Urinary Incontinence:

For Some, A Fate

Worse Than Death
Society for Women’s Health Research
Interdisciplinary Network on Urological Health in Women
SWHR: WHO WE ARE
THE SOCIETY FOR WOMEN’S HEALTH RESEARCH (SWHR®)
leads the women’s health revolution as a pioneer in the study of sex and
gender differences. We work to eliminate imbalances in care for women
by advancing science, policy, and education.
SWHR: INTERDISCIPLINARY NETWORKS

SWHR recognizes the need to have researchers and clinicians work

collaboratively to define the current state of knowledge, gaps, and
recommendations for future directions in urological health in women.

The Network model rests of the following key principles:

 Key thought leaders
 Multi-year
 Interdisciplinary and multi-sites
 Peer-driven science and the right question
SWHR: Interdisciplinary Network on
Urological Health in Women

MISSION: Raise awareness of the impact of bladder health on women’s

well-being across the lifespan. Since unhealthy bladders disproportionately
affect women and girls the Network aims to:

 Review current information and identify knowledge gaps and make

recommendations to inform research, policy, and education.
 Raise awareness through advocacy among agencies, patient advocacy groups and
medical societies.
 Promote education among health care providers, educators, and the general public
 Urogynecology

Gerontology Pediatrics

Urology Cellular &

Microbiology &
Network Molecular
Immunology
Biology

Obstetrics &
Urology
Gynecology

Reconstructive
Surgery
Current Members
 Elizabeth R. Mueller, MD, MSME, Loyola University (Chair)
 Margot S. Damaser, PhD, Cleveland Clinic (Co-Chair)
 Cindy Amundsen, MD, Duke University
 Toby Chai, MD, Yale University
 Clare Close, MD, Close Pediatric Urology
 Michael E. DiSanto, PhD, Rowan University
 Matthew O. Fraser, PhD, Duke University
 Stephanie Kielb, MD, Northwestern University
 George Kuchel, MD, University of Connecticut
 Mary H. Palmer, PhD, RN, UNC at Chapel Hill
 Candace Parker-Autry, MD, Wake Forest University
 Alan Wolfe, PhD, Loyola University
Urinary Incontinence (UI):
Viewed As a Fate Worse Than Death

Rubin et al., JAMA Internal Medicine, 2016

Multiple Types of UI

Mixed
Stress (Stress+Urge) Urge

Adapted from Wein & Rackley, J Urol. 2006.

 Global Prevalence of UI

25 million American adults and

200 million adults worldwide suffer from UI
Over Active Bladder

85% of UI patients are women

>50% of women in nursing home suffer from UI

National Continence
U.S. Department of Health and Human Services. Urinary incontinence in adults. Clinical
Practice Guideline. (AHCPR Publication No. 92-0038), 1992
 UI Is Stigmatizing and Prevalent Across the Lifespan
45.0%

40.0%

35.0%

90% 30.0%

of women never Over Active Bladder

25.0%
discuss UI symptoms
Other
with their health care 20.0%
Urgency
provider
15.0% Mixed
Stress
10.0%

5.0%

0.0%
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+
AGE
Ebbesen et al., BMC Urology, 2013
Losada et al., J Women’s Health, 2016
 UI Is More Prevalent Than Other Chronic Diseases in Women
35.0%

30.0%

25.0%

20.0%
Over Active Bladder
15.0%

10.0%

5.0%

0.0%
Incontinence Hypertension Depression Diabetes

Ebbesen et al., BMC Urology, 2013

Losada et al., J Women’s Health, 2016
Co-Morbidities and UI

Risk factors for UI: UI increases risk for:

Age Falls (in the elderly)

Obesity Anxiety
Over Active Bladder
Hypertension Depression

Diabetes

Dementia

Depression

Decline in mobility Perry et al. Br J Health Psychol, 2006.; Komesu et al. Female Pelvic Med Reconstr Surg, 2011.
Uzun & Zorba. Urology, 2012.; Meville, Katon, Delaney, JAMA Internal Medicine, 2005.
Chiarelli, Mackenzie, & Osmotherly. Aust J Physiother, 2009.
 UI Significantly Impacts Quality of Life

Depression, Anxiety, Avoidance

Urinary Incontinence

Social isolation, Decreased life-space

Over
Financially burdensome, Unable to work outside the Active Bladder
home

Lots of $$$ spent on protective garments

Falls, Hip Fractures

Nursing home admissions, Permanent loss of independence

Charalambous & Trantafylidis, Pelviperineology, 2009

Grimby et al., Age and Ageing; 1993
 UI Significantly Impacts Quality of Life

37% of working women reported urine leakage during the previous 30 days
Over Active Bladder

Series1

88% of women with severe urine leakage reported UI negatively impacted their abilities at work
e.g. concentration, self-confidence, ability to complete work without interruption

Fultz et al., Occupational Medicine, 2005

 Economic Burden of UI in the U.S.

$65.9B
In total UI costs
$49.1B $82.6B
Direct medical Over Active Bladder
in the U.S. in 2007 costs Total UI costs
in the U.S. projected
for 2020
$2.3B
$2.3B
Direct
Direct non-
non-medical
costs
medical costs $14.6B
Direct non-
medical costs
Coyne et al., J Manag Care Pharm, 2014
 Economic Burden of UI in Canada

$5.13B Access to new treatments

In total UI costs $2.3B
could reduce
Over Activecosts, as seen in the
Bladder
in Canada Direct costs
U.S. 70-80% reduction in direct
costs after successful treatment
$6263
Per person
costs

Canadian Continence Foundation, 2014;

Subak et al., Obstet Gynecol, 2012;
Subak et al., Am J Obstet Gynecol, 2014
 UI Expenditures Are Greater Than Other Women’s Health Conditions
30
Estimated Total Economic Costs (Billions)

25

20

15 Over Active Bladder

10

0
Urinary Incontinence Osteoporosis (direct cost only) Breast Cancer

1. Wilson et al., Obstet Gynecol, 2001.

2. Wagner & Hu. Urology, 1998.
3. NIH. Electronic citation, 2001.
Conclusions

• The reasons why women who suffer with UI are hesitant to seek care
are poorly understood and provide an opportunity for researchers

• Understanding how women can achieve and maintain a healthy bladder

is also poorly understood and a critical area for research
Contact
 Elizabeth R. Mueller, MD, MSME, Loyola University (Network Chair)

 Margot S. Damaser, PhD, Cleveland Clinic (Network Co-Chair)

 SWHR Director of Scientific Programs, science@swhr.org

For more information, visit www.swhr.org.

Follow on Twitter @SWHR.