Table of contents
- See also VitaminDWiki
- VitaminDWiki pages containing INCONTINENCE in title (6 as of Sept 2021)
- Urinary Incontinence reduced by 50,000 IU of vitamin D weekly (details behind paywall) – RCT Feb 2023
- 2,000 IU Vitamin D did not treat male Overactive Bladder and Urinary Incontinence - VITAL RCT Sept 2022
- Urinary incontinence associated with low vitamin D in most studies - Review Sept 2021
- The effect of vitamin D deficiency in children with overactive bladder related urinary incontinence - April 2022
- 3X reduction in Urinary Incontinence in elderly black women having low vitamin D after supplementation - RCT March 2019
- Urgent urinary incontinence reduced about 40% by 50,000 IU Vitamin D weekly – RCT April 2018
- Urinary incontinence 3.2X less likely in elderly if OK level of vitamin D – Sept 2016
- Syracuse gynecologist shows how vitamin D deficiency leads to urinary incontinence - April 2010
- Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. - April 2010
- 2,000 IU of vitamin D daily did not reduce Uninary Incontinence (no surprise)
See also VitaminDWiki
- Prostate and Urinary systems much better with higher vitamin D – many studies
- Pelvic floor muscle strength is low after giving birth if vitamin D deficient – March 2015
- Pelvic floor disorder strongly associated with lower vitamin D – March 2012
- Overview Women and Vitamin D
- All items in category Women and vitamin D
VitaminDWiki pages containing INCONTINENCE in title (6 as of Sept 2021)
This list is automatically updatedItems found: 7
Urinary Incontinence reduced by 50,000 IU of vitamin D weekly (details behind paywall) – RCT Feb 2023
The effect of vitamin D on urgent urinary incontinence in postmenopausal women
International Urogynecology Journal (2023) https://doi.org/10.1007/s00192-023-05486-5
Mahsa Arjmand, Hajar Abbasi & Athena Behforouz
Introduction and hypothesis
Conflicting results have been reported on the effect of vitamin D supplementation on urinary incontinence (UI). Therefore, the aim of this study was to evaluate the effect of consuming vitamin D oral supplements on improving urge UI (UUI) in postmenopausal women with vitamin D deficiency.
This randomized clinical trial was conducted in 2019–2020 in postmenopausal women with UUI or nocturia more than once at night with vitamin D levels less than 30 ng/ml. After recording the severity of UI and its impact on the patient's daily life, patients were randomly divided into two groups of 45 patients: one taking vitamin D3 (50,000 IU) tablets and one taking placebo weekly for 8 weeks.
There was no significant difference between the two groups in terms of the severity of UI and the frequency of nocturia before treatment. However, after treatment, in the vitamin D group, the severity of UI and the frequency of nocturia significantly reduced. Before treatment, the impact of UI on patients' daily life was reported to be high in more than 70% of patients in both groups, which was not significantly different; however, after treatment, its impact was significantly reduced in the vitamin D group.
The findings of the present study showed that in postmenopausal women with UUI or nocturia, weekly use of vitamin D 50,000 IU tablets for 8 weeks can reduce the severity of UI and the frequency of nocturia, and reduce their impact on disruption in daily life.
2,000 IU Vitamin D did not treat male Overactive Bladder and Urinary Incontinence - VITAL RCT Sept 2022
Effect of Vitamin D Supplementation on Overactive Bladder and Urinary Incontinence Symptoms in Older Men: Ancillary Findings from a Randomized Trial
Kournal of UrologyAdult Urology6 Sep 2022 https://doi.org/10.1097/JU.0000000000002942
To evaluate vitamin D supplementation for preventing or treating overactive bladder (OAB) and urinary incontinence (UI) in men.
Ancillary study of men aged ≥55 years in the VITamin D and OmegA-3 TriaL (VITAL). Randomized treatments included: vitamin D3 (cholecalciferol), marine omega-3 fatty acids, or matching placebo. Structured UI questions measured the prevalence of OAB at year 5, and UI at years 2 and 5, along with incidence and progression of UI from years 2 to 5. Pre-specified subgroup analyses examined men with low baseline serum vitamin D [25(OH)D<20 ng/mL.
