Urinary incontinence in adults with cerebral palsy: prevalence, type, and effects on participation.

ABSTRACT

OBJECTIVE: To assess the prevalence, type, and impact of urinary problems in adults with cerebral palsy and their relation with the Gross Motor Function Classification System for cerebral palsy. DESIGN: A cross-sectional prospective survey study. SETTING: An outpatient, urban, academic rehabilitation clinic. PARTICIPANTS: Ninety-one adults with cerebral palsy (45 women, 46 men). INTERVENTIONS: Subjects were approached at clinic presentation and were interviewed regarding current function, type and incidence of bladder issues, and concerns with bladder problems. MAIN OUTCOME MEASURES: The International Consultation on Incontinence Questionnaire-Female, or the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms Module, Gross Motor Function Classification System, employment, and type of residence. RESULTS: The mean age for both women and men was 36 years (range, 18-79 years). The subjects were currently assessed with the Gross Motor Function Classification System scales I-V I, 4.4%; II, 19.8%; III, 13.2%; IV, 40.7%; and V, 22.0%. 95.6% of females and 84.7% of males were living at home. Twenty-three percent were currently employed. Twenty percent of the women indicated that they had bladder urgency most to all of the time and 46.7% of the women had leakage that occurred 2-3 times per week to several times per day. In men, urgency that occurred more often than "occasionally" was reported by 45.7%, and 19.6% reported this occurred "most to all of the time." Multivariable analyses found that obesity compared with normal weight was significantly related to leaking before reaching a toilet (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.3-14.7), to leaking with cough, exercise, or sneeze (OR 5.6, 95% CI 1.3-23.1), and to nocturia (OR 5.4, 95% CI 1.2-25.1). Women were more likely to leak with cough, exercise, or sneeze (OR 5.5, 95% CI 1.5-20.0). On scales that indicate symptom interference with life, high levels of interference were reported for women with symptoms of leaking and for men with urgency and leaking. No significant differences in living situation or employment were related to incontinence scores for women or men. CONCLUSION: There are high levels of incontinence in adults with cerebral palsy, and these individuals report interference with quality of life. Despite these issues, most participants were living in the community, and incontinence scores were not related to employment.