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PRIMARY CARE: Yngvild S Hannestad, Rolv Terje Lie, Guri Rortveit, and Steinar Hunskaar Familial risk of urinary incontinence in women: population based cross sectional study BMJ 2004; 329: 889-891 [Abstract] [Full text]

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Higher prevalence of urinary incontinence in daughters and sisters of such patients not surprising

Jai B Sharma, Professor Suneeta Mittal   (20 October 2004)

Higher prevalence of urinary incontinence in daughters and sisters of such patients not surprising 20 October 2004
Jai B Sharma, Assistant Professor of Obstetrics and Gynaecology All India Institute of Medical Sciences, New Delhi, India, Professor Suneeta Mittal Send response to journal: Re: Higher prevalence of urinary incontinence in daughters and sisters of such patients not surprising	The article by Hannestad et al on population based cross sectional study on frequency of all types of urinary incontinence in sisters and daughters of women affected by urinary incontinence is not surprising but raises certain questions.Higher familial incidence of urinary incontinence in close relatives of such patients is well known (1).But in such a population based study where the diagnosis was made from patients' own account and not confirmed by urodynamic studies, there may be some amount of reporting bias as the daughters and younger sisters of patients suffering from urinary incontinence are very aware of the condition and are likely to report the symptoms of urinary incontinence much more often than the daughters and sisters of normal women as they become much more sensitive about it and ask for help much earlier(2,3). This is like the relatives of breast or ovarian cancer report to doctors for screening much earlier than normal women or the daughters of women with kyphosis due to osteoporosis report to doctors much more often to start hormone replacement therapy to avoid the fate of their mothers. Similarly the daughters or sisters who have seen the suffering of their mothers or sisters about urinary incontinence are more likely to report and seek treatment to avoid the similar fate. Moreover there may be other common factors in the families like the use of similar diets, smoking or toilet habits which may have a bearing on the prevalence of urinary incontinence like use of Indian type of toilet seat where a woman is forced to sit in a squating posture each time she goes to the toilet with forced perineal floor exercises each time is known to have partial preventive effect on the prevalence of urinary incontinence as all the members of the house shall have to use the similar type of toilet seat. However, a higher incidence of urinary incontinence by the relatives of such patients should be used as an oppurtunity to visit their doctors to seek help for urinary incontinence as most of these conditions can be easily treated and they should not suffer in silence thinking it to be a natural and ageing process, an ideology rampant in developing countries like India. References: 1. Elia G, Bergman J, Dye TD. Familial incidence of urinary incontinence. Am J Obstet Gynecol 2002;187:53-5. 2. Rortvein G, Daltveit AK, Hannestad YS, Hunskar S. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003;348:900-7. 3. FitzGerald MP, Brubaker L. Urinary incontinence symptom scores and urodynamic diagnoses. Neurourol Urodyn 2002;21:30-5. Competing interests: None declared