Professor Susan Davis Bladder Control Issue for Young Women InterviewTraditionally considered an older women's condition, urinary incontinence (UI) affects one in eight healthy young women causing depression in some, ?according to a new study.
Published today in high impact journal, the Annals of Internal Medicine, the study was undertaken to determine the prevalence of UI, risk factors, and effect on quality of life in otherwise healthy young women aged 16 to 30 years. The study is the first of its kind to look at incontinence in young women who have never experienced a pregnancy. Pregnancy is a known contributor to UI.
Monash University honours student Tessa O'Halloran, together with Professors Susan Davis and Robin Bell, from the Department of Epidemiology and Preventive Medicine, surveyed 1000 healthy young women and found 12.6 per cent of the women had UI.
Professor Davis said the extent to which UI affects younger women who have never been pregnant had not been well understood until now.
"An embarrassing problem, UI is actually very common, affecting around 40 per cent of Australian women, but is usually attributed to having been pregnant, obesity or ageing," Professor Davis said.
"Our study is the first to look at incontinence in young women who have never experienced a pregnancy. We found that one in eight young women are vulnerable to incontinence irrespective of common risk factors such as pregnancy or obesity.
Professor Davis said symptoms of UI interfered with everyday functioning and wellbeing, with half of the women reporting they worried about odour and restricted their fluid intake.
"We also found that UI for young women can have adverse effects on behaviour and general wellbeing. Women experiencing incontinence had lower wellbeing, greater levels of anxiety and were more likely to have a depressed mood," Professor Davis said.
The study found sexually active women were more likely to report incontinence and, of this group, the likelihood of incontinence was halved for those who used the oral contraceptive pill.
Interview with Professor Susan DavisQuestion: What is urinary incontinence?
Professor Susan Davis: Urinary incontinence is defined as any involuntary leakage of urine. Stress Incontinence is if there is an involuntary leakage of urine which happens when someone coughs sneezes or jumps because the pelvic floor muscles stretch and you leak urine. Urge urinary incontinence is when a woman feels the sudden urge to go to the toilet and rushes off to the toilet and actually can't hold her urine and leaks it before she gets to an appropriate place to relieve herself. Woman can have a mixture of these and then it's called mixed urinary incontinence. It is generally an involuntary leakage of urine.
Question: Why has urinary incontinence previously been considered as an older woman's condition?
Professor Susan Davis: Urinary incontinence has previously been considered as an older woman's condition because of the way we think due to the concept that during pregnancy a woman's hormones relax the muscular that supports the bladder. Obesity and age can also cause an increase in leakage of urine because the muscles become weaker. No-one has actually thought that maybe there is a sub-group of young, healthy girls who already have this problem before they even get pregnant or before they get older.
Sometimes we have ridged views about things and not before have thought outside the box about urinary incontinence in younger women.
Question: What factors can cause urinary incontinence?
Professor Susan Davis: Obesity, age and pregnancy are main factors but in this study the population of girls were young and relatively healthy, there were very few obese girls in this study. We cannot rule out that obesity might be a factor in younger women whereas we have already shown it is a factor in older women. In a young physically fit healthy population very few of them were smokers so they were not clotting and we still found that one in eight of the younger women had reported involuntary leakage of urine and we used a questionnaire that got validated; this means they didn't just say "it's happened to me once" and that was a diagnoses this questionnaire actually diagnosed them as urinary incontinence by using a 'point on the scale' system to diagnose the problem and one in eight women had the problem of involuntary leakage of urine.
Question: Did the results of this study surprise you?
Professor Susan Davis: We were pretty surprised actually because we thought that being such a healthy group that we wouldn't see urinary incontinence; we didn't expect to see that many.
Question: Why are urinary incontinence (UI) affecting one in eight healthy young women?
Professor Susan Davis: The only study ever done in young women has included women who have been pregnant and this is the very first study that's ever been done that has only looked at young women who have never been pregnant.
Question: What else did you find from the study?
Professor Susan Davis: What we did find was women who were sexually active were significantly more likely to have incontinence verses women who had never been sexually active. The other thing that we found which is provocative is that women who are sexually active and taking the pill didn't have an increased risk of urinary incontinence. The pill appears to have a protective effect of some kind which we currently do not understand. This is the first urinary incontinence study for young women we did not look at mechanisms although we've opened Pandora's Box.
Question: How is depression and anxiety related to urinary incontinence in the young?
Professor Susan Davis: Of the girls with urinary incontinence we found a third of them were wearing protection to protect against leakage. Women were anxious because they were worried that they were going to leak unexpectedly or leak and it will smell; women were so worried they were restricting their fluid intake so they wouldn't make urine and therefore couldn't leak. Urinary incontinence really altered the behaviour of the young girls and that came as a great surprise.
Question: How can urinary incontinence be treated?
Professor Susan Davis: In older women we know that losing weight if you are obese or doing pelvic floor exercises and a range of medications can reduce the symptoms. This study has unmasked a problem we didn't realise was there previously and because we don't know what is causing the problem we need to understand it better in order to decide what treatments might be best.
If a woman has urinary incontinence when she is pregnant we tell her to do pelvic floor exercises - at this point in time we do not know if this is going to be useful in young girls who leak urine and have never been pregnant because we do not know if their pelvic floor is weak.
The biggest factor in the surveyed group was if they had been sexually active and the oral contraceptive pill appeared to be protective and that certainly needs to be investigated further as it is a completely new field.
Question: If a young girl is experiencing involuntary leakage of urine, what should she do?
Professor Susan Davis: They should go to their GP and talk about it because if they have incontinence the GP will need to exclude if they have an ongoing infection such as a bladder infection and there are other things that need to be looked at. It's important that young girls feel that they can go and talk to someone if they're experiencing these types of issues and they won't be laughed at or feel embarrassed.