現代人生活忙碌，容易緊張、壓力大，造成作息不正常、失眠。雖然大家都知道要有健康的生活方式，才能有健康的身體，但結果卻是知易行難。而心理健康、睡眠品質和生理機能跟尿失禁到底有沒有關聯性呢?在泌尿科領域排名第一的期刊”THE JOURNAL OF UROLOGY”最新一期的期刊中，正好有一篇文章就是探討這個問題。這是一篇收集了六間醫學中心、510位、因受下尿路症候群困擾而來求診的婦女，利用問卷評量的方式，來進行橫斷面分析的前瞻式研究。作者使用了LUTS Tool來評估患者尿失禁的種類及嚴重度，使用PROMIS、PSS、IPAQSF這些問卷來了解病患心理健康(包括憂鬱、焦慮、壓力狀態)、睡眠品質、生理機能的情況。最後利用多變項迴歸分析來探討其中的關聯性。研究結果發現，這510位平均56歲的尿失禁婦女，其中82%是白種人，47%體態肥胖，甚至14%有糖尿病。在這些婦女中，有尿失禁的比例高達82.4%。分析其尿失禁的種類，應力性尿失禁佔17%，急迫性佔21%，混和型最多，佔57%，其他型只佔5%。在過去的研究當中，已經發現那些經常覺得不開心的女性，也就是經常有憂鬱、焦慮、覺得壓力大的人，發生急迫性尿失禁的比例及嚴重度是較高的。這現象同時也發生在膀胱過動症的女性患者。而另外兩項研究因素(睡眠品質和生理機能)並不會影響急迫性尿失禁的發生機率或是嚴重度。但是過去的研究對象是從公共衛生的角度，去調查分析所有有下尿路症候群的女性，這同時包含有接受治療及未接受治療者。而本篇文章特別針對有尋求治療的下尿路症候群女性患者進行研究。其結果顯示，對於這些有接受治療的下尿路症候群女性患者，若發生有尿失禁的情況，其心理健康度(憂鬱、焦慮和壓力增加)與尿失禁的嚴重度有高度相關，但是與尿失禁的類型及發生機率無關。嚴重度這部份與先前急迫性尿失禁及膀胱過動症的研究結果相吻合，也就是尿失禁的情況越嚴重，患者越常處於憂鬱、焦慮和壓力之下。越常憂鬱、焦慮、高壓，尿失禁的情況越嚴重，如此惡性循環，以至於患者生活品質相當差。

至於另外兩項因素，睡眠品質及生理機能。雖然分析結果與尿失禁呈正相關，尤其是急迫性尿失禁。但是沒有達到統計學上的意義，看來是需要更多的研究及證據才能證明其中的關聯性。所以，根據目前的研究結果，無論是哪一種尿失禁的患者，配合醫療團隊的治療，改善尿失禁的情況，有助於心情愉快，減少焦慮，使患者不會經常性地處於高壓狀態，對於改善生活品質有很大的幫忙的。

Purpose: We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms.

Materials and Methods: This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity.

Results: We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measures. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function.

Conclusions: Among treatment seeking women with lower urinary tract symptoms increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress.