The international continence society (ICS) incontinence definition: Is the social and hygienic aspect appropriate for etiologic research?

Objective. To investigate the effect of applying a problem assessment versus a pure symptom urinary incontinence (UI) caseness definition in etiologic research. Subjects. A random population sample of 2613 women aged 30–59 years, who responded to a postal questionnaire. Main parameters. One-year period prevalence of the symptom of stress UI; UI assessed by the woman to be a social and/or hygienic problem; childbirth and history of abdominal, gynecological, obstetric or urologic surgery. Results. Among the 388 women (14.8% of the population sample) who reported stress UI, 62.6% considered it a social or hygienic problem, and 21.9% had ever abstained socially because of UI. Applying a problem assessment caseness definition caused under-estimation of the role of childbirth, as compared with analyses including a pure symptom caseness definition. Conclusion. The International Continence Society (ICS) incontinence definition presents intrinsic logical problems that invalidates its use in biomedical, if not in sociomedical, research. As definition and medical decision are different concepts, this does not necessarily affect the potential utility of the problem assessment aspect when used in everyday clinical practice as a basis for the decision whether to treat women with UI or not.