BMI, smoking, and HRT use influence risk of late-life incontinence

Factors such as body mass index, smoking, and the use of hormone replacement therapy affect whether women will develop various forms of incontinence in later life, according to results of a longitudinal study by German researchers presented here yesterday.

Researchers from Charite University Hospital in Berlin looked at a community-based sample of 440 women ages 40 to 79 years, excluding women who had previous pelvic floor surgery. The women underwent an interview involving pelvic floor function questionnaires and clinical examination. Pelvic exams and interviews were repeated after 1 year.Researchers calculated incidence as new cases over 1 year out of women who displayed no symptoms in year 1. They calculated progression as the number of cases with deteriorating symptoms out of women who complained of symptoms less than once a week in year 1.

Stress urinary and fecal incontinence increased significantly from from year 1 to year 2. Specifically, women with a BMI above 30 were nearly twice as likely to have stress urinary incontinence. The risk was 1.5 times greater when BMI was between 25 and 30 or when waist circumference was greater than 88 cm.

Women who were on hormone replacement therapy were twice as likely to have urge incontinence. Risk for fecal incontinence for loose stool was nearly three times higher in women with a BMI above 30 and was close to four times higher in women who had a waist circumference greater than 88 cm.

There were no associations between urinary and fecal incontinence prevalence, incidence and progression with either age, mode of delivery, or age at first delivery.

"We get fatter, more immobile, and we start to see the effect of smoking many years later in life," said Kaven Baessler, MD, a consultant urogynecologist at Charite University Hospital. "There is an effect in terms of age [during childbearing years], but we don't see an effect beyond that."