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Urinary Incontinence Often Accompanied by Low Back Pain

In brief:

  • Authors used 125,645 responses from the 2011–2012 Statistics Canada Canadian Community Health Survey

  • Study is the first to also examine the association between urinary incontinence (UI) and back pain in men

  • Both men and women diagnosed with UI were more than 2 times as likely to also have a back pain diagnosis

  • Incidence was similar in both men and women, but there may be some underreporting

  • Providers should perform a thorough review of systems when interviewing patients with either UI or back pain

It isn’t just coincidence that many patients with urinary incontinence (UI) also have low back pain (LBP), according to a new Canadian study. Researchers called it "surprising" that men and women had nearly the same likelihood of having both conditions, and suggest that providers screen all adults who present with one condition for the other.

In the April issue of Physical Therapy (PTJ), a special issue on pelvic floor dysfunction in adults, authors analyzed the 125,645 responses to the 2011–2012 Statistics Canada Canadian Community Health Survey to see if there was a true statistical relationship between UI and LBP. While previous studies have found a high prevalence of both conditions in women, none have examined the link in men.

In the initial analysis, 1.05% of men and 2.5% of women had diagnoses of both LBP and UI. The overall incidence was 1.79%. Adults with UI were more than 2 times more likely to have LBP (OR = 2.18, 95% CI = 1.78–2.66 for men; OR = 2.21, 95% CI = 1.94–2.51, for women) than those who do not have UI. The association was stronger in patients who were overweight or who currently or previously smoked, and it increased with age.

Authors expected the strong association between the conditions, as it has been shown in previous studies of women. But it was, they write, "surprising that the strength of the associations was so similar in men and women."

The large sample size allowed the results to be generalized to most of the Canadian population. However, the survey did not include "people living on First Nations reservations or crown lands," those living in institutions or remote areas, or military personnel.

While the overall prevalence of UI was lower than in previous research, this study was different because the survey asked specifically about physician-diagnosed conditions. Researchers note, "It is well documented that a majority of women with UI do not

report their leakage to a health care provider." They also suggest that the lower prevalence among men may be due to the survey excluding men who reside in institutions such as long-term care facilities, where the prevalence has been found to be higher than in community-dwelling men.

Because the survey was cross-sectional, "is not possible to determine the order which the conditions presented themselves or to determine whether the conditions developed from a common dysfunction or if they had separate, summative etiologies," authors note. However, because having UI more than doubles the risk of having LBP, they assert that it's important for health care professionals to understand the strong connections between back pain and UI. "This finding reinforces the importance of screening for these conditions in people with the other condition," they write.

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