Urge Urinary Incontinence Clinical Trial
Official title:
Incontinence & Intimate Partners: Assessing the Contribution of Treatment
Urge urinary incontinence (UUI) is a socially debilitating disease due to its inherently
unpredictable nature and sometimes large volumes of urine loss. Women with UUI may experience
anxiety over public episodes of incontinence and concerns about odor and, as a result,
isolate themselves socially. This isolation affects both partners in the relationship and may
be a source of discord. The impact of UUI also moves into personal relationships where fears
or actual episodes of incontinence during physical intimacy, including but limited to
intercourse, may result in limited interactions and changes in the relationship satisfaction
for both partners. Few studies have examined the role of urinary incontinence, particularly
UUI, in the dynamics of an intimate partner relationship and none have evaluated the impact
of successful UUI treatment.
The long-term goal of our research is to understand the social and emotional impact of pelvic
floor disorders, particularly UUI, on the well-being of an intimate relationship. Ultimately,
we aim to evaluate the role that successful treatment plays in the alleviation of discord in
intimate partner relationships that are affected by UUI and other pelvic floor disorders.
Our objective for this proposal is to characterize, using validated, quantifiable methods the
quality of the relationship in couples affected by UUI and to identify the role that
treatment plays in improving this relationship. Our central hypothesis is that UUI has a
negative impact upon the emotional and physical well-being of a relationship and that
effective treatment will result in improvement in areas of the relationship that have been
detrimentally affected by UUI. Our rationale for this study is that an understanding of UUI
in the context of a couple, particularly from the perspective of the male partner, will
improve our ability to holistically treat UUI, thus improving patient outcomes and
satisfaction.
Chronic illness places emotional, physical, and financial burdens upon both the patient and
her partner and can be a significant source of stress in a relationship. The symptoms of UUI
inherently pose greater social challenges than those faced by women other forms of pelvic
floor disorders. For example, women with UUI may avoid social situations due to fear of
having an accident or may be reluctant to participate in activities during which it may be
difficult to find a bathroom. The resulting social isolation impacts both members of the dyad
and may serve as a source of relationship discord. Changes in sexual function and perceived
intimacy, including non-intercourse intimacy, as well as communication may be new sources of
stress in a previously healthy relationship or may serve to amplify pre-existing relationship
problems.
Sexual function is another area in which UUI may cause a negative impact. Studies of coital
incontinence among incontinent clinic populations report prevalence ranging from 10%-56% with
a median of 22%. The prevalence of coital incontinence may be related to the type of
incontinence as well as the severity of symptoms. Stress incontinence has been associated
with leakage of urine during intercourse, while detrusor instability and urge incontinence
have been correlated with leakage during orgasm. A cross-sectional study of women with UUI
and urinary incontinence found that among women reporting low sexual desire, stress
incontinence was common (47%), while 46% of women reporting orgasmic phase dysfunction
reported symptoms of urge incontinence. Qualitative data corroborates the negative impact of
UUI on dyadic and sexual relations.
Another mechanism by which UUI may affect satisfaction with dyadic relations is through
depressive symptomatology. Urinary incontinence is associated with a decrease in overall
health-related quality of life and is positively correlated with depression, anxiety, and
stress. Studies of other chronic illnesses demonstrate a correlation between the patient's
level of depression and that of their spouse; level of depression shows an inverse
relationship with degree of satisfaction with the relationship.
One of the two studies in the published literature that use quantitative methods to evaluate
the impact of urodynamic stress incontinence and detrusor overactivity on the marital
relationship concluded that both sexual function and marital relationships are negatively
affected by incontinence. This study, like others, is based upon the perspective of the
female partner. A recent study of Swedish women with urinary incontinence and urgency is the
only study which includes the perspective of the male partner to examine the impact of UUI on
the relationship. It concludes that, "Female urinary incontinence, urgency and frequency
significantly impair the quality of life in both younger and older women, and also have
negative effects on the partner relationship and the partner's life".
The perspective of intimate partners of women with UUI and other forms of PFD is largely
missing from the literature. Any analysis of the role of UUI in intimate partner
relationships is incomplete without this perspective.
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