Among the 11,486 men who provided data at year 2 and 10,474 at year 5, mean age was 68 years at Year 2, with 23% racial/ethnic minorities. In primary analyses, vitamin D supplementation compared to placebo did not lower odds of OAB at year 5 (OR 0.97, 95% CI 0.87-1.08), or weekly UI at year 2 (OR 0.94, 95% CI 0.83-1.05) or year 5 (OR 0.98, 95% CI 0.88-1.09). We found interactions of baseline serum 25(OH)D level with vitamin D supplementation for OAB (p-interaction=0.001), and secondarily, for any UI at year 2 (p-interaction=0.05).
Men with baseline 25(OH)D <20 ng/mL, who were assigned to vitamin D supplements, had
- lower odds of OAB (OR 0.51, 0.35-0.76) compared to placebo,
- yet higher odds of any UI (OR 1.24, 0.93-1.64).
Overall, vitamin D supplementation did not improve OAB, or UI, compared to placebo. However, specific use of vitamin D in men with lower 25(OH)D levels had inconsistent findings.
Urinary incontinence associated with low vitamin D in most studies - Review Sept 2021
The effect of vitamin D deficiency and supplementation on urinary incontinence: scoping review
Int Urogynecol J .. 2021 Sep 7. doi: 10.1007/s00192-021-04963-z
Ronnie Baer 1, Lea Tene 2, Adi Y Weintraub 3, Leonid Kalichman 1
Introduction and hypothesis: Vitamin D receptors are found in skeletal and smooth muscle cells throughout the body, specifically in the bladder detrusor muscle. We reviewed the current literature on the association between vitamin D deficiency and urinary incontinence (UI), and whether vitamin D supplementation plays a role in the treatment of UI symptoms.
Methods: We performed a scoping review of all available studies. PubMed, Google Scholar, and PEDro databases were searched from inception until August 2020 with the keywords "urinary incontinence," "pelvic floor disorders," "lower urinary tract symptoms," "overactive bladder," and various terms for vitamin D. No language restrictions were imposed. The reference lists of all retrieved articles were also searched.
Results: The search revealed 12 studies of different research methodologies after elimination.
- In 6 out of the 7 cross-sectional studies reviewed, a significant association between vitamin D deficiency or insufficiency and the onset and severity of UI was found.
- In 2 out of the 3 prospective studies included, no association between vitamin D intake and UI was found; however,
- both randomized controlled trials that were reviewed found that vitamin D supplementation is effective for the treatment of UI.
Conclusions: The existing literature supports an association between low levels of serum vitamin D and UI. Initial evidence regarding the effect of vitamin D supplementation on UI is accumulating, yet additional, comprehensive research is warranted to establish these findings.
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- Morelli A, Squecco R, Failli P, et al. The vitamin D receptor agonist elocalcitol upregulates L-type calcium channel activity in human and rat bladder. Am J Physiol Cell Physiol. 2008;294(5):C1206–C14. - DOI
- Aspell N, Laird E, Healy M, Lawlor B, O'Sullivan M. Vitamin D deficiency is associated with impaired muscle strength and physical performance in community-dwelling older adults: findings from the English Longitudinal Study Of Ageing. Clin Interv Aging. 2019;14:1751–61. - DOI
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- Garcia M, Seelaender M, Sotiropoulos A, Coletti D, Lancha AH Jr. Vitamin D, muscle recovery, sarcopenia, cachexia, and muscle atrophy. Nutrition. 2019;60:66–9. - DOI
- Tomlinson PB., Joseph C, Angioi M. Effects of vitamin D supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis. J Sci Med Sport. 2015;18(5):575–80. - DOI
- Salman S, Khouzami M, Harb M, Saleh B, Boushnak MO, Moussa MK, Mohsen ZH. Prevalence and predictors of vitamin D inadequacy: a sample of 2,547 patients in a Mediterranean country. Cureus. 2021;13(5):e14881. - PubMed - PMC
- Gannagé-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. 2000;15(9):1856–62. - DOI
- Gannagé-Yared MH, Maalouf G, Khalife S, et al. Prevalence and predictors of vitamin D inadequacy amongst Lebanese osteoporotic women. Br J Nutr. 2009;101(4):487–91. - DOI
- Lips P, Hosking D, Lippuner K, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006;260(3):245–54. - DOI
- El-Hajj Fuleihan G, Nabulsi M, Choucair M, et al. Hypovitaminosis D in healthy schoolchildren. Pediatrics. 2001;107(4):E53. - DOI
- Vaughan CP, Johnson TM 2nd, Goode PS, Redden DT, Burgio KL, Markland AD. Vitamin D and lower urinary tract symptoms among US men: results from the 2005–2006 National Health and Nutrition Examination Survey. Urology. 2011;78(6):1292–7. - DOI
- Badalian SS., Rosenbaum PF. Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. Obstet Gynecol. 2010;115(4):795–803. - DOI
- Lee HS, Lee JH. Vitamin D and urinary incontinence among Korean women: a propensity score-matched analysis from the 2008–2009 Korean National Health and Nutrition Examination Survey. J Korean Med Sci. 2017;32(4):661–5. - DOI
- Li D, Xu Y, Nie Q, Li Y, Mao G. Predictors of urinary incontinence between abdominal obesity and non-obese male adults. Postgrad Med. 2017;129(7):747–55. - DOI
- Stafne SN, Mørkved S, Gustafsson MK, et al. Vitamin D and stress urinary incontinence in pregnancy: a cross-sectional study. BJOG. 2020;127(13):1704–11. - DOI
- Vaughan CP, Tangpricha V, Motahar-Ford N, et al. Vitamin D and incident urinary incontinence in older adults. Eur J Clin Nutr. 2016;70(9):987–9. - DOI
- Parker-Autry CY, Markland AD, Ballard AC, Downs-Gunn D, Richter HE. Vitamin D status in women with pelvic floor disorder symptoms. Int Urogynecol J. 2012;23(12):1699–705. - DOI
- Dallosso HM, McGrother CW, Matthews RJ, Donaldson MMK, Leicestershire MRC Incontinence Study Group. Nutrient composition of the diet and the development of overactive bladder: a longitudinal study in women. Neurourol Urodyn. 2004;23(3):204–10. - DOI
- Vaughan CP, Markland AD, Huang AJ, Tangpricha V, Grodstein F. Vitamin D intake and progression of urinary incontinence in women. Urology 2021;150:213–8. - DOI
- Markland AD, Vaughan C, Huang A, Tangpricha V, Grodstein F, et al. Vitamin D intake and the 10-year risk of urgency urinary incontinence in women. J Steroid Biochem Mol Biol. 2020;199:105601. - DOI
- Digesu GA, Verdi E, Cardozo L, Olivieri L, Khullar V, Colli E. Phase IIb, multicenter, double-blind, randomized, placebo-controlled, parallel-group study to determine effects of elocalcitol in women with overactive bladder and idiopathic detrusor overactivity. Urology. 2012;80(1):48–54. - DOI
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- Linde JM, Nijman RJM, Trzpis M, Broens PMA. Urinary incontinence in the Netherlands: prevalence and associated risk factors in adults. Neurourol Urodyn. 2017;36(6):1519–28. - DOI
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The effect of vitamin D deficiency in children with overactive bladder related urinary incontinence - April 2022
IBJUInt. braz j urol 48 (2) • Mar-Apr 2022 • https://doi.org/10.1590/S1677-5538.IBJU.2021.0645
Burak Özçift Uygar Micoogullari
Overactive bladder (OAB) is a common syndrome associated with lower urinary tract symptoms (LUTS), especially urinary incontinence in children, which may affect the patient's quality of life (QoL). Vitamin D deficiency has been shown to be associated with OAB syndrome. This study evaluated the relationship between vitamin D status and OAB-related symptoms and QoL in children.
Materials and Methods:
The study included 52 pediatric patients with OAB-related urinary incontinence and 41 healthy children. LUTS were assessed using the Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) questionnaire, and QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). Oral vitamin D supplementation was given to patients with OAB with vitamin D deficiency. Urinary symptoms and QoL were evaluated before and after vitamin D supplementation.
Vitamin D deficiency was more common in the OAB group (75%) than in the control group (36.6%). Logistic regression analysis revealed that vitamin D status (<20ng/mL) was a significant predictor of OAB. Both pre-treatment and post-treatment DVISS and PINQ scores showed a positive correlation. After vitamin D supplementation, 8 (23.5%) patients had a complete response and 19 (55.9%) patients had a partial response. Significant improvement in QoL was also achieved.
Vitamin D deficiency is more common in children with urinary incontinence and OAB than in healthy children. Although vitamin D deficiency is not routinely evaluated for every patient, it should be evaluated in treatment-resistant OAB cases. Vitamin D supplementation may improve urinary symptoms and QoL in patients with OAB.
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3X reduction in Urinary Incontinence in elderly black women having low vitamin D after supplementation - RCT March 2019
Comparing Vitamin D Supplementation Versus Placebo for Urgency Urinary Incontinence: A Pilot Study
J Am Geriatr Soc. 2019 Mar;67(3):570-575. doi: 10.1111/jgs.15711. Epub 2018 Dec 21.
Download the PDF from VitaminDWiki
OBJECTIVES: To estimate the efficacy of vitamin D supplementation to reduce urgency urinary incontinence (UUI) episodes.
DESIGN: Pilot, two-arm, randomized trial conducted from 2013 to 2017.
Interventions were 12 weeks of weekly oral 50,000 IU vitamin D3 or placebo.
SETTING: Academic, university-based outpatient clinic.
PARTICIPANTS: Community-dwelling postmenopausal women, 50 years or older, with at least three UUI episodes on 7-day bladder diary and serum vitamin 25-hydroxyvitamin D (25OHD) of 30 ng/mL or less.
The primary efficacy estimate was the percentage change in UUI episodes. Secondary estimates included changes in other lower urinary tract symptoms, along with exploratory subgroup analysis by race/ethnicity and obesity.
We randomized 56 women (aged 50-84 years; mean = 60.5 ± 8.2 years), 28 to vitamin D and 28 to placebo; 51 completed treatments. Mean serum 25(OH)D at baseline (21.2 ± 5.2 and 18.2 ± 5.6, P = .30) improved to 57.9 ± 16.3 ng/mL with vitamin D3 and 21.9 ± 8.2 ng/mL with placebo (P < .001). UUI episodes per 24-hour day decreased by 43.0% with vitamin D3 compared to 27.6% with placebo (P = .22).
Among black women (n = 33), UUI episodes decreased by 63.2% with vitamin D3 compared to 22.9% with placebo (P = .03). Among obese women, UUI episodes decreased by 54.1% with vitamin D compared to 32.7% with placebo (P = .29). For all women, changes in voiding frequency (P = .40), nocturia (P = .40), urgency (P = .90), incontinence severity (P = .81), and overactive bladder symptom severity (P = .47) were not different between arms.
Postmenopausal women with UUI and vitamin D insufficiency demonstrated a greater than 40% decrease in UUI episodes, which did not reach statistical significance compared to placebo, except in the subset of black women. The results of this pilot study support further investigation of vitamin D3 alone or in combination with other treatments for UUI, particularly for women in higher-risk subgroups. J Am Geriatr Soc 67:570-575, 2019.
Urgent urinary incontinence reduced about 40% by 50,000 IU Vitamin D weekly – RCT April 2018
PD32-08 VITAMIN D SUPPLEMENTATION FOR URGENCY URINARY INCONTINENCE IN POST-MENOPAUSAL WOMEN: A PILOT RANDOMIZED CLINICAL TRIAL
The Journal of Urology, Vol 199, Issue 4, Sup, April 2018, Pages e648, AUA Annual Meeting, https://doi.org/10.1016/j.juro.2018.02.1551
Alayne Markland, T. Mark Beasley, Kathryn BurgioCamille Vaughan, Vin Tangpricha Patricia GoodeVitaminDWiki
- Probably would have had more improvement and statistical significance if enough vitamin D had been given to achieve >30 ng/mL
- Perhaps 50,000 IU of Vitamin D every 4 days instead of every 7 days
- Perhaps more benefits if use a form of Vitamin D which is gut-friendly
INTRODUCTION AND OBJECTIVES
Urgency urinary incontinence (UUI) is a very common, distressing condition. First-line behavioral and drug therapies are effective but novel therapies are needed. The primary aim of this study was to evaluate the efficacy of vitamin D supplementation compared to placebo to improve UUI in postmenopausal women with vitamin D insufficiency.
This was a single-site pilot randomized trial conducted 2013-2017. Participants were community-dwelling postmenopausal women, 50 years of age or older, with at least 3 UUI episodes on 7-day bladder diary and 25(OH)D≤30 ng/mL (insufficiency). They were randomized to 12 weeks of weekly 50,000 IU vitamin D3 or placebo. Using Wilcoxon tests, we calculated the percent reduction in 24-hour UUI episodes (primary outcome), along with urinary frequency and nocturia episodes from the diaries for the overall group and for African American (AA) and obese women (higher-risk subgroups). Secondary outcomes included scores on validated bladder symptom questionnaires.
We randomized 56 women (50 to 84 years of age; mean age = 60.5 ±8.2; 70% AA; 64% obese), 28 to vitamin D and 28 to placebo; 51 completed treatment. For the completer analysis, mean 25(OH)D at baseline (21.2 ±5.2 and 18.2 ±5.6, p=0.30) improved to 57.9 ±16.3 for the vitamin D3 group and to 21.9 ±8.2 in the placebo group, p<0.001. UUI episodes per 24-hour day decreased 52.4% with vitamin D3 compared to 30.9% with placebo (p=0.09). Among Black women, changes in UUI episodes decreased 63.2% with vitamin D3 compared to 23.0% with placebo (p=0.03). There were no group differences among obese women (p=0.29). For all women, no differences between D3 and placebo were found for improvements in voiding frequency (p=0.40), nocturia (p= 0.40), incontinence symptom severity (p=0.80), or overactive bladder symptom severity (p=0.47).
Post-menopausal women with UUI and vitamin D insufficiency recorded a >50% decrease in UUI episodes that did not reach statistical significance compared to placebo, except in the subset of AA women. Based on these pilot study estimates for efficacy, further investigation of vitamin D3 alone or in combination with other treatments for UUI is warranted, particularly for women in higher-risk subgroups.
Urinary incontinence 3.2X less likely in elderly if OK level of vitamin D – Sept 2016
Vitamin D and incident urinary incontinence in older adults.
Eur J Clin Nutr. 2016 Sep;70(9):987-9. doi: 10.1038/ejcn.2016.20
Vaughan CP1,2,3, Tangpricha V2,3, Motahar-Ford N2,3, Goode PS4,5,6, Burgio KL4,5,6, Allman RM7, Daigle SG4, Redden DT4,8, Markland AD4,5,6.
The aim of this study is to determine whether vitamin D status is associated with incident urinary incontinence (UI) among community-dwelling older adults.
The University of Alabama at Birmingham Study of Aging is a prospective cohort study of community-dwelling Medicare enrollees. Standardized assessment of UI was conducted using the validated Incontinence Severity Index. The analysis of 25-hydroxyvitamin D [25(OH)D] levels was performed on stored baseline sera. UI was assessed every 6-12 months for up to 42 months. The analyses included multivariable logistic regression and Cox proportional hazard models.
Of 350 participants (175 male, 147 black, mean age 73.6±5.8), 54% (189/350) were vitamin D deficient (25(OH)D <20 ng/ml) and 25% (87/350) were vitamin D insufficient (25(OH)D: 20 ng/ml to <30 ng/ml). Among the 187 subjects with no UI at baseline, 57% (107/187) were vitamin D deficient and 24% (45/187) were vitamin D insufficient. A total of 175 of the 187 subjects had follow-up evaluation for incident UI over 42 months, and incident UI occurred in 37% (65/175). After adjustment, cumulative incident UI at 42 months was associated with baseline vitamin D insufficiency (P=0.03) and demonstrated a trend association with deficiency (P=0.07). There was no association between baseline vitamin D status and the time to incident UI.
These preliminary results support an association between vitamin D and incident UI in community-dwelling older adults. Future studies may target specific at-risk groups, such as men with BPH or women with pelvic floor disorders for evaluation of the impact of vitamin D supplementation on urinary symptoms.
Syracuse gynecologist shows how vitamin D deficiency leads to urinary incontinence - April 2010
By Amber Smith/The Post-Standard April 20, 2010,
We know vitamin D is important for keeping our bones healthy.
In recent years we've heard how it boosts our immune functioning, improves blood flow by relaxing our blood vessels and helps our insulin work better so we can lose belly fat.
Now a Syracuse gynecologist says the prevalence of vitamin D deficiency helps explain why so many women suffer pelvic floor disorders including urinary incontinence.
Dr. Samuel Badalian's study, "Vitamin D and Pelvic Floor Disorders" is published in this month's journal of Obstetrics & Gynecology.
He began wondering about the role of vitamin D when he realized so many of his patients with osteoporosis also had pelvic problems. Because those pelvic disorders are "connective tissue disorders, same as osteoporosis," he was not surprised to find a connection.
Using data from the 2005-2006 National Health and Nutrition Examination Study, he looked at the vitamin D measurements for 1,881 nonpregnant women with pelvic floor disorders. One in four American women have a pelvic floor disorder, which includes urinary incontinence, pelvic organ prolapse and other problems.
Badalian's work builds on previous research that has connected vitamin D deficiency with bladder dysfunction. He found that women of all ages with pelvic floor disorders or urinary incontinence had significantly lower levels of vitamin D. Women age 20 and older, with high levels of vitamin D, had a significantly lower incidence of pelvic floor disorders; and women age 50 and older, with high levels of vitamin D, had a significantly lower incidence of urinary incontinence.
"Given the increase in the number of patients with pelvic floor disorders, further evaluation of the role of vitamin D is warranted, particularly future research to assess the relationship between vitamin D levels and pelvic muscle strength in women of all ages and racial/ethnic groups," he writes in his summary.
Badalian says vitamin D levels should be checked annually. Taking 2,000 international units per day of vitamin D3 can provide healthy levels for most people, but those who are elderly, obese or who have renal insufficiency need more.
"People need to realize, they need their vitamin D."
You can eat foods fortified with vitamin D, you can take supplements. Or, you can spend 15 or 20 minutes in the sun to get your daily dose of vitamin D.
Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. - April 2010
Obstet Gynecol. 2010 Apr;115(4):795-803.
Badalian SS, Rosenbaum PF.
Department of Obstetrics and Gynecology, SUNY Upstate Medical University, and Gynecology and Urogynecology Center, St. Joseph's Hospital Health Center, Syracuse, New York 13203, USA. badalian at netzero.com
OBJECTIVE: To estimate the prevalence of vitamin D deficiency in women with pelvic floor disorders and to evaluate possible associations between vitamin D levels and pelvic floor disorders. METHODS: Using 2005-2006 National Health and Nutrition Examination Survey data, we performed a cross-sectional analysis of nonpregnant women older than 20 years of age with data on both pelvic floor disorders and vitamin D measurements (n=1,881). Vitamin D levels lower than 30 ng/mL were considered insufficient. The prevalence of demographic factors, pelvic floor disorders, and vitamin D levels were determined, accounting for the multi-stage sampling design; odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate associations between vitamin D levels and pelvic floor disorders with control for known risk factors.
RESULTS: One or more pelvic floor disorders were reported by 23% of women. Mean vitamin D levels were significantly lower for women reporting at least one pelvic floor disorder and for those with urinary incontinence, irrespective of age. In adjusted logistic regression models, we observed significantly decreased risks of one or more pelvic floor disorders with increasing vitamin D levels in all women aged 20 or older (OR, 0.94; 95% CI, 0.88-0.99) and in the subset of women 50 years and older (OR, 0.92; 95% CI, 0.85-0.99). Additionally, the likelihood of urinary incontinence was significantly reduced in women 50 and older with vitamin D levels 30 ng/mL or higher (OR, 0.55; 95% CI, 0.34-0.91).
CONCLUSION: Higher vitamin D levels are associated with a decreased risk of pelvic floor disorders in women.
LEVEL OF EVIDENCE: III., PMID: 20308841
2,000 IU of vitamin D daily did not reduce Uninary Incontinence (no surprise)
Sept 2022 doi: 10.1097/JU.0000000000002942
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