Previous stroke or transient ischemic attack (TIA) may be a risk factor for urgency urinary incontinence (UUI), according to a British study of older individuals. In addition, findings suggest that severe UUI has a distinct presentation with more specific contributory mechanisms than milder UUI.

In a study of 1762 participants aged 68 years, individuals who had a previous stroke or TIA at age 60 to 64 years had a significant 2-fold higher risk of UUI, in adjusted analyses, Alex Tsui, of the MRC Unit for Lifelong Health and Ageing at UCL, London, and colleagues reported online ahead of print in BJU International. As in previous studies, higher body mass index (BMI) was linked with an increased risk of UUI. Each standard deviation increment in BMI was associated with a significant 19% higher odds of UUI. Female sex and co-presentation with stress urinary incontinence were associated with a significant 4-fold and 1.8-fold increased odds of UUI, respectively.

The prevalence of UUI at age 68 was 12% among men and 19% among women.

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The associations between UUI and these risk factors were stronger with severe UUI.  Prior stroke or TIA was associated with a 3.6 times greater relative risk of severe UUI symptoms. The investigators found no corresponding association with mild UUI. Hypertension at age 60 to 64 years was independently associated with a significant 1.6-fold higher risk of UUI in men, but was not associated with UUI risk in women.  

Among women, the study found no association between UUI symptoms and menopause or use of hormone replacement therapy. It also found no link between smoking status, educational attainment, or physical activity and UUI.

Study participants were part of a Medical Research Council National Survey for Health and Development birth cohort. All were born in 1 week in March 1946. At a home or clinic visit, a research nurse collected information on vascular risk factors when the individuals were aged 60 to 64 years.

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“Taken together, these results suggest that vascular risk factors, in particular hypertension, may contribute towards UUI pathophysiology in addition to previous stroke/TIA, raised BMI, female sex, and co-presentation with SUI,” the authors noted.

Although the present study corroborates previous findings that BMI has a central role in the etiology of UUI, “our results also support the emerging view that obesity contributes to UUI as part of a wider metabolic syndrome.”


Tsui A, Kuh D, Cardozo L, Davis D. Vascular risk factors for male and female urgency urinary incontinence at age 68 years from a British birth cohort study. BJU Int. 2018; doi: 10.1111/bju.14137