Incidence and Resolution Rates of Different Types of Urinary Incontinence in Women: Findings From a Cohort Study

The Prevalence and Related Risk Factors of Urinary Incontinence Among Adult Women in Al Medina Al Munawara, Saudi Arabia

Introduction Urinary incontinence (UI) is a common clinical problem. It has an impact on an individual's social, professional, psychological, and physical elements of life. The present study aimed to identify the prevalence of UI and associated risk factors among Saudi women in Al Medina Al Munawara, Saudi Arabia. Methods A cross-sectional study was conducted using an online questionnaire among 430 women aged 18-60 in Al Medina Al Munawara. The participants completed the validated Arabic version of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) to assess the prevalence of UI and its associated factors. Results Among the participants, 64.8% did not experience urine incontinence, while 17.8% reported slight, 14.0% reported moderate, and 3.3% reported severe incontinence. Stress incontinence caused by coughing or sneezing was the most common cause (48.6%), followed by before reaching the toilet (urge incontinence) (34.5%) and after urination (15.5%). Significant associations were found between age, marital status, number of children, diabetes mellitus, urinary tract diseases, previous abdominal or pelvic surgery, obesity, constipation, and menopausal symptoms. However, no significant association was found between pregnancy and urine incontinence. Conclusions This study reveals a moderate prevalence of UI among Saudi women in Al Medina Al Munawara. The findings highlight the importance of early detection, treatment, and education on pelvic floor exercises to address UI. Factors such as age, marital status, number of children, and various medical conditions are associated with this condition, emphasizing the need for comprehensive management strategies.

Advances in the natural history of urinary incontinence in adult females

The aim of this review is to summarise the related characteristics of the natural history of female urinary incontinence (UI) using a narrative descriptive approach. PubMed, EMBASE and Web of Science were searched for articles published from 1 January 2010 to 1 January 2020 on the natural history of female UI, which including incidence, persistence, progression, remission, and regression of a single subtype of UI and the mutual influence of different UI subtypes. This literature review includes 15 articles published, indicates that UI is highly dynamic, with symptoms varying according to disease severity and subtype and influenced by multiple factors at different disease stages. Recent studies have increased our understanding of the natural history of UI. Future research should systematically analyse the progression of each subtype of UI and interactions between subtypes to prevent the progression of UI across females life course.

A population-based cross-sectional survey on the prevalence, severity, risk factors, and self-perception of female urinary incontinence in rural Fujian, China

INTRODUCTION AND HYPOTHESIS

To determine the prevalence, severity, risk factors and self-perception of female urinary incontinence (UI) in rural Fujian, China.

METHODS

This population-based cross-sectional study was conducted between June and October 2022. Women aged 20 to 70 years from rural communities in Fujian Province were selected by multistage random sampling. Data from respondents were collected by completing standardised questionnaires through face-to-face interviews. The main outcome was prevalence and self-perception of UI.

RESULTS

A total of 5659 valid questionnaires were collected. The overall prevalence of female UI was 23.6% (95% CI 22.5-24.7). The most common type was stress UI with a prevalence of 14.0% (95% CI 13.1-14.9), followed by mixed UI with a prevalence of 6.1% (95% CI 5.5-6.7), and finally urgency UI with a prevalence of 3.5% (95% CI 3.0-3.9). Multivariate regression analysis suggested that older age, obesity, postmenopausal status, multiple vaginal deliveries, macrosomia, instrumental vaginal delivery and previous pelvic floor surgeries were independently associated with UI (P < 0.05). The overall awareness rate of UI was 24.7%, and older age, lower level of education, and income were significantly associated with a decrease in awareness (P < 0.05). Only 33.3% of respondents believed they should seek medical help for UI.

CONCLUSION

UI affects more than one-fifth of women in rural Fujian, and several factors are thought to be associated with its development. Rural women have a poor self-perception of UI, which is exacerbated by older age, lower levels of education, and lower income.

Seminal papers in urology: anticholinergic therapy vs. onabotulinumtoxina for urgency urinary incontinence

In this critical review, we explore the study design, strengths, and limitations of landmark trial "Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence". This trial was the first to directly compare two key treatment options for urge urinary incontinence - anticholinergic medication and intravesical botox, and still influences clinical guidelines a decade after publication. This non-inferiority, double-blinded, multi-centre randomised controlled trial administered Solifenacin or intra-detrusor botox to women, measuring outcomes six months post-treatment. Non-inferiority of the treatments was established, though Botox had a higher rate of retention and infection, with side effect profile rising as the key discriminator in selecting first-line therapy.

Personalised 3D-Printed Mucoadhesive Gastroretentive Hydrophilic Matrices for Managing Overactive Bladder (OAB)

Overactive bladder (OAB) is a symptomatic complex condition characterised by frequent urinary urgency, nocturia, and urinary incontinence with or without urgency. Gabapentin is an effective treatment for OAB, but its narrow absorption window is a concern, as it is preferentially absorbed from the upper small intestine, resulting in poor bioavailability. We aimed to develop an extended release, intragastric floating system to overcome this drawback. For this purpose, plasticiser-free filaments of PEO (polyethylene oxide) and the drug (gabapentin) were developed using hot melt extrusion. The filaments were extruded successfully with 98% drug loading, possessed good mechanical properties, and successfully produced printed tablets using fused deposition modelling (FDM). Tablets were printed with varying shell numbers and infill density to investigate their floating capacity. Among the seven matrix tablet formulations, F2 (2 shells, 0% infill) showed the highest floating time, i.e., more than 10 h. The drug release rates fell as the infill density and shell number increased. However, F2 was the best performing formulation in terms of floating and release and was chosen for in vivo (pharmacokinetic) studies. The pharmacokinetic findings exhibit improved gabapentin absorption compared to the control (oral solution). Overall, it can be concluded that 3D printing technology is an easy-to-use approach which demonstrated its benefits in developing medicines based on a mucoadhesive gastroretentive strategy, improving the absorption of gabapentin with potential for the improved management of OAB.

Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019

Background

Despite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC).

Material and Methods

This was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence.

Results

Overall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1-6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33-550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10-9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02-45.21).

Conclusion

Prior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.

Patterns of Urinary Incontinence Among Women in Asir Region, Saudi Arabia

Background

Urinary incontinence among women is a widespread clinical condition that is frequently associated with marked physical, social, and psychological adverse impact that significantly worsens their quality of life. This study is conducted to identify the prevalence of urinary incontinence and associated risk factors among Saudi women in Asir Region, Saudi Arabia.

Methods

Following a cross-sectional design, 1,964 healthy non-pregnant females aged above 13 years attending primary healthcare centers in Asir Region, Saudi Arabia were included. A self-administered semi-structured questionnaire was used, which included sociodemographic and clinical characteristics, questions related to voiding habits, and the validated Arabic version of the International Consultation on Incontinence Questionnaire (ICIQ).

Results

Almost half of the participants (47.5%) had urinary incontinence, of which 26.8% was slight, 16.3% was moderate, and 4.3% was severe. About 15.2% used to leak urine once a week or less, 3.6% used to leak two to three times a week, and 5.6% leaked daily. The leaked amount of urine was small in 26% of participants, while it was moderate and large in 8% and 1.4% of participants, respectively. Leaking urine moderately affected the daily life of 21.9% of participants, while it severely affected 14.7% of participants. Their grades of urinary incontinence differed significantly according to their age group, with the highest prevalence of severe incontinence among those aged 50 years or more (p < 0.001). Grades of urinary incontinence also differed significantly according to participants’ marital status, with those married or widowed having the highest prevalence of severe incontinence (8.5% and 19%, respectively; p < 0.001). Moreover, its grades differed significantly according to participants’ number of pregnancies, with severe incontinence being highest among those with twice gravidity or three times or more (8.3% and 7.9%, respectively; p = 0.004). Grades of urinary incontinence also differed significantly according to the presence of associated diabetes mellitus and renal/urinary tract diseases (p = 0.001 for both).

Conclusions

Urinary incontinence is common among Saudi females. Older age, multiparty, and menopause are significant risk factors for urinary incontinence.

Prevalence and Risk Factors of Urinary Incontinence Among Elderly Adults in Rural China: A Cross-Sectional Survey

PURPOSE

The purpose of this study was to explore the prevalence of urinary incontinence (UI) and several subtypes: (stress, urge, and mixed UI) and the influence of multiple factors on the likelihood of UI.

DESIGN

Epidemiological study based on cross-sectional data collection.

SUBJECTS AND SETTING

The sample comprised 1279 inhabitants 65 years and older residing in 10 villages randomly selected from the Shanxi province, located in North China.

METHODS

The presence and types of UI were assessed using the International Consultation of Incontinence Questionnaire-Short Form. Sociodemographic parameters were also recorded, along with data on lifestyle, bowel function, and medical conditions. The Activity of Daily Living Scale and Mini-Mental State Examination instruments were used to evaluate physical and cognitive functions, respectively. A multivariate logistic regression model with the backward method was employed to identify factors associated with UI.

RESULTS

The prevalence of any UI among the rural Chinese elderly 65 years and older was 46.8%, with a female predominance (56.3% in females vs 35.0% in males). The most common incontinence subtype in women was mixed UI (n = 170, 24.0%), followed by stress UI (n = 131, 18.5%) and urge UI (n = 97, 13.7%). The most prevalent form of UI in males was urge UI (n = 190, 33.2%), followed by stress UI (n = 5, 0.9%) and mixed UI (n = 5, 0.9%). Less than one quarter of respondents (17%, n = 102) of participants with UI had consulted a doctor. Multivariate analysis found that poorer physical function, poor quality of sleep, and fecal incontinence were common factors associated with UI in both women and men. In women, higher body mass index and constipation were also independent correlates, as were poor vision and heart disease in men. Poorer physical function was associated with all UI subtypes. For female stress UI, poorer cognitive status, tea drinking, and hypertension also emerged as independent risk factors. Heart disease was an independent risk factor in both female and male urge UI; as was consumption of a non-plant-based diet for female mixed and urge UI; nonfarmer and traumatic brain injury for female urge UI; and poor vision and fecal incontinence in male urge UI.

CONCLUSIONS

Chinese rural citizens showed a high UI prevalence, but only a small proportion had consulted a health care provider. Physical function decline was the most important contributor to UI among participants. Individualized intervention programs targeting modifiable risk factors among high-risk populations should be developed.

The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review

OBJECTIVE

The objective of this consensus document is to broaden the perspective on clinical management of genitourinary syndrome of menopause to include androgens.

METHODS

A modified Delphi method was used to reach consensus among the 14 international panelists representing multiple disciplines and societies.

RESULTS

Menopause-related genitourinary symptoms affect over 50% of midlife and older women. These symptoms have a marked impact on sexual functioning, daily activities, emotional well-being, body image, and interpersonal relations. Tissues in the genitourinary system are both androgen and estrogen-dependent. The clitoris, vestibule, including minor and major vestibular glands, urethra, anterior vaginal wall, periurethral tissue, and pelvic floor are androgen-responsive. Historically, treatment of postmenopausal genitourinary symptoms involved both androgens and estrogens. This subsequently gave rise to predominantly estrogen-based therapies. More recently, double-blind, placebo-controlled clinical trials have demonstrated that local vaginal dehydroepiandrosterone improves symptoms in postmenopausal women, including moderate to severe dyspareunia. Limited data suggest that systemic testosterone treatment may improve vaginal epithelial health and blood flow. Open-label studies that have used high doses of intravaginal testosterone in the presence of aromatase inhibitor therapy for breast cancer have resulted in supraphysiological serum testosterone levels, and have been reported to lower vaginal pH, improve the vaginal maturation index, and reduce dyspareunia.

CONCLUSIONS

Vaginal dehydroepiandrosterone, hypothesized to enhance local production of both androgen and estrogen, is effective for the management of dyspareunia in menopause. Vaginal testosterone offers potential as a treatment for genitourinary syndrome of menopause, but more studies are needed.

Urinary incontinence and its relation to delivery circumstances: A population-based study from rural Kilimanjaro, Tanzania

OBJECTIVES

To investigate the prevalence and risk factors of urinary incontinence (UI), the different UI subtypes and the association between UI and delivery circumstances.

DESIGN

Cross-sectional population-based study conducted in Kilimanjaro Region, Tanzania.

PARTICIPANTS AND SETTINGS

1048 women aged 18-90 women living in rural Kilimanjaro. Simple random sampling was done to select villages, households and participants. Community health workers helped in identifying eligible women and trained nurses/midwives conducted face-to-face interviews. Data were analysed using descriptive statistics and Univariate and Multivariate logistic regression modelling.

RESULTS

The overall prevalence rate of UI was 42%. When focusing on the different types of UI, 17% of the women had stress UI, 9% had urge UI and 16% had mixed UI. Only one woman (0.1%) with vesico-vaginal fistula was identified. UI was found to be significantly associated with increasing parity (OR = 2.41 (1.55-3.74). In addition, women who in relation to their first delivery had delivered at home or had been in labour for more than 24 hours, had increased adjusted ORs of 1.70(1.08-2.68) and 2.10(1.08-4.10), respectively, for having UI.

CONCLUSION

UI is common in rural Tanzania and of the subtypes of UI, Stress Urinary Incontinence (SUI) is the commonest followed by Mixed Urinary Incontinence (MUI). Home