3 Questions Check Urinary Incontinence

May 15, 2006 -- Researchers have designed a three-question quiz to help diagnose urinary incontinenceincontinence in women.

The quiz covers two types of urinary incontinence: stressstress incontinence and urge incontinence. Stress incontinence is urine leakage during laughing, coughing, sneezing, or other movements. Urge incontinence (also known as overactive bladder) is urine leakage while feeling a sudden need or urge to urinate.

The quiz is "a simple, quick, and noninvasive test with acceptable accuracy for classifying urge and stress incontinence and may be appropriate for use in primary care settings," write Jeanette Brown, MD, and colleagues in the Annals of Internal Medicine.

Brown works at the University of California, San Francisco.

What's on the Quiz?

Here are the quiz questions.

• During the last three months, have you leaked urine (even a small amount)? If no, end quiz.
• During the last three months, did you leak urine (check all that apply):
  1. When you were performing some physical activity, such as coughing, sneezing, lifting, or exercise?
  2. When you had the urge or the feeling that you needed to empty your bladder, but you could not get to the toilet fast enough?
  3. Without physical activity and without a sense of urgency?
• During the last three months, did you leak urine most often (check only one):
  1. When you were performing some physical activity, such as coughing, sneezing, lifting, or exercise?
  2. When you had the urge or the feeling that you needed to empty your bladder, but you could not get to the toilet fast enough?
  3. Without physical activity and without a sense of urgency?
  4. About equally as often with physical activity as with a sense of urgency?

What It Means

The patient's type of urinary incontinenceincontinence is defined by the third question on the quiz. Here is the answer sheet:

1. Most often with physical activity: stressstress-only or stress-predominant urinary incontinence.
2. Most often with the urge to empty the bladder: urge-only or urge-predominant urinary incontinence.
3. Without physical activity or sense of urgency: incontinence due to other causes.
4. About equally with physical activity and sense of urgency: a mix of incontinence types.

The researchers tested the quiz on 301 women aged 40 and older (average age: 56) at five academic medical centers in the U.S. Nearly 70% of the women were white, 13% were black, and 12% were Hispanic.

The women had untreated urinary incontinence for seven years, on average. None had been pregnant for at least six months before the study. Most reported themselves to be in good or excellent health, the study shows.

Besides taking the quiz, the women got an extensive medical checkup and completed a three-day diary on their urination.

'Acceptable' Accuracy

Brown and colleagues checked the women's quiz answers to the results from medical evaluations. The results:

• Urge incontinence: 119 women (nearly 40%)
• Stress incontinence: 132 women (nearly 44%)
• Mixed incontinence: 42 women (14%)
• Other types of incontinence: 8 women (almost 3%)

The quiz wasn't perfect. Its accuracy was "modest but acceptable, given that the risk for misclassification and inappropriate treatment by primary care physicians is low," the researchers write.

For instance, Brown's team notes that drugs for urge incontinence may cause dry mouth but are rarely associated with more serious side effects. The study was funded by Astellas Pharma US, a drug company with products including urinary incontinence medicines.

The researchers also point out that while surgery is sometimes used to treat stress incontinence when behavioral therapy fails, "surgery would not be performed without first completing an extended evaluation."

The quiz needs further study in other groups of women, write the researchers. In the journal, several of Brown's colleagues (but not Brown) disclose having received honoraria and/or grants from various drugs companies, including Astellas Pharma.

SOURCES: Brown, J. Annals of Internal Medicine, May 16, 2006; vol 144: pp 715-723. WebMD Medical Reference from the National Institutes of Health: "Urinary Incontinence in Women." News release, American College of Physicians.