Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort

Study objective-To investigate the prevalence and lifetime risk factors for urinary incontinence in middle aged women. Design-Nationally representative birth cohort study with prospective data on childhood enuresis, measured adult height and weight, childbearing histories and measures of socioeconomic status updated at regular contacts, and measures of menopausal status, symptomatology and health care in midlife. Setting-England, Scotland and Wales. Participants-General population sample of 1333 women aged 48 years. Main results-Fifty per cent reported symptoms of stress incontinence and 22% reported symptoms of urge incontinence in the previous year. Eight per cent had severe symptoms. Women who at age 6 years had wet in the day or several nights a week were more likely to suffer severe incontinence and report urge symptoms but occasional bedwetting was not associated with an increased risk in adult life. Those who were older at the birth of their children and who had vaginal deliveries had an excess risk of stress symptoms. Heavier adult body weight was also a risk factor for these symptoms and for severe incontinence. Postmenopausal women were less likely to report stress symptoms. These risk factors remained significant after taking account of the increased reporting of incontinence among women with high levels of general symptomatology and general practioner visits, and of stress symptoms among better educated women. Conclusions-Urinary incontinence is a common problem among middle aged women. This is the first prospective study of a general population sample to support the postulated link between childhood enuresis and adult incontinence. Childbearing has long term adverse effects, particularly for older mothers. Overweight is a common risk factor.