Urinary incontinence and genital prolapse : A prospective population-based study

Sammanfattning: The aims of this study were to investigate the prevalence and possible determinants of urinary incontinence and genital prolapse and the natural course of urinary incontinence and its effect on well-being in a population-based sample of women aged 20 to 59 years. 491(77%) women participated in the baseline examination of a gynaecological health survey and 382 participated in a 5-year follow-up.The prevalence rate of urinary incontinence of any degree was 28% and of incontinence at least once a week 8.4%. Stress urinary incontinence was the dominant type. The prevalence rate was positively correlated to age, parity, smoking, estrogen replacement therapy and the presence of prolapse, and negatively correlated to the pelvic floor muscle strength. The mean annual incidence rate of any degree of incontinence was 2.9% and of incontinence weekly or more often 0.5%. The only factor significantly associated with onset of incontinence in a multivariate analysis was estrogen use at baseline. The mean annual remission rate was 5.9% and tended to decrease with increasing age and increasing severity of the incontinence.There was a strong correlation between how troublesome the women felt their leakage to be and the frequency of incontinence. Incontinent women rated their perceived health, sleep, fitness and satisfaction with their work situation lower than continent women and the rating was related to the frequency of incontinence.The prevalence of any degree of genital prolapse was 31%; only 2% had a prolapse that reached the introitus. Age, parity, pelvic floor muscle strength and, among parous women, the maximum birth weight were significantly and independently associated with presence of prolapse. Genital prolapse was mostly asymptomatic.Women who wanted treatment for their incontinence had more frequent incontinence, more often faecal incontinence and had poorer perceived well-being. One quarter of the incontinent women or 7% of the total population started treatment by a nurse midwife when offered. Of those who completed treatment, almost 90% were improved.