Introduction: Nocturnal enuresis (NE) occurs in 3% of older women.¹ Our objective was to conduct a conjoint analysis experiment to better understand the relative importance of different consequences of NE.

Methods: Using expert clinical opinion and input from a patient stakeholder, we developed a conjoint analysis survey that included four attributes related to NE: awakening at night, feeling rested in the morning, restricting fluid intake before bed, and skin breakdown due to NE. We performed a prospective, cross-sectional, online study of women over 62 years of age with self-reported NE using Sawtooth Software. Patients completed baseline questions, the International Consultation on Incontinence Questionnaire Nocturia Quality of Life (ICIQ-NQoL) questionnaire, and the conjoint analysis experiment. Data validity checks were built into the questionnaire. Hierarchical Bayes random effects regression analysis was used to determine the relative importance of the four attributes.

Results: A total of 200 people completed the study. The mean age was 71 (standard deviation [SD] 6) years, and most were Caucasian (183/200) and living independently (197/200). The most common management of enuresis was diapers/pads (132/200). Approximately half of the participants experienced enuresis several times a week or nightly (101/200), and most had coexisting mixed incontinence (140/200). The most important attribute was the frequency being awakened at night (34, SD 16) and the frequency of feeling rested in the morning (32, SD 15); they were moderately correlated (r=0.43, p<0.01). Limiting drinking before bed (18, SD 12) and skin breakdown (16, SD 10) had significantly lower importance scores (p<0.05) and were not correlated. Age, body mass index, and the ICIQ-NQoL score were generally not significantly associated with the importance scores. 

Conclusions: Older women with NE place significantly more importance on the frequency of awakening at night and feeling rested in the morning, and lesser importance on associated lifestyle modifications or physical manifestations of NE.