Coital incontinence: what can we learn from urodynamic assessment?
OBJECTIVE
To evaluate the association of coital incontinence (CI) with lower urinary tract symptoms (LUTS) and to understand the pathophysiology of CI.


METHODS
A database of all women who underwent urodynamic testing in a tertiary referral center in the United Kingdom, from January 1991 to December 2009, was retrospectively analyzed. All women reporting CI were included in the study. Urodynamic testing and interpretation of results were performed in accordance with the recommendations of the International Continence Society.


RESULTS
The prevalence of CI in women with LUTS undergoing urodynamics was 11.8%, and they were significantly younger (mean age = 45.3 years; P <.001) than the rest of the group (mean age = 53.4 years). Obesity (body mass index >30 kg/m(2)) and parity were significantly associated with CI (P <.001). Women reporting CI significantly smoked cigarettes and used antidepressants (P <.001). There were fewer postmenopausal women (P <.001) with CI, and previous hysterectomy had a negative association with CI (P = .005). The majority of women had overactive bladder symptoms and stress urinary incontinence (P <.001). CI was significantly associated with urodynamic stress incontinence (UDSI; odds ratio = 2.35) and detrusor overactivity (DO; odds ratio = 1.22) but not DO incontinence (P <.001). Parity, overactive bladder symptoms, and UDSI reached statistical significance when analysis was performed for age-matched controls.


CONCLUSIONS
CI is not uncommon in women with LUTS, and they present earlier than women with LUTS and no CI. CI is significantly associated with risk factors like parity, obesity, cigarette smoking, and antidepressant usage. CI is multifactorial and associated with UDSI and DO but not DO incontinence.
Department of Urogynecology, Derriford Hospital, Plymouth, Devon, UK; Department of Urogynecology, Bristol Urological Institute, Southmead Hospital, Bristol, UK. Electronic address: cmadhu@nhs.net.
Chendrimada
C
Madhu
Department of Urogynecology, Bristol Urological Institute, Southmead Hospital, Bristol, UK; Department of Urogynecology, University of Bristol, Bristol, UK.
Hashim
H
Hashim
Department of Urogynecology, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, UK.
Doyo
D
Enki
Department of Urogynecology, Bristol Urological Institute, Southmead Hospital, Bristol, UK.
Musaab
M
Yassin
Department of Urogynecology, Bristol Urological Institute, Southmead Hospital, Bristol, UK; Department of Urogynecology, University of Bristol, Bristol, UK.
Marcus
M
Drake
D003075:Coitus; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D001745:Urinary Bladder Diseases / Q000150:complications*; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology*; D014563:Urodynamics