Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study

doi:10.1016/S0029-7844(01)01566-6

Obstetrics & Gynecology

Volume 98, Issue 6, December 2001, Pages 1004-1010

https://doi.org/10.1016/S0029-7844(01)01566-6 Get rights and content

Abstract

OBJECTIVE:

To investigate the association between parity and urinary incontinence, including subtypes and severity of incontinence, in an unselected sample, with special emphasis on age as a confounder or effect modifier.

METHODS:

This was a cross-sectional study (response rate 80%) with 27,900 participating women. Data on parity and urinary leakage, type, frequency, amount, and impact of incontinence were recorded by means of a questionnaire. A validated severity index was used. Relative risks (RR) with nulliparous women as reference were used as an effect measure.

RESULTS:

Incontinence was reported by 25% of participants. Prevalences among nulliparous women ranged from 8% to 32%, increasing with age. Parity was associated with incontinence, and the first delivery was the most significant. The association was strongest in the age group 20–34 years with RR 2.2 (95% confidence interval [CI] 1.8, 2.6) for primiparous women and 3.3 (2.4, 4.4) for grand multiparous women. A weaker association was found in the age group 35–64 years (RRs between 1.4 and 2.0), whereas no association was found among women over 65 years. For stress incontinence in the age group 20–34 years, the RR was 2.7 (2.0, 3.5) for primiparous women and 4.0 (2.5, 6.4) for grand multiparous women. There was an association with parity also for mixed incontinence, but not for urge incontinence. Severity was not clinically significantly associated with parity.

CONCLUSION:

Parity is an important risk factor for female urinary incontinence in fertile and peri- and early postmenopausal ages. Only stress and mixed types of incontinence are associated with parity. All effects of parity seem to disappear in older age.

Section snippets

Materials and methods

The study was part of the Norwegian EPINCONT study (EPidemiology of INCOntinence in the county of Nord-Trøndelag), which is presented in detail elsewhere.1 The EPINCONT study is again part of the Nord-Trøndelag Health Survey 2 (HUNT 2), a large survey performed in one county in Norway during the years 1995–97. Everyone aged 20 years or more (n = 94,197) residing in the county were invited to participate. The complete HUNT 2 survey covered many topics, for example, mental health, cardiovascular

Results

Table 1 shows the prevalence and number of incontinent women, according to age groups and parity. Urinary incontinence was associated with both age and parity. Notably, prevalence among nulliparous women was high, ranging from 8% to 32% according to age. For age groups over 65 years, parity had no influence on prevalence. In age groups affected by parity, the first delivery had a higher impact than each of the next. The prevalences increased by between 6% (in age group 35–44 years) and 14% (in

Discussion

This study demonstrates a strong and significant association between parity and urinary incontinence with RRs ranging from 1.6 for primiparous women to 2.3 for grand multiparous women. The findings support deliveries as an important risk factor for incontinence. However, the prevalence of incontinence among nulliparous women also was rather high, indicating that other risk factors have substantial influence. The effects of parity were clearly related to age and type of incontinence. Women in

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^☆: The Nord-Trøndelag Health Study (the HUNT Study) is a collaboration between the HUNT Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Verdal, the National Institute of Public Health, the National Health Screening Service of Norway, and the Nord-Trøndelag County Council. The EPINCONT Study was also supported by the Research Council of Norway. The authors have no commercial affiliations relevant to this study.

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Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study☆

Abstract

Section snippets

Materials and methods

Results

Discussion

J Clin Epidemiol

J Urol

Int J Gynaecol Obstet

Obstet Gynecol

Obstet Gynecol

J Clin Epidemiol

Obstet Gynecol

Epidemiology and natural history of urinary incontinence

Int Urogynecol J Pelvic Floor Dysfunct

Reproductive and hormonal risk factors for urinary incontinence in later lifeA review of the clinical and epidemiologic literature

J Am Geriatr Soc

Leaking urinePrevalence and associated factors in Australian women

Neurourol Urodyn

Determinants of urinary incontinence in a population of young and middle-aged women

Acta Obstet Gynecol Scand

Prevalence of urinary incontinence

BMJ