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One and the Same? Nocturnal Enuresis and Overactive Bladder in the Female Veteran Population: Evaluation of a Large National Database

Ninivaggio, Cara, MD*; Riese, Heather, MD*; Dunivan, Gena C., MD*; Jeppson, Peter C., MD*; Komesu, Yuko M., MD*; Murata, Allison, MS; Murata, Glen, MD; Rogers, Rebecca G., MD*; Cichowski, Sara B., MD*†

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 307–311
doi: 10.1097/SPV.0000000000000439
Original Articles

Objectives The aims of this study were to describe relationships between women given a diagnosis of nocturnal enuresis (NE) and controls without any urinary complaints and to compare women with NE with those with overactive bladder (OAB). We hypothesized that NE has unique associations with demographics and medical and psychosocial diagnoses.

Methods This is a secondary analysis of a database that included all female veterans who established care with a primary care provider from 1997 to 2015. International Classification of Diseases, Ninth Revision, codes identified women with a diagnosis of NE or OAB. Patient characteristics, medical diagnoses, and psychosocial factors previously described as relating to NE and/or OAB were compared between the 2 distinct comparative groups, with significance set at P < 0.05. Stepwise logistic regression was used to assess all significant findings.

Results A total of 596,815 women were identified; controls totaled 570,049, the group with OAB totaled 26,446 (4.4%), and the group with NE totaled 301 (0.05%).

Multivariable analysis compared the group with NE with controls; all measured psychosocial characteristics remained significantly associated with an NE diagnosis (all Ps < 0.05), as well as obstructive sleep apnea history, stroke, self-identification as “minority,” smoking, hypertension, and a body mass index higher than those of the general control population (all Ps < 0.05).

When the populations with NE and OAB were compared, a diagnosis of posttraumatic stress disorder, an overdose history, depression, military sexual trauma, increasing body mass index, and younger age remained significantly associated with NE (all Ps < 0.05).

Conclusions The association of NE with psychosocial characteristics and psychiatric illnesses persisted irrespective of the comparison population. Practitioners should investigate the diagnosis of NE in those female veterans with psychosocial issues.

In the female veteran population, when compared separately with both the general control population and the population with overactive bladder, nocturnal enuresis is associated with important psychosocial characteristics such as a diagnosis of posttraumatic stress disorder, overdose history, depression, and a history of military sexual trauma.

From the *Department of Obstetrics and Gynecology, University of New Mexico; and

New Mexico VA Health Care System, Albuquerque, NM.

Correspondence: Sara B. Cichowski, MD, Department of Obstetrics and Gynecology, MSC 10-5580, 1 University of New Mexico, Albuquerque, NM 87131-0001. E-mail:

C.N. contributed to project development, data analysis, manuscript writing, and editing. H.R. contributed to manuscript writing and editing. G.C.D., P.C.J., Y.M.K., and R.G.R. contributed to project development and manuscript editing. A.M. and G.M. contributed to data analysis and manuscript editing. S.C. contributed to project development, data analysis, and manuscript editing.

This material is the result of work supported with resources and the use of the facilities at the New Mexico VA Health Care System, Albuquerque, New Mexico.

Supported by the new investigator grant from the Biomedical Research Institute of New Mexico.

Presented as an oral poster at the PFD Week, the 27th American Urogynecologic Society Annual Scientific Meeting in Denver, CO, on September 27 to October 1. It was published in the book of abstracts.

C.N.'s travel/lodging and food/beverage for AUGS Fellows' course were sponsored by Medtronic. G.C.D. received research support from Pelvalon, Inc, and the Pelvic Floor Disorders Network. Y.M.K. received research support from the Pelvic Floor Disorders Network. R.G.R. received UptoDate royalties, royalties from McGraw-Hill for a textbook, and research support from the Pelvic Floor Disorders Network. The remaining authors have nothing to declare.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.