegian University Hospitals including healthy, pregnant women aged >18 years with a singleton live fetus. Women in the exercise group received a 12-week standardized exercise program including pelvic floor muscle training, with once weekly group exercise classes led by a physiotherapist and twice weekly home exercise sessions. The controls received standard antenatal care. Data were obtained from questionnaires answered in pregnancy weeks 18-22, and three months postpartum. Urinary incontinence prevalence in the exercise and control groups was compared, and multivariable logistic regression analyses were applied. Urinary incontinence prevalence three months postpartum was assessed by the Sandvik severity index., Results: Among the 722 (84%) women who responded three months postpartum, significantly fewer women in the exercise group (29%) reported urinary incontinence compared with the standard antenatal care group (38%, P = .01). Among women who were incontinent at baseline, 44% and 59% (P = .014) were incontinent at three months postpartum in the exercise and control groups, respectively. Urinary incontinence three months postpartum was associated with age (OR 1.1, 95% CI 1.0-1.1), experiencing urinary incontinence in late pregnancy (OR 3.6, 95% CI 2.3-5.9), birthweight ≥4000 g (OR 1.8, 95% CI 1.2-2.8), and obstetric anal sphincter injuries (OR 2.6, 95% CI 1.1-6.1). Cesarean section significantly reduced the risk of urinary incontinence three months postpartum compared with spontaneous vaginal delivery (OR 0.2, 95% CI 0.1-0.5)., Conclusions: A moderate-intensity exercise program including pelvic floor muscle training reduced prevalence of urinary incontinence 3 months postpartum in women who were incontinent at baseline., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.)

Skaug, KL, Bø, K, Engh, ME, and Frawley, H. Prevalence of pelvic floor dysfunction, bother, and risk factors and knowledge of the pelvic floor muscles in Norwegian male and female powerlifters and Olympic weightlifters. J Strength Cond Res 36(10): 2800–2807, 2022—Strenuous exercise has been suggested as a risk factor of pelvic floor dysfunction (PFD). Powerlifters and Olympic weightlifters compete with high external loads. To date, knowledge of PFD in these athletes has been sparse. The aim of this study was to investigate prevalence, risk factors, and bother of PFD in powerlifters and Olympic weightlifters and their knowledge of the pelvic floor muscles (PFM). All athletes aged ≥18 years competing in ≥1 National Championship in powerlifting or Olympic weightlifting in 2018/2019 were invited. The International Consensus on Incontinence Questionnaires were used to assess PFD. One hundred eighty women and 204 men participated. The prevalence of urinary incontinence (UI), anal incontinence (AI), and pelvic organ prolapse in women was 50.0, 80.0, and 23.3%, respectively. Stress UI (SUI) was reported by 41.7% of the women and 87.8% reported a negative influence on sport performance. The prevalence of UI and AI in men was 9.3 and 61.8%. In women, increasing body mass index was significantly associated with SUI (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.01–1.17) and international level of competition (OR: 3.27, 95% CI: 1.32–8.07) and weightlifting ≥4 d·wk−1 (OR: 0.26, 95% CI: 0.08–0.86) with AI. In men, increasing age (OR: 1.03, 95% CI: 1.00–1.07) and frequently straining to void (OR: 4.84, 95% CI: 1.02–22.94) were significantly associated with AI. Forty-three percent of the women and 74% of the men did not know why and 44.4 and 72.5% how to train the PFM. In conclusion, the prevalence of PFD was high, and the athletes had limited knowledge of the PFM. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Urinary incontinence is common postpartum. Our aims were to assess whether antenatal exercise including pelvic floor muscle training (PFMT) has long-term effects on urinary incontinence (UI) and to explore factors associated with UI 7 years postpartum. Methods: A follow-up of a two-centre randomized controlled trial performed at St. Olavs Hospital and Stavanger University Hospital, Norway. In the original trial women were randomized to a 12-week structured exercise protocol including PFMT or standard antenatal care during pregnancy. Link to an electronic questionnaire was sent by postal mail 7 years postpartum. Prevalence of UI was assessed with Sandvik severity index and compared between groups. Factors associated with UI were studied using multivariable logistic regression analysis. Results: The response rate was 35% (298/855). UI was reported by 78 (51%) in the intervention group and 63 (57%) in the control group (p = 0.539). In the multivariable logistic regression analyses, women with UI at inclusion had a five-fold increase in odds of UI at 7 years (OR 5.4, 95% CI 2.6, 11.5). Engaging in regular exercise was not significantly associated with UI at 7 years; however, UI was associated with lower exercise intensity (OR 2.4, 95% CI 1.2, 4.6). Conclusions: We found no group differences of antenatal exercise including PFMT on UI after 7 years among the responders. UI in pregnancy increased the risk of long-term UI. Regular exercise was not associated with UI at 7 years; however, women with UI were more than twice as likely to exercise at lower intensity than continent women. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pregnancy and delivery are known risk factors for stress and mixed urinary incontinence. The most common surgical treatment is mid-urethral sling (MUS) surgery. This study evaluated the potential impact of the obstetrical history on the short-term subjective and objective failure rates after MUS surgery. Methods: A registry-based surgical cohort study using data from the Medical Birth Registry of Norway (MBRN) and the national Norwegian Female Incontinence Registry (NFIR). Data from 14,787 women that underwent MUS surgery from 1998 to 2016 with complete registrations in the MBRN were included. Outcomes were 6–12-month postoperative subjective and objective failure rates. The potential impact of obstetrical and constitutional factors on both outcomes was tested in a multivariate logistic regression model. Results: Several obstetrical variables seemed to impact both outcomes in the univariate analyses. However, in the multivariate analyses, none of the obstetrical variables significantly impacted subjective failure, and only being nulliparous before MUS surgery remained a risk factor for objective failure [aOR 1.60, (95% CI 1.07–2.40), p = 0.022]. High body mass index at time of surgery, non-retropubic slings, high preoperative urgency symptom load, and surgical complications were all strong risk factors for poor outcomes in the multivariate analyses. Conclusion: Although childbirth is considered a risk factor for developing stress urinary incontinence, childbirth does not appear to affect the result of MUS in parous women. Our results suggest that nulliparous women with SUI may have a different pathophysiology than SUI after childbirth. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between levels of vitamin D and urinary incontinence (UI) in pregnancy. Design: A cross‐sectional study. Secondary analysis of a randomised controlled trial. Setting: Two university hospitals in Norway. Population: A total of 851 healthy, pregnant women >18 years in gestational weeks 18–22 with a singleton live fetus. Methods: Data on UI were collected from a questionnaire at inclusion and serum analysis of 25‐hydroxy vitamin D (25(OH)D) was performed. Univariable and multivariable logistic regression analyses were applied to study associations between exposure and outcomes. Main outcome measures: Prevalence of self‐reported UI, stress (SUI) and urge (UUI) or mixed UI. Results: In total, 230/851 (27%) of the participants were vitamin D insufficient (25(OH)D <50 nmol/l) and 42% reported to have any UI. Women with 25(OH)D <50 nmol/l were more likely to report any UI (P = 0.03) and SUI (P < 0.01) compared with women with 25(OH)D ≥50 nmol/l. In a univariable logistic regression analysis, serum levels of 25(OH)D <50 nmol/l was associated with increased risk of any UI (odds ratio [OR] 1.5 with 95% CI 1.0–2.1), SUI only (OR 1.7, 95% CI 1.2–2.4), but not mixed UI or UUI only (OR 0.8, 95% CI 0.5–1.5). In a multivariable logistic regression model, serum levels of 25(OH)D <50 nmol/l were associated with a higher risk of experiencing SUI only (OR 1.5, 95% CI 1.1–2.2). Conclusions: Serum 25(OH)D <50 nmol/l was associated with increased risk of any UI, and SUI in particular. Low levels of vitamin D are associated with increased risk of urinary incontinence in pregnancy. Low levels of vitamin D are associated with increased risk of urinary incontinence in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Medical quality registries have gained popularity as tools for monitoring the quality of medical treatments and they serve as data sources for research. The Norwegian Female Incontinence Registry (NFIR) was established in 1998 to monitor and improve the quality of surgery for women with stress and mixed urinary incontinence in Norway and to collect data for research. This study aimed to assess the completeness and accuracy of the Norwegian Female Incontinence Registry, and potential differences in data accuracy over time and according to surgical volume of the reporting hospitals. Material and methods: A random selection of 300 women from a total of 20 610 operated for urinary incontinence between 1998 and 2016 reported to the Norwegian Female Incontinence Registry from 28 public hospitals were selected for validation. The database completeness was estimated for 2008‐2017 by comparing surgical procedures registered both in the Norwegian Female Incontinence Registry and the Norwegian National Patient Registry. Historical data recorded in the Registry for 10 selected key variables were extracted and compared with the patients' individual medical records at the reporting hospitals as reference. The reviewers were blinded to the previously stored information. The intraclass correlation coefficient for continuous variables and Cohen's kappa for categorical variables were calculated. Results: Primary source data on 285 of the 300 women selected from Norwegian Female Incontinence Registry were successfully retrieved. The completeness of the registry has increased from 61% in 2008 to 99% in 2017. The national coverage has increased from 12 reporting departments in 1998 to all 38 public departments performing female incontinence surgery in 2017. Excellent accuracy was found for both continuous variables (intraclass correlation coefficient >0.94) and categorical variables (Cohen's kappa >0.86). No differences in data accuracy were found comparing high‐volume hospitals with low‐volume hospitals, or when comparing data accuracy over time. Conclusions: The Norwegian Female Incontinence Registry is a reliable tool for quality assessment of incontinence surgery and research. The registry completeness has improved over time and now contains data on nearly all women undergoing incontinence surgery in Norway. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aims of this study were to investigate patterns of prescribing anticholinergic drugs among women with urinary incontinence (UI) and to identify factors associated with prescription of these drugs.Methods: We analysed questionnaire data on UI from 21,735 women older than 20 years who participated in a cross-sectional population-based study in Nord-Trøndelag county, Norway (the HUNT study). These data were linked at the individual level to a national prescription database, and analysed using a multivariate logistic regression model.Results: Among the women with UI, 4.5% had been prescribed an anticholinergic drug during the previous 12 months. Prescription was most frequent in women with urge UI (10.5%) and mixed UI (7.0%). Of women with UI without treatment with an anticholinergic drug, 1.8% obtained such a prescription during the subsequent 12 months, corresponding to 3.1% of women with urge UI and 3.0% of women with mixed UI. Characteristics significantly associated with starting treatment were age above 50 years, urge or mixed UI, severe or very severe symptoms, consumption of four or more cups of coffee per day, and having visited a doctor for UI. No association was found with marital status, parity, smoking, alcohol, body mass index or anxiety/depression.Conclusions: In this population-based study, 4.5% of women with UI were prescribed an anticholinergic drug, and the 12-month incidence of starting treatment was 1.8%. Age above 50 years, urge or mixed UI, severe symptoms, high coffee consumption and having visited a doctor for UI were factors associated with first-time drug prescription. [ABSTRACT FROM AUTHOR]

Introduction: The primary aim of this study was to compare the objective and subjective outcomes and short-term complication rates of an adjustable single-incision mini-sling (SIMS) vs. standard mid-urethral slings (SMUS). The secondary aim was to report pain perception and complications at the one-year follow up.Material and Methods: The study was designed as a multicenter prospective randomized trial where women were included from eight centers in Denmark, Norway and Sweden. The trial was registered at ClinicalTrials.gov: NCT01754558. A total of 305 women less than 60 years old with verified stress urinary incontinence were included. All women were randomized to SIMS (Ajust® ; n = 155) or SMUS (TVT, TVT-O or TOT; n = 150) and were evaluated by stress test and bladder diary before and after surgery and symptoms related to incontinence using ICIQ-SF, PISQ-12 and PGI-S and PGI-I. Objective cure was defined as no leakage during a stress test and subjective cure defined as no leakage stated in the bladder diary or no indication of urinary leakage in the ICIQ-SF. Furthermore, mesh exposure and dyspareunia were recorded.Results: In total, 280 women [141 (91%) in the SIMS and 139 (94%) in the SMUS groups] participated in the one-year follow up. No difference between the groups was observed regarding objective and subjective outcomes. VAS score disclosed a lower postoperative pain perception in the SIMS group than in the SMUS group.Conclusions: Ajust® appears to be as efficient as SMUS regarding objective and subjective outcomes and was associated with less pain perception during the postoperative period. [ABSTRACT FROM AUTHOR]

Introduction: Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.Material and Methods: This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and six months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses.Results: Birthweight was associated with significantly higher risk of urinary incontinence six months postpartum [3541-4180 g: odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.6; >4180 g: OR 1.6, 95% CI 1.2-2.0]. Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence six months postpartum; birthweight ≥3540 g and ≥36 cm head circumference; birthweight ≥3540 g and forceps, birthweight ≥3540 g and episiotomy; and ≥36 cm head circumference and episiotomy.Conclusion: Some combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence six months postpartum in a synergetic way. [ABSTRACT FROM AUTHOR]

Objectives To determine the feasibility and acceptability of traditional Chinese medicine (TCM) acupuncture and pelvic floor muscle training (PFMT) in reducing symptoms and bothersomeness in women with mixed urinary incontinence (MUI); and to estimate the sample size for a full scale trial. Methods Thirty-four women with MUI were randomly assigned to either 12 sessions of TCM acupuncture, 12 sessions of PFMT, or to a waiting list control group. Outcome measures included an assessment of interest to participate in the trial, identification of successful recruitment strategies, the appropriateness of eligibility criteria, and compliance with treatment. Clinical outcomes were assessed at baseline and 12 weeks, and included the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI SF), expectations of treatment effect, and adverse events. Results Recruitment was feasible and randomisation worked adequately by means of SurveyMonkey. SurveyMonkey does not permit stratification by ICIQ-UI SF baseline score. Fourteen of 22 women found the treatment options acceptable. The dropout rate was high, especially in the control group (6/12). Outcome forms were completed by 20 of 34 women. The median (IQR) changes of the ICIQ-UI SF scores in the acupuncture, physiotherapy, and waiting list group were 5.5 (2.3 to 6.8), 1.0 (-3.0 to 4.5), and 1.5 (-1.5 to 3.0), respectively, suggesting the need for a full scale trial. Conclusions Women with MUI were willing to participate in this study. There is a need for adjusting eligibility criteria. A sample size of 129 women, 43 in three arms, is required. No major adverse events occurred. [ABSTRACT FROM AUTHOR]

Background: To determine incidence and remission of UI as well as changes in UI prevalence in the Norwegian EPINCONT surveys. Methods: The EPINCONT surveys were conducted in the county of Nord-Trøndelag, Norway, as part of two large cross-sectional health surveys (HUNT2 and HUNT3) in 1995 - 1997 (EPINCONT1 (E1)), and 2006 - 2008 (EPINCONT2 (E2)). EPINCONT collected information about prevalence of UI, as well as information about type and severity of UI. Results: A 16% relative increase in UI prevalence was found in 11 years. The women who answered E2 were significantly older, had a higher BMI and higher prevalence of diseases such as asthma, diabetes and angina compared with the women who answered E1. The incidence of UI was 18.7%. Increase in BMI (OR 1.03, 95% CI: 1.02 - 1.04), weight increase (OR 1.29 (95% CI: 1.14 - 1.45) for gaining 3 - 10 kilos and OR 1.71 (95% CI: 1.47 - 1.99) for gaining 10 kilos or more) and parity (OR 1.37 (95% CI: 1.04 - 1.79) for 1 childbirth, OR 1.28 (95% CI: 1.03 - 1.61) for 2 childbirths, and OR 1.56 (95% CI: 1.26 - 1.95) for 3 or more childbirths when participating in E2) were all found to be associated with increased odds of incident UI in adjusted regression analyses. Increasing age reduced the odds of incident UI. The 11 year remission of UI was 34.1%. Increasing age (OR 0.98, 95% CI: 0.98 - 0.99), increasing BMI (OR 0.96, 95% CI: 0.95 - 0.98) and large weight gains of 10 kilos or more (OR 0.69, 95% CI: 0.54 - 0.88) were all associated with reduced remission of UI. Conclusion: Crude UI prevalence increased between the studies. Changes in known risk factors for UI such as age, BMI, weight and parity could explain some of the relative increase in prevalence, and were also found to be associated with either incidence of UI, remission of UI or both. [ABSTRACT FROM AUTHOR]

Background: The main objective of the present study was to determine whether UI is an independent predictor of ADL decline and IADL decline in elderly women. We also aimed to find out whether incontinent subjects were at higher risk of needing help from formal home care or home nursing care during 11 year follow-up. Methods: A prospective cohort study conducted as part of the North-Trøndelag Health Study 2 and 3. Women aged 70-80 years when participating in the HUNT 2 study, who also participated in the HUNT 3 study, were included in this study. Analyses on self-reported urinary incontinence at baseline and functional decline during a11-year period were performed for incontinent and continent subjects. Results: Baseline prevalence of urinary incontinence was 24%. At on average eleven year follow up, logistic regression analysis showed a significant association between incontinence and decline in activities of daily living (ADL) (OR =2.37, 95% CI =1.01-5.58) (P=0.04). No association between urinary incontinence and instrumental activities of daily living (IADL) in incontinent women compared with continent women was found (OR=1.18, CI=.75-1.86) (P=.46). Data were adjusted for ADL, IADL and co morbid conditions at baseline. No significant differences in need of more help from formal home care and home nursing care between continent and incontinent women were found after 11 years of follow-up. Conclusions: Urinary incontinence is an important factor associated with functional decline in women aged 70-80 years living in their own homes. At eleven years of follow up, no significant differences in need of more help from formal home care and home nursing care between continent and incontinent women were found. [ABSTRACT FROM AUTHOR]

