Prevalence and Overlap of Urinary and Bowel Disorders in Younger Women Veterans

Bradley CS, Nygaard IE, Torner J, Hillis SL, Johnson SR, Sadler AG. Prevalence and Overlap of Urinary and Bowel Disorders in Younger Women Veterans. Poster session presented at: American Urogynecologic Society Annual Scientific Meeting; 2012 Oct 5; Chicago, IL.

Related HSR&D Project(s)

• DHI 08-051 – Urogenital Symptoms, Depression and PTSD in OEF/OIF Women Veterans

Objectives To describe the prevalence and overlap of urinary and bowel disorders based on self-reported symptoms in a younger, diverse veteran population. Methods Baseline data were analyzed from an ongoing, nationwide longitudinal study of urogenital symptoms in women veterans. Women who returned from deployment to Iraq or Afghanistan in the prior two years and had separated from the military were eligible. Contact information and race/ethnicity was obtained from the Defense Manpower Data Center. Data were collected via computer-assisted telephone interview and included validated urinary and bowel symptom-based instruments: Urogenital Distress Inventory (UDI), RAND Interstitial Cystitis Epidemiology (RICE) measure, Fecal Incontinence Severity Index (FISI) and Rome III. Overactive bladder (OAB) and stress urinary incontinence (SUI) were identified if specific UDI symptoms (urinary frequency and/or urgency urinary incontinence (OAB) and urine leak with physical activity, coughing or sneezing (SUI)) were present and at least moderately bothersome. Fecal incontinence (FI) was defined as leakage of solid, liquid or mucous stool at least monthly. Interstitial cystitis/painful bladder syndrome (IC/PBS) was defined using the RICE high specificity definition, and functional constipation and irritable bowel syndrome (IBS) with Rome III diagnostic criteria. Rates and overlap of urinary and bowel conditions were compared by age, race/ethnicity, BMI and parity. Results 1,358 women with mean (SD) age 31.0 (8.4) yrs (range 20-67) and BMI 25.7 (4.3) kg/m < sup > 2 < /sup > completed the interview. 59% were white, 21% black, 11% Hispanic and 5% Asian. 53% were nulliparous; 23%, 17% and 8% had parity of 1, 2 and 3. 429 (32%) reported symptoms of at least one urinary disorder and 181 (13%) had symptoms of more than one disorder (Figure). 336 (25%) reported symptoms of at least one bowel disorder and 39 (3%) of two disorders. 158 women (11.7%) had at least one urinary and one bowel disorder identified. Black women veterans were more likely to report symptoms of at least one bowel disorder (36% vs. 22%, p = 0.0001) and more often reported OAB, FI and constipation (p = 0.02, 0.03 and < 0.001, respectively) than white veterans. Age, BMI and parity were significantly associated with OAB, SUI and FI, but not with bladder and bowel pain disorders (IC/PBS and IBS). Conclusions OAB, SUI and painful bladder symptoms were common, affecting one in three of these younger women veterans. Urinary and bowel disorders co-occurred in one in ten women. Significant overlap of urinary symptoms/conditions may make epidemiologic identification of urinary disorders challenging. Increased rates of bowel symptoms in black women deserve additional study.