When you always gotta go...
Problems related to urination, including incontinence and having to get up to urinate at night-time, have become more acceptable topics of discussion over recent years. New treatment options have also led doctors to address these symptoms more actively. Despite this, no study has effectively compared the bother of each of these bladder symptoms for men and women of all ages.
The FINNO Study is an ongoing questionnaire survey conducted right across Finland. A random sample of 6,000 adults identified from the Finnish Population Register, were contacted with a questionnaire asking about all the most common urinary complaints. The researchers received a total of 3,727 replies (62.4% response rate), and slightly more than half of the respondents were female.
Across the whole population, the most common urinary symptoms which caused substantial bother were rushing to the toilet (urinary urgency, 7.9%), leaking urine with coughing or exercise (stress incontinence ,6.5%), night-time voiding (nocturia, 6.0%), dribbling after urination (post-micturition dribble, 5.8%), and leaking urine before reaching a toilet (urgency incontinence, 5.0%). Women were more likely to suffer from either kind of incontinence, while men experienced more problems with slow or incomplete urination.
However, when the researchers focused specifically on the sufferers of each symptom, they found that leaking urine before reaching a toilet was listed as the most embarrassing personal problem by both men and women.
"In women, stress incontinence is the condition whose investigation and treatment we should particularly focus on. The symptom occurs in approximately one in eight of all women at a level of severity that causes substantial bother," explains Kari Tikkinen, MD, PhD, from the Helsinki University Central Hospital and lead researcher for the FINNO Study.
"In both genders, rushing to the toilet and waking at night-time to urinate were listed as fairly common and troublesome problems - approximately one in twelve people stated they had substantial trouble with rushing to the toilet, and one in seventeen said they had trouble with getting up at night-time to urinate ."
"According to this study, however, the most common cause of bother among men is post-micturition dribble, which has been usually ignored," Tikkinen points out.
Urgency as a symptom has received a great deal of attention in recent years - as evidenced by the recently coined term "overactive bladder syndrome". Tikkinen finds the term problematic:
"It implies that the cause of the symptoms lies in the bladder, even though this is often not the case. On the other hand, the term has efficiently raised awareness of urinary symptoms, which is in principle a good thing."
According to Tikkinen, the prevalence of the symptoms in the study was determined by the level of bother the participants experienced, so the results bear clinical significance.
"Most earlier prevalence studies, in both urology and other disciplines, have reported inflated estimates. It is typical that even very mild symptoms are being categorized as pathological. It would be better to define symptoms as pathological based on the discomfort the patient experienced. Then the results would reliably reflect which complaints are genuinely undertreated and in need of more attention."