Background and aims Chronic pelvic pain (CPP) in women is a complex condition that can seriously impact health and quality of life. Clinical guidelines for CPP place great demands on healthcare professionals, as they require both specialized knowledge about the pelvic area and knowledge of the mechanisms of chronic pain. To ensure best possible assessment and treatment of these women it is important to bring about more knowledge of the special CPP features. The purpose of this paper is to describe the characteristics of women with CPP evaluated at the University Hospital of North Norway, and further referred to physiotherapy. The frequency of having a history of abuse or previous pelvic surgery will also be reported, and analyses performed to investigate if subjective health status differs between women with and without these experiences. Methods We collected cross-sectional data from 62 women with CPP aged 20-65 (mean age 38.0), referred to physiotherapy after assessment by medical specialists. Data were collected by semi-structured interviews for demographic variables and medical history, and self-administered questionnaires on pain intensity, sexual function, urinary incontinence (UI), anal incontinence (AI), obstructed defecation syndrome (ODS), subjective health complaints (SHC) and symptoms of anxiety and depression. Results Pain duration of more than 10 years was reported by 42%, mean pain score was 4.7/10, and analgesics were used weekly by 48%. Previous pelvic or abdominal surgery was reported by 71%, and sick leave >12 weeks the last year by 34%. Reduced sexual desire was reported by 78%, dyspareunia by 73%, UI by 54%, AI by 23%, and obstructed defecation syndrome (ODS) by 34%. More than 90% reported musculoskeletal or pseudoneurologic complaints. Anxiety and depression scores defined as requiring treatment were reported by 40%. Abuse was reported by 50%, and associated with significantly more reports of ODS (p=0.02), more SHC (p=0.02) and higher anxiety scores (p=0.009). Analgesic use and sick leave were significantly higher both among women with a history of abuse (p=0.04 and p=0.005) and among those with previous surgery (p=0.04 and p=0.02). Women with previous surgery reported significantly lower pain intensity during intercourse than those without previous surgery (p=0.008). Conclusions Women with CPP have complex symptoms and high scores for both physical and psychological complaints. Women exposed to abuse have especially high scores related to analgesic use, sick leave, ODS, anxiety and SHC. Women with previous surgery report more analgesic use and sick leave, and lower pain intensity during intercourse, than those without previous surgery. Implications This study illustrates the complexity of CPP and highlights the need for health professionals to have specialized knowledge of the possible features of the condition. Previous abuse seems to be more associated with poor scores on several health outcomes than surgery, but this needs to be investigated further.

Please cite this paper as: Bø K, Pauck Øglund G, Sletner L, Mørkrid K, Jenum A. The prevalence of urinary incontinence in pregnancy among a multi-ethnic population resident in Norway. BJOG 2012;119:1354-1360. Objectives To investigate prevalence of urinary incontinence (UI) in a multi-ethnic population of pregnant women, and to analyse for possible associations of the known risk factors for UI in such a population. Design Population-based cross-sectional study. Setting All pregnant women in three administrative city districts attending the Child Health Clinics. Population and sample Out of 823 women identified in first trimester, 722 (74%) agreed to participate in the study at 28 weeks of gestation. Inclusion criteria were: healthy women at 20 weeks of gestation or less and able to communicate in Norwegian, Arabic, English, Sorani, Somali, Tamil, Turkish, Urdu or Vietnamese. Methods Differences between ethnic groups were tested by simple descriptive statistics. Associations were estimated by logistic regression analysis and presented as crude (cOR) and adjusted (aOR) odds ratios. Main outcome measures Prevalence of UI as ascertained using the International Consultation on Incontinence Questionnaire-urinary incontinence-short form. Results Prevalence rates of UI at 28 weeks of gestation were 26% for women of African origin, 36% for women of Middle Eastern origin, 40% for women of East Asian origin, 43% for women of South Asian origin and 45% for women of European/North American origin. The difference was significant between women of African and European/North American origins ( P = 0.011) and between women of African and South Asian origins ( P = 0.035). Age (aOR 1.05; 95% CI 1.01-1.09) and parity (aOR 2.34; 95% CI 1.66-3.28) were positively associated with the prevalence of UI in pregnancy. Women of African origin had significantly reduced odds for UI (aOR 0.42; 95% CI 0.20-0.87). East Asian and African women reported the highest perceived impact of UI in pregnancy. Conclusions A high prevalence of UI was found in a multi-ethnic pregnant population. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Several studies have indicated depression and anxiety to be associated with urinary incontinence (UI), however, the strength of the associations varies widely. The objective of this study was to determine these associations in a large survey. Methods: In a cross-sectional population-based survey study, we analysed questionnaire data on UI, depression and anxiety from 5,321 women between 40 and 44 years. A multivariate logistic regression model was used to predict the odds of having high levels of anxiety and depression among women with UI of different types and severities. Results: Among women with UI, the adjusted OR for depression was 1.64 (95% CI, 1.32-2.04) and for anxiety 1.59 (95% CI, 1.36-1.86) compared with women without UI. Conclusion: UI was associated with both anxiety and depression in middle-aged women, with the strongest associations for mixed and urgency UI. [ABSTRACT FROM AUTHOR]

Weight gain during pregnancy may contribute to increased urinary incontinence (UI) during and after pregnancy, but scientific support is lacking. The effect of weight loss on UI postpartum is unclear. From 1999 to 2006, investigators in the Norwegian Mother and Child Cohort Study recruited pregnant women during pregnancy. This study was based on 12,679 primiparous women who were continent before pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and 6 months postpartum. Weight gain greater than the 50th percentile during weeks 0–15 of pregnancy was weakly associated with higher incidence of UI at week 30 compared with weight gain less than or equal to the 50th percentile. Weight gain greater than the 50th percentile during pregnancy was not associated with increased prevalence of UI 6 months postpartum. For each kilogram of weight loss from delivery to 6 months postpartum among women who were incontinent during pregnancy, the relative risk for UI decreased 2.1% (relative risk = 0.98, 95% confidence interval: 0.97, 0.99). Weight gain during pregnancy does not seem to be a risk factor for increased incidence or prevalence of UI during pregnancy or postpartum. However, weight loss postpartum may be important for avoiding incontinence and regaining continence 6 months postpartum. [ABSTRACT FROM PUBLISHER]

Objective. To investigate the epidemiology of prescriptions for duloxetine for the treatment of stress urinary incontinence during its entire lifecycle in Norway (October 2004–May 2007), including the persistence of use of the drug and the prescribers. Design and setting. Observational study in Norway. Sample. All prescriptions on duloxetine filled in Norwegian pharmacies. Methods. Data from the Norwegian Prescription Database. Main outcome measure. Patient's age, unique identification, date of dispensing, data on specialty of the prescribing doctor, and number of packages purchased. Persistence of use of duloxetine was analyzed by grouping the months of first prescription filled into quarters of a year, from the fourth quarter of 2004 to the third quarter of 2007. Results. A total of 3,024 filled prescriptions were recorded of which 2,903 (96%) could be further analyzed, corresponding to 37 users per 100,000 women in the population. Each patient filled a mean of 3.4 prescriptions. The persistence of use was very low from the second quarter itself, and after 1 year only 12.5% of the patients still purchased the drug. Most prescriptions were written by GPs and gynecologists. A prescription database like ours consists of dispensed prescriptions and not drugs taken. We believe that these biases are of little importance for the main results. Conclusions. Analyses from the national prescription database show that duloxetine had a low uptake on the market and a low persistence rate among the patients during its full lifecycle on the Norwegian market. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to describe the characteristics of pregnant women who wish to have a caesarean section. Methods: Data were collected as part of the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Pregnant women booked for antenatal care in Norway between 1999 and 2006 were invited to participate in the study. Data on women's interest in mode of delivery and a set of associated variables were gathered from a questionnaire completed by 55,859 women at 30 weeks of pregnancy. Results: A wish for caesarean section was expressed by 10% of the women, and 33% thought that the woman herself should be allowed to decide whether to have a caesarean section or not. A negative experience from a previous labour, a second birth, an age > 435, a low level of education, being single, being unemployed, having an assisted conception, expecting more than one foetus, experiencing urinary and bowel incontinence before current pregnancy, experiencing pelvic pain, having a fear of childbirth and reporting negative intra-psychic phenomena were significantly associated with a wish for caesarean section. Conclusions: At 30 weeks of pregnancy, one out of 10 women in a sample of Norwegian women would choose a caesarean section. Negative experiences from previous pregnancies and fear of giving birth are two of the strongest factors associated with a wish for a caesarean section and should be taken into consideration. [ABSTRACT FROM AUTHOR]

The aim of the present investigation was to study prevalence of low back pain, pelvic girdle pain (PGP) and pelvic floor disorders during pregnancy and after childbirth in elite athletes. A postal questionnaire was sent to all elite athletes who had given birth registered with The Norwegian Olympic Committee and Confederation of Sports ( n=40). Eighty age-matched women served as the control group. The response rates were 77.5% and 57.5% in the elite athletes and control groups, respectively. There were no significant differences in the prevalence of low back and PGP, urinary or fecal incontinence among elite athletes and controls at any time point. The prevalence of low back pain without radiation to the leg in elite athletes was 25.8%, 18.5%, 9.7% and 29% the year before pregnancy, during pregnancy, 6 weeks postpartum and at the time of completing the questionnaire, respectively. The prevalence of PGP was 0, 29.6%, 12.9% and 19.4%. Prevalence of stress urinary incontinence was 12.9%, 18.5%, 29% and 35.5%. None of the elite athletes had fecal incontinence at any time point. There were no differences in mode of delivery or birthweight between elite athletes and controls. The elite athletes had a significantly lower body mass index at 6 weeks postpartum and at present compared with the control group. [ABSTRACT FROM AUTHOR]

Background. Few large epidemiological studies have investigated whether diabetes might increase the risk for, or cause greater severity of, urinary incontinence. The aim of the present study was to investigate the association between diabetes and urinary incontinence, including the possible influence of diabetes on the severity of incontinence. Methods. The study was a cross-sectional, population-based, study from the county of Nord-Trøndelag, Norway, from 1995 to 1997. Data were collected by means of questionnaires, simple clinical measurements, and some blood tests. A total of 21,057 women, 20 years or older, answered the questions on both diabetes and incontinence, and 685 women were identified with diabetes. Results. The prevalence of incontinence among women with diabetes was 39% compared to 26% in women without diabetes. The women with diabetes had more urge and mixed incontinence. The associations between diabetes and urge incontinence (OR: 1.49; 95% CI: 1.03-2.16), mixed incontinence (OR: 1.32; 95% CI: 1.05-1.67), and severe incontinence (OR: 1.54; 95% CI: 1.21-1.96) were still significant after adjusting for age, body mass index, parity and smoking. Conclusion. We found a strong association between diabetes and urinary incontinence, especially for urge incontinence and severe degree of incontinence. [ABSTRACT FROM AUTHOR]

Describes the demography, medical history and clinical characteristics of women treated with home-managed electrical stimulation in Norway. Levels of health care systems in the treatment of urinary incontinence; Consideration of electric stimulation as a treatment option.

Objective: Lower urinary tract symptoms (LUTS) has become the preferred term used to classify the urinary symptoms of elderly men. This term places more emphasis on clinical appearance rather than being restricted to the functional pathophysiology. The objective of this study was to investigate this new concept in a group of patients who had been tentatively diagnosed with benign prostatic hyperplasia (BPH). The range of urinary symptoms, incontinence, sexual function and impact on daily living were registered. Material and Methods: Data from a group of 480 men awaiting urologic assessment were collected by questionnaire shortly after referral from their general practitioner between 1997 and 2000. The questionnaires used were the International Prostate Symptom Score (1PSS), the Symptom Problem Index, the International Continence Society-BPH, the Sandvik Incontinence Severity Index and the BPH-specific interference with Activities. Results: The mean age of the subjects was 67.0 years. As assessed by the 1PSS, 15%, 54% and 31% of the men had mild, moderate and severe symptoms, respectively. Men who gave positive answers to questions regarding the frequency, amount and type of leakage were considered to have urinary incontinence (UI), which was found in 37% of cases. The majority of men had mild or moderate UI. Influence on daily living varied with the severity of symptoms. However, no significant differences in influence on daily living were found between groups with different degrees of severity of incontinence as all groups reported a relatively high impact. Conclusions: Our results show that UI is fairly common, very bothersome and socially embarrassing in male LUTS patients waiting for urologic evaluation. Although UI is not typically associated with BPH and is not regarded as a crucial component of LUTS, this study indicates that more emphasis should be placed on UI in the terminology of LUTS. UI may also act as an indicator of a need for healthcare. [ABSTRACT FROM AUTHOR]

• The aim of the study was to understand the variability of Norwegian staff’s attitudes towards patients with urinary incontinence across years and place of work, age and education levels. • The Incontinence Stress Questionnaire – Staff Reaction (Norwegian version) (ISQ-SR-N) was used to measure staff’s reactions and feelings towards patients with urinary incontinence. • A cross-sectional survey design was used to gather self-reported data. The research sites were five nursing homes, three home care districts and medical and surgical wards at a university hospital. • Of the 745 staff invited, 535 (72%) returned the questionnaire. Staff members working in long-term care units were older than staff members working in acute care units. Most of the registered nurses worked in acute care, whilst most of the nursing assistants worked in long-term care. • Stepwise regression analysis identified education, working in a medical/surgical units, and the interaction of education and working in a medical unit to be most predictive of attitudes. • Nursing assistants had more positive attitudes than registered nurses. Working in medical/surgical units predicted the most negative attitudes. Only 15.2% of the variability of attitudes can be explained by the predictive variables. [ABSTRACT FROM AUTHOR]

Editorial. Comments on whether research should become obligatory in the vocational training of general practitioners (GP) in Norway. Differences in attitudes between academic institutions and GP; Significance of experiences as a basis for research; Presentation of law for the specialist health care.

Scand J Caring Sci; 2011; 25; 410-416 The aim of this study was to explore the usefulness of applying a global, evaluation-based quality of life (QoL) questionnaire in assessing the impact of urinary incontinence (UI) on women's lives. The study population comprised long-term gynaecological cancer survivors (n = 160) and controls from the general population (n = 493). The presence of UI was assessed by the question 'Do you leak urine?' while UI perceived as a problem was assessed on a five-point scale from 'No problem' to 'A very large problem'. QoL was measured by Ferrans & Powers' QoL index (QLI), generic version II. UI was distributed equally among women with a history of gynaecological cancer and among women from the general population (34%). UI has a negative impact on overall QLI as well as a wide range of items. Approximately 20% of the incontinent women defined UI as no problem, with QLI scores similar to continent women. Only 5% experienced UI as a large/very large problem; with exceptionally low QLI scores. The psychometric testing of QLI (acceptability, internal consistency reliability and known-group validity) supports the use of QLI in UI-studies. The Ferrans & Powers' QLI is considered an acceptable tool for UI research, but further psychometric testing is required. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of home-managed electrical stimulation for treating women with urinary incontinence in Norway. Types of urinary incontinence; Effects of the treatment among women; Improvement and change in incontinence parameters.

Objective: To investigate the association between parity and urinary incontinence, including subtypes and severity of incontinence, in an unselected sample, with special emphasis on age as a confounder or effect modifier., Methods: This was a cross-sectional study (response rate 80%) with 27,900 participating women. Data on parity and urinary leakage, type, frequency, amount, and impact of incontinence were recorded by means of a questionnaire. A validated severity index was used. Relative risks (RR) with nulliparous women as reference were used as an effect measure., Results: Incontinence was reported by 25% of participants. Prevalences among nulliparous women ranged from 8% to 32%, increasing with age. Parity was associated with incontinence, and the first delivery was the most significant. The association was strongest in the age group 20-34 years with RR 2.2 (95% confidence interval [CI] 1.8, 2.6) for primiparous women and 3.3 (2.4, 4.4) for grand multiparous women. A weaker association was found in the age group 35-64 years (RRs between 1.4 and 2.0), whereas no association was found among women over 65 years. For stress incontinence in the age group 20-34 years, the RR was 2.7 (2.0, 3.5) for primiparous women and 4.0 (2.5, 6.4) for grand multiparous women. There was an association with parity also for mixed incontinence, but not for urge incontinence. Severity was not clinically significantly associated with parity., Conclusion: Parity is an important risk factor for female urinary incontinence in fertile and peri- and early postmenopausal ages. Only stress and mixed types of incontinence are associated with parity. All effects of parity seem to disappear in older age.

Background: The selection process of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice., Objective: The objective of this study was to use female urinary incontinence as a model in an attempt to provide empirical support for selection bias., Method: The analyses are based on three populations of incontinent women: community level (epidemiological survey, 535 women), primary care level (general practice, prospective clinical study, 105 women), and secondary care level (university hospital, prospective clinical study, 228 women)., Results: The general practice patients were older and the hospital patients younger than those in the community. From community via general practice to hospital, there was an increase in duration, frequency of leakage, amount of leakage, severity and perceived impact of incontinence. Help-seeking at the primary care level was associated with increasing age and severity, and with urge symptoms and substantial impact. Referral from general practice to hospital level was only associated with age and urge symptoms., Conclusion: The study provides empirical evidence to support the existence of selection bias. This phenomenon must not be overlooked when recommendations developed at the consultant level are presented at a level with a significantly different clinical picture of a condition.

Six case histories concerning female urinary incontinence were mailed to 191 randomly selected general practitioners (GPs) in Norway, of whom 139 (73%) replied. Great variations in suggested investigations and treatment were found between individual doctors. Four explanatory variables were examined: doctors' sex, years since graduation, urban/rural location, and GP specialization. GP specialists treated fewer patients adequately than non-specialists. Experienced female doctors instructed more patients in pelvic floor exercises, prescribed more oestrogens, referred more patients, and also indicated the possibility of surgery more frequently than their colleagues. Nevertheless, patient management is largely independent of a doctor's sex and age, practice location, and GP specialization.

In order to investigate how Norwegian gynecologists manage female urinary incontinence in their daily practice, a questionnaire about six typical case histories was sent to the members of the Norwegian Gynaecological Association. The questionnaire comprised questions about investigations, use of laboratory tests and treatment options. Of 268 questionnaires sent out, 190 were returned (71%). Frequency-volume charts were recommended by 42% of the doctors and pad-weighting tests by 12%. Urodynamic examination was recommended for 55% of the cases, but mainly in mixed incontinence (76 and 77%). Pelvic floor exercises were suggested more often to younger patients than to the elderly. Drugs were infrequently suggested, mainly following appropriate indications. Drugs and pads were recommended especially for the elderly. The recommendation rate for surgical repair was higher for young age and greater degree of stress incontinence. The modest therapeutic ambition on behalf of the elderly women lacks basis in clinical research. A general management program for female urinary incontinence would possibly standardize and improve the quality of incontinence care by gynecologists in Norway.