Mental Health, Sleep and Physical Function in Treatment Seeking Women with Urinary Incontinence

J Urol. 2018 Oct;200(4):848-855. doi: 10.1016/j.juro.2018.04.076. Epub 2018 May 3.


Purpose: We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms.

Materials and methods: This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity.

Results: We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measure based on the presence vs the absence of urinary incontinence. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function.

Conclusions: Among treatment seeking women with lower urinary tract symptoms, increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress.

Keywords: anxiety; depression; patient reported outcome measures; urinary bladder; urinary incontinence.

MeSH terms

  • Age Factors
  • Aged
  • Anxiety / epidemiology
  • Anxiety / etiology*
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Depression / etiology*
  • Female
  • Humans
  • Incidence
  • Lower Urinary Tract Symptoms / complications
  • Lower Urinary Tract Symptoms / psychology
  • Lower Urinary Tract Symptoms / therapy
  • Mental Health
  • Middle Aged
  • Multivariate Analysis
  • Patient Reported Outcome Measures
  • Physical Fitness / physiology
  • Quality of Life*
  • Regression Analysis
  • Risk Assessment
  • Severity of Illness Index
  • Sleep Wake Disorders / epidemiology*
  • Sleep Wake Disorders / etiology
  • Surveys and Questionnaires
  • Urinary Incontinence, Stress / complications
  • Urinary Incontinence, Stress / psychology*
  • Urinary Incontinence, Stress / therapy*