Prevalence of urinary incontinence in patients with chronic cough: a systematic review
Autori
Scotti Ludovica [University of Udine, Udine, Italy]
Salvitti Simone [Azienda Sanitaria Universitaria Friuli Centrale, University of Udine, Udine, Italy]
Background and aims
Individuals with diseases associated with chronic cough have a higher risk of developing urinary incontinence, due to repeated increasing endoabdominal pressure that is spread over the pelvic floor (1). Studies found in literature examine populations affected by a single disease and do not extend the analysis to the main problem, that is urinary incontinence. The aim of the study is to determine the prevalence of urinary incontinence in patients with diseases associated with chronic cough and to compare it with the prevalence of urinary incontinence in healthy populations.
Methods
The systematic review followed the PRISMA 2020 guidelines, with study selection based on a predefined protocol. The search was conducted through Medline, Embase, Cochrane, OvID, Scopus, ProQuest, PEDro and EBSCO. The study selection process, done by two blinded revisors utilizing a Microsoft Excel spreadsheet, included only prevalence studies that met the prespecified criteria. Data from selected studies were extracted and synthesized. The evidence was then assessed using the GRADE method and quality of reporting was assessed using the STROBE checklist.
Results
A total of 1585 articles were identified through database searches, with three added via reference screening. After duplicate removal and screening, 23 observational studies (cross-sectional or prospective) published between 2000 and 2024 were included. These studies investigated urinary incontinence (UI) prevalence in patients with chronic respiratory diseases, with considerable variability in demographics and disease characteristics. UI prevalence in patients with chronic cough ranged from 2.2% to 45% in pediatric patients, 30.4% to 74% in adult women, and 2.4% to 39% in adult men. 11 studies included only females, 3 only males and 9 mixed-gender populations. Most had small sample sizes (<250), while 3 were nationwide. Inclusion criteria were broad, particularly in cystic fibrosis, while exclusion criteria were more consistent. UI was primarly assessed via ICIQ-SF questionnaires. Risk factors included overweight (2) in chronic cough and underweight in cystic fibrosis. Lower FEV1% predicted correlated with increased UI in some cases, The quality of evidence was low, while reporting quality was acceptable.
Conclusion
This review met its objective of investigating the prevalence of urinary incontinence (UI) in patients with chronic cough-related diseases. Results show significantly higher UI rates in females, often double those in healthy individuals. Prevalence estimates for pediatric and male populations remain unclear, requiring further research. The underestimated nature of UI calls for enhanced clinical guidelines, patient education, and clinician engagement, as stigma and limited awareness may prevent proper diagnosis and treatment (3).
REFERENCES
(1) Cobb WS, Burns JM, Kercher KW, Matthews BD, James Norton H, Todd Heniford B. Normal Intraabdominal Pressure in Healthy Adults. J Surg Res. dicembre 2005;129(2):231–5.
(2) Shang X, Fu Y, Jin X, Wang C, Wang P, Guo P, et al. Association of overweight, obesity and risk of urinary incontinence in middle-aged and older women: a meta epidemiology study. Front Endocrinol. 10 ottobre 2023;14:1220551.
(3) Haukeland-Parker S, Frisk B, Spruit MA, Stafne SN, Johannessen HH. Treatment of urinary incontinence in women with chronic obstructive pulmonary disease—a randomised controlled study. Trials. dicembre 2021;22(1):900.