Association between respiratory disease and stress urinary incontinence: An analysis of the 2015-2020 National Health and Nutrition Examination Survey

Introduction: There is a logical association between chronic obstructive pulmonary disease (COPD) or asthma with stress urinary incontinence (SUI), given the propensity for coughing which increases intra-abdominal pressure. However, there are few studies examining the association between COPD or asthma and specifically SUI. We aimed to utilize the National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2020 to measure the association between respiratory diseases like COPD and asthma with SUI.

Methods: Data was collected from NHANES, a database representative of the United States population. Participants were included if they were female, older than 20 years, and completed the incontinence survey question. Self-reported history of asthma and COPD diagnosis from a physician, as well as history of incontinence associated with activities such as coughing, lifting, or exercise, were collected. Characteristics of participants were compared using χ² and Student t-tests. Multivariable logistic regression was performed using a multimodel approach to adjust for sociodemographic and health-related covariates.

Results: A total of 9059 women were included in this study. 42.13% reported an episode of SUI in the past year, 6.29% had a COPD diagnosis, and 11.86% had an asthma diagnosis. In the unadjusted analysis, participants with COPD were more likely to report SUI (odds ratio [OR] 3.42, 95% confidence interval [CI] 2.13-5.49, p < 0.001); this association persisted on multivariable analysis (OR 2.87, 95% CI 1.46-5.60, p = 0.003). There was no significant association between asthma and SUI in the unadjusted (OR 1.15, 95% CI 0.96-1.38, p = 0.14) or adjusted model (OR 1.18, 95% CI 0.86-1.60, p = 0.30).

Conclusion: Although a strong association between COPD and SUI was observed, an analogous one was not found between asthma and SUI. Chronic cough may be more difficult to control with treatment or more common in those with COPD than asthma, explaining this difference. Future research should continue to explore drivers for SUI in large populations to dispel or affirm historically assumed SUI risk factors.