Prevention of Stress Urinary Incontinence in Women

Abstract

Lower urinary tract dysfunction (LUTD), including stress urinary incontinence (SUI), is increasingly recognized as a public health issue due to the prevalence, individual burden, and societal impact. Women are disproportionately affected by UI and are exposed to unique events that affect LUT function including higher rates of LUT infection, childbirth, pelvic floor anatomic changes, and hormonal milieu. The majority of LUTD research and clinical practice has focused on treatment of the most affected subset of women, but there are millions of women living with urinary incontinence that do not seek advice or treatment, and the evidence base for prevention or detection of early symptoms is lacking. Individual factors such as sociodemographic elements, medical history, physical exam, and comorbidities have been well studied; however, the contribution of family and environmental factors is less well understood. Emerging data suggests that some types of high-impact physical activity in adolescence can confer increased UI risk later in life. Prenatal and postpartum pelvic floor muscle training appears to be beneficial in preventing SUI in some women. While certain individual risk factors for SUI have been identified, sociocontextual factors also affect health outcomes and can mediate an individual’s risk of disease. The social ecological model considers factors within the family/peer, community, and societal levels that can affect an individual’s health behaviors. Prevention research that investigates these multiple levels of influence on individual biology and behavior is a fundamental step to better understand the complex factors that impact bladder health and inform LUTS prevention agendas. In addition, strategies to educate girls and women and engage communities in bladder health promotion are essential in order to effectively disseminate scientific findings and implement intervention programs.