Cigarette smoking and urinary incontinence in women

      This paper is only available as a PDF. To read, Please Download here.


      OBJECTIVE: The goal of this case control study was to evaluate the relationship between smoking and female urinary incontinence.
      STUDY DESIGN: The study included 606 women whose smoking histories were known; 322 were incontinent and 284 were continent. The condition(s) causing each subject's incontinence was determined by urodynamic testing; 40% of the continent subjects had the same testing.
      RESULTS: There were highly significant overall differences (p = 0.000009) in the distribution of current, former, and never smokers between incontinent (35%, 16%, 49%) and continent (24%, 8%, 68%) groups. The odds ratio for genuine stress incontinence was 2.20 for former (95% confidence interval 1.18 to 4.11) and 2.48 for current smokers (95% confidence interval 1.60 to 3.84); for motor incontinence it was 2.92 for former (95% confidence interval 1.58 to 5.39) and 1.89 (95% confidence interval 1.19 to 3.02) for current smokers. Increasing daily and lifetime cigarette consumption was associated with an increasing odds ratio for genuine stress incontinence but not for motor incontinence. The increased risk for incontinence was not due to differences in age, parity, weight, or hypoestrogenic status.
      CONCLUSION: The data establish a strong statistical relationship between current and former cigarette smoking and both stress and motor urinary incontinence in women.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fielding JE
        Smoking: health effects and control.
        N Engl J Med. 1985; 313: 491-498
        • Rowe JW
        • National Institutes of Health Consensus Development Panel
        Urinary incontinence in adults.
        JAMA. 1989; 261 (chairperson): 2685-2690
        • Zacharin RF
        Abdominoperineal urethral suspension in the management of recurrent stress incontinence of urine—a 15-year experience.
        Obstet Gynecol. 1983; 62: 644-654
        • Centers for Disease Control
        The surgeon general's 1989 report on reducing the health consequences of smoking: 25 years of progress (executive summary).
        MMWR. 1989; 38: 2-18
        • Centers for Disease Control
        The surgeon general's 1990 report on the health benefits of smoking cessation (executive summary).
        MMWR. 1990; 39: 2-10
        • Bump RC
        The urodynamic laboratory.
        Obstet Gynecol Clin North Am. 1989; 16: 795-816
        • Abrams P
        • Blaivas JG
        • Stanton SL
        • Andersen JT
        The International Continence Society Committee on Standardisation of Terminology. The standardisation of terminology of lower urinary tract function.
        Scand J Urol Nephrol. 1988; 114S: 5-19
        • Hosmer DW
        • Lemeshow S
        Applied logistic regression. John Wiley, New York1989: 43-45
        • Fleiss JL
        Statistical methods for rates and proportions. ed 2. John Wiley, New York1981: 83-99Statistical methods for rates and proportions. ed 2. John Wiley, New York1981: 112-137
        • Centers for Disease Control
        Cigarette smoking among reproductive-aged women: behavioral risk factor surveillance system, 1989.
        MMWR. 1991; 40: 719-723
        • Centers for Disease Control
        Tobacco use by adults: United States, 1987.
        MMWR. 1989; 38: 685-687
        • Baron JA
        • LaVecchia C
        • Levi F
        The antiestrogenic effect of cigarette smoking in women.
        Am J Obstet Gynecol. 1990; 162: 502-514
        • Last JA
        • King TE
        • Nerlich AG
        • Reiser KM
        Collagen cross-linking in adult patients with acute and chronic fibrotic lung disease.
        Am Rev Respir Dis. 1990; 141: 307-313
        • Brincat M
        • Versi E
        • Moniz CF
        • Magos A
        • de Trafford J
        • Studd JWW
        Skin collagen changes in postmenopausal women receiving different regimens of estrogen therapy.
        Obstet Gynecol. 1987; 70: 123-127
        • Versi E
        • Cardozo L
        • Brincat M
        • Cooper D
        • Montgomery J
        • Studd J
        Correlation of urethral physiology and skin collagen in postmenopausal women.
        Br J Obstet Gynaecol. 1988; 95: 147-152
        • Larsson B
        • Andersson KE
        • Batra S
        • Mattiasson A
        • Sjogren C
        Effects of estradiol on norepinephrine-induced contraction, alpha adrenoceptor number and norepinephrine content in the female rabbit urethra.
        J Pharmacol Exp Ther. 1984; 229: 557-563
        • Swash M
        The neurogenic hypothesis of stress incontinence.
        in: Bock G Whelan J Ciba Foundation Symposium 151: neurobiology of incontinence. John Wiley, New York1990: 156-170
        • Gilpin SA
        • Gosling JA
        • Smith ARB
        • Warrell DW
        The pathogenesis of genitourinary prolapse and stress incontinence of urine: a histological and histochemical study.
        Br J Obstet Gynaecol. 1989; 96: 15-23
        • Smith ARB
        • Hosker GL
        • Warrell DW
        The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study.
        Br J Obstet Gynaecol. 1989; 96: 23-28
        • Snooks SJ
        • Badenoch DF
        • Tiptaft RC
        • Swash M
        Perineal nerve damage in genuine stress incontinence; an electrophysiological study.
        Br J Urol. 1985; 57: 422-426
        • Hisayama T Shinkai M
        • Takayanagi I
        • Toyoda T
        Mechanism of action of nicotine in isolated bladder of guineapig.
        Br J Pharmacol. 1988; 95: 465-472
        • Koley B
        • Koley J
        • Saha JK
        The effects of nicotine on spontaneous contractions of cat urinary bladder in situ.
        Br J Pharmacol. 1984; 83: 347-355
        • Ruggieri MR
        • Whitmore KE
        • Levine RM
        Bladder purinergic receptors.
        J Urol. 1990; 144: 176-181
        • Cowan WD
        • Daniel EE
        Human female bladder and its noncholinergic contractile function.
        Can J Physiol Pharmacol. 1983; 61: 1236-1246
        • Fiore MC
        • Novotny TE
        • Pierce JP
        • Hatziandreu EJ
        • Patel KM
        • Davis R
        Trends in cigarette smoking in the United States: the changing influence of gender and race.
        JAMA. 1989; 261: 49-55