title: Mixed urinary incontinence: greater impact on quality of life.
abstract: OBJECTIVE
  We compared the impact of mixed, stress and urge urinary incontinence on quality of life in middle-aged or older women.
  
  
  METHODS
  We analyzed cross-sectional data from a population based cohort of 2,109 ethnically diverse middle-aged or older women. Among participants reporting weekly incontinence, clinical type of incontinence was assessed by self-reported questionnaires and disease specific quality of life impact was evaluated using the Incontinence Impact Questionnaire. Multivariable logistic regression was used to compare the odds of greater quality of life impact from incontinence, defined as an Incontinence Impact Questionnaire score in the 75th percentile or greater in women with stress, urge and mixed incontinence.
  
  
  RESULTS
  More than 28% (598) of women reported weekly incontinence, including 37% with stress, 31% with urge and 21% with mixed incontinence. Unadjusted Incontinence Impact Questionnaire scores were higher for women with mixed vs urge or stress incontinence (median score 29 vs 17 and 13, respectively, p <0.01). Adjusting for age, race/ethnicity, health status and clinical incontinence severity, women with mixed incontinence were more likely to report a greater overall quality of life impact compared to those with stress incontinence (OR 2.5, 95% CI 1.4-4.3), as well as a greater specific impact on travel (OR 2.2, 95% CI 1.3-3.7) and emotional (OR 1.8, 95% CI 1.0-3.4) Incontinence Impact Questionnaire domains. The overall impact of urge incontinence did not differ significantly from that of stress (urge vs stress OR 1.6, 95% CI 0.9-2.7) or mixed incontinence (mixed vs urge OR 1.6, 95% CI 0.9-2.8) in adjusted models.
  
  
  CONCLUSIONS
  In middle-aged or older women mixed incontinence is associated with a greater quality of life impact than stress incontinence independent of age, race, health or incontinence severity. Identification of women with mixed incontinence symptoms may be helpful in discovering which women are most likely to experience functional limitations and decreased well-being from incontinence.
authors.affiliation: Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, USA. fricka@ccf.org
authors.forename: Anna C
authors.initials: AC
authors.lastname: Frick
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Huang
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van den Eeden
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Knight
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Creasman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yang
authors.forename: Arona I
authors.initials: AI
authors.lastname: Ragins
authors.forename: David H
authors.initials: DH
authors.lastname: Thom
authors.forename: Jeanette S
authors.initials: JS
authors.lastname: Brown
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D014549:Urinary Incontinence / Q000145:classification*