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Younger male vets may be at raised risk for incontinence

By Kathryn Doyle

NEW YORK (Reuters Health) - In a U.S. national survey, men age 55 and younger with a history of military service were three times more likely than men who had never served to report urinary incontinence.

Conditions more common in combat veterans, including traumatic brain injuries and depression, are also linked with urinary incontinence, so screening even young male vets for urinary problems may be worthwhile, the researchers point out in the Journal of Urology.

Still, lead author Dr. Camille Vaughan of the Atlanta VA Medical Center in Decatur, Georgia, told Reuters Health, "We were surprised the association was only present in the younger age cohort."

Her team considered urge incontinence, which is a frequent feeling of needing to urinate - so much so that it's difficult to make it to the bathroom in time - according to Vaughan, as opposed to stress incontinence, which is leakage of urine during a sneeze or cough, for example.

Urge incontinence is the most common form of urinary incontinence among men, and is thought to affect more than 30 million U.S. adults, according to Brigham and Women's Hospital in Boston.

Urinary troubles become more common with age and with health conditions including bladder cancer, infection, nervous system diseases like multiple sclerosis and some medications.

Previous research analyzing Veterans Administration medical records had found no extra risk for urinary incontinence among vets. But since men might not seek treatment for mild or moderate incontinence, Vaughan and her colleagues looked to an annual health survey covering a nationally representative sample of the population.

In the survey, men completed questionnaires and in-person interviews. Vaughan's team analyzed data on 4,700 men over the age of 20 gathered between 2005 and 2008. Nearly one quarter of the men had served in the military.

Overall, the researchers found, 10 percent of the men with no military background reported urinary incontinence, compared to 18 percent of men with military experience.

In general, men with incontinence were more likely to be overweight, depressed and to have enlarged prostates, prostate cancer and multiple other chronic conditions such as diabetes, heart disease or chronic obstructive pulmonary disease.

And when the researchers separated the men into three age groups - 55 years old or younger, 56 to 69 and 70 or above - they found no differences in the rates of incontinence between men in the two older groups based on their military history.

Among those 55 and younger, however, nine percent of military men reported moderate to severe urinary incontinence, compared to three percent of the other men.

There are two possible explanations for the link between urinary incontinence and military service: physical and psychological, according to Dr. Christopher Amling of the urology department of Oregon Health and Science University in Portland, who was not involved in the study.

Blast forces like those suffered in combat might physically affect the bladder and increase the risk of urinary incontinence, he told Reuters Health.

Psychological stress is also linked to bladder irritation, which is tied to urinary incontinence, he said, adding that post-traumatic stress may have the same effect.

Brain health is closely linked to urinary function, he said. "We know that urinary incontinence can be associated with brain disorders of many kinds, including traumatic brain injury, depression or other psychiatric diagnosis."

More study is needed to further investigate the connection, Amling said, but perhaps the most curious finding was that the phenomenon was only seen among men under age 56.

The study cannot prove that military service caused the incontinence. The younger veterans with urinary problems may have been different from the civilians in other ways not accounted for by the analysis.

The increased risk in the younger age group held, however, even after researchers adjusted for weight, depression, prostate conditions and other chronic diseases.

If the problem is tied to military service, the finding could mean that urinary repercussions of military service wear off over time, Vaughan suggested.

Amling said the results might indicate that combat itself may have changed over the past decades, and young men serving in the military now face different kinds of stress than those experienced by men who served 20 or 30 years ago.

The link may exist for military women as well, but more data is needed for that group, Vaughan said.

In the meantime, Vaughan said, "military men should be aware that treatments for urinary symptoms like incontinence are available, and should talk to their healthcare providers if they are experiencing bothersome symptoms."

Urinary symptoms can be treated with medications, lifestyle changes or surgery, which is why it is important to talk about these symptoms with your healthcare provider, she said.

SOURCE: http://bit.ly/16MOWYA The Journal of Urology July 18, 2013

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