News Release

UCSF study finds increased risk of falls and fractures in older women who have urge incontinence

Peer-Reviewed Publication

University of California - San Francisco

Older women who have frequent urge incontinence have a higher risk of falling and fracturing a bone than women who are not urge incontinent, a University of California, San Francisco study has found.

The study showed that weekly or more frequent urge incontinence -- when someone feels a sudden, strong need to urinate and urine leakage occurs before reaching the bathroom -- increased the risk of falls by 26 percent and the risk of fractures by 34 percent. This study will be published in the July issue of the Journal of the American Geriatrics Society.

"Women who have urge incontinence get up often to urinate at night -- jumping out of the bed and rushing to the bathroom to prevent urine leakage or incontinence. This most likely causes them to trip and fall," said lead author Jeanette S. Brown, MD, UCSF associate professor of obstetrics and gynecology and specialist in women's incontinence. "Or during the day, they also frequently have a sudden desire to urinate and may fall while rushing to the bathroom."

The significance of this study, Brown said, is it shows early diagnosis and treatment of urge incontinence may help physicians decrease a woman's risk of falling and fractures. In older women, urge incontinence is a common condition occurring in up to 40 percent of women over the age of 60, Brown said. However, women are often too embarrassed to discuss incontinence with their physicians and may not seek treatment for this common condition. Falls and fractures are also common major health concerns for older women, Brown said. "Falls instill fears of future falling. And fractures can destroy lives," Brown said.

" Once an older person has already fallen or fractured a bone, it makes her fearful of going out and living an active life. We are looking for simple ways to prevent falls and fractures and keep women active. Treatments for urge incontinence are simple, such as bladder re-training or medications, and don't require surgery."

Though other studies have examined whether incontinence can lead to falls and fractures in older women, the UCSF report is the first to factor in a specific type of incontinence, Brown said. Stress incontinence, another common form of incontinence, was not found to increase risk of falls and fractures. Stress incontinence is the loss of urine with an activity such as coughing, sneezing, laughing, lifting a bag of groceries, jogging, or rising from a sitting to a standing position.

The study assessed 6,049 women living in community dwellings using a self-completed questionnaire. Postcards were mailed subsequently every four months to inquire about falls and fractures. The mean age of the women in the study was 78.5 years old and 80 percent were in good health. During an average follow up of three years, 55 percent of the women in the study reported falling and 8.5 percent reported fractures. One quarter of the women, 1,493, reported weekly or more frequent urge incontinence. Nineteen percent, or 1,137, reported weekly or more frequent stress incontinence. And 708 women, or 12 percent, reported both types of incontinence.

Urinary incontinence is a condition that affects more than 13 million people in the United States -- male and female, young and old -- according to the National Kidney and Urologic Diseases Information Clearing House. Women experience urinary incontinence two times more often than men and older women suffer from the condition more often than younger women do.

"Incontinence has a profound affect on many aspects of older women's day to day lives, Brown said. "We see women who stop walking with their friends, or won't stay overnight at their grandchildren's homes because they are afraid they will have an accident. Incontinence can begin a downward spiral of inactivity and social isolation. "

"We know women don't talk about incontinence," she said. "It is important for women to understand how common it is, that treatment is available and that they are at a greater risk of falls and fractures if they have urge incontinence."

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Other study authors are: Eric Vittinghoff, PhD, assistant adjunct professor; Katie Stone, Ph.D., specialist; Michael Nevitt, Ph.D., associate adjunct professor; Deborah Grady, MD, MPH, associate professor in residence. All are in the UCSF department of epidemiology and biostatistics. Jean Wyman, RN, PhD, University of Minnesota, School of Nursing; Kristine Ensrud, MD, MPH, University of Minnesota, Department of General Internal Medicine, Veteran's Affairs Medical Center and Department of Epidemiology and Medicine. The National Institute on Aging funded the study.



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