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J Urol. 2018 Oct;200(4):848-855. doi: 10.1016/j.juro.2018.04.076. Epub 2018 May 3.

Mental Health, Sleep and Physical Function in Treatment Seeking Women with Urinary Incontinence.

Author information

Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina. Electronic address:
Arbor Research Collaborative for Health, Ann Arbor, Michigan.
Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.
Departments of Obstetrics and Gynecology and Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
University of Michigan, Ann Arbor, Michigan.
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.



We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms.


This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity.


We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measure based on the presence vs the absence of urinary incontinence. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function.


Among treatment seeking women with lower urinary tract symptoms, increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress.


anxiety; depression; patient reported outcome measures; urinary bladder; urinary incontinence

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