URINARY INCONTINENCE IN CHRONIC COUGH AND RESPONSES TO TREATMENTS

Introduction and Objectives Chronic coughing is associated with a number of distressing complications including urinary incontinence. However the response of incontinence to treatments for chronic cough and/or management of the incontinence is poorly described. The objective of this study was to assess the prevalence of urinary incontinence in a tertiary cough clinic and to describe the effects of interventions. Methods We reviewed the case notes of patients attending our clinic to identify those reporting urinary incontinence associated with coughing, documented at initial assessment in our standard clinic proforma. We then followed up a random selection of those reporting incontinence to evaluate the effects of interventions for cough and specific advice/onward referral to incontinence services delivered by our specialist nurse. Subjects used a 15-point global rating of change scale (GRCS) to rate changes in their urinary incontinence, with 7 graded descriptions of improvement (+1 to +7), 7 of worsening (-1 to -7) or 0 for no change. Results Of 137 chronic cough patients [median age 62.0 yrs (IQR 50 -71), 100 (72.5%) female], 43 patients (31.4%) had urinary incontinence associated with coughing (one also reported faecal incontinence), 83 (60.6%) were continent and the information was missing for 11 (8%). Patients with urinary incontinence were much more likely to be female (41/43 subjects, p In 23 patients [median age 66.0 yrs (IQR 55.0–71.5); 21 (91%) female] followed up, the median GRCS score for urinary incontinence was +4 i.e. moderately better (IQR 0 to +6). Scores suggesting improved urinary continence were recorded by 15 (65.2%) patients, with 8 reporting no change and none reporting a worsening. Patients established on effective drug therapy (mainly low dose morphine sulphate) were more likely to report improved continence (median GRCS +5 versus 0, p=0.003), as were those seen by the specialist nurse (GRCS +6 versus +4, p=0.043) however speech and language therapy did not seem to influence continence (p=0.46). Conclusions Different Interventions for chronic cough may have different impacts upon associated complications such as urinary incontinence. Furthermore specific intervention for urinary incontinence may be independently beneficial in this patient group.