Urinary Incontinence in Diabetic Women Is Often Neglected

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Physicians need to pay closer attention to the possibility of urinary incontinence (UI) in their female diabetic patients, because 35% of this population reports at least weekly episodes, a group said here at the American Urological Association 2010 Annual Scientific Meeting.

The researchers issued their recommendation after their study found that diabetic women with weekly UI episodes seek treatment less often than nondiabetic women with UI and have less understanding of UI and more UI-related depression.

“Given that diabetic women with IU may not report their symptoms to their physician, coupled with the fact that their UI may lead to depression, we believe that it is extremely important that physicians who care for women with diabetes routinely screen them for UI,” Michelle Y. Morrill, MD, director of urogynecology for Kaiser Permanente in San Francisco, California, explained to Medscape Urology during an interview.

"The good news is that effective treatments are available for UI. It’s unfortunate that diabetic women are often denied such treatments simply because we don’t know they suffer from UI.”

Dr. Morrill said that questionnaires are probably not the best way to screen for UI. “Screening questionnaires can be cumbersome when trying to address all general health issues for patients at a check-up,” she explained. “My recommendation is to say to a patient: ‘Many women experience urinary urgency or leakage. For women who are bothered by these symptoms, there are a variety of treatments, ranging from exercises to medications and surgery. Are you interested in learning more about these treatments?’ “

Large Population-Based Study Shows High Prevalence of UI in Diabetic Women

The investigators compared treatment-seeking for, knowledge of, and beliefs about UI in 488 diabetic women with UI and in 1784 nondiabetic women with UI. The mean age of the study population was 55 ± 9 years.

“Urinary incontinence and diabetes mellitus are common and costly disorders, and diabetes is a known risk factor for UI,” Dr. Morrill observed.

Regrettably, many women do not seek care even though the condition significantly affects their quality of life, she said.

Few studies to date have examined patterns of UI care-seeking and understanding in diabetic women.

Participants in the trial were drawn from the Reproductive Risks for Incontinence Study. The ongoing study consists of a large-scale, population-based, ethnically diverse cohort of randomly selected women who are members of the Kaiser Permanente Medical Care Program of Northern California, an integrated healthcare delivery system with more than 3 million members.

The presence of UI was determined by the frequency of self-reported urinary leakage, and UI severity was determined using the Sandvik Severity Scale. The scale has been widely validated for assessing the severity of female UI.

The analysis focused on women who had a UI episode at least once a week, because weekly UI has been shown to be an important determinant of whether or not patients seek care.

UI More Problematic in Diabetic Than in Nondiabetic Women

There were 3 key findings from the Kaiser Permanente study: the prevalence of weekly UI was 25% in nondiabetic and 35% in diabetic women (P < .001); diabetic women were less likely than nondiabetic women to discuss their UI with their spouse/partner or with a doctor or nurse; and among women with UI who sought treatment, diabetics were more concerned that they had more serious disease (33% vs 13%; P = .007), more depressed about their UI (31% vs 13%; P = .01), and more likely to report that it made them feel older (36% vs 16%; P = .01).

Dr. Morrill emphasized that more studies are needed to determine the mechanisms for the increased incidence of UI in diabetic women and to identify UI prevention and treatment strategies. "Our goal is to reduce the medical, psychosocial, and economic costs of this chronic disorder that affects many women with diabetes," she said.

"This study helps identify a high-risk group for UI, which tells us that we need to target this population for more rigorous UI screening and treatment, if indicated," Alayne Markland, DO, assistant professor of medicine at the University of Alabama at Birmingham, told Medscape Urology. "Since the study showed that diabetic women are less likely to seek care for UI symptoms, we as physicians need to be more proactive in asking patients about UI and other lower urinary tract symptoms, with a goal of improving their overall quality of life."

The study was funded by the National Institutes of Health and the Kaiser Permanente Division of Research. Dr. Morrill and Dr. Markland have disclosed no relevant financial relationships.

American Urological Association (AUA) 2010 Annual Scientific Meeting: Abstract 1667. Presented June 1, 2010.

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Jill Stein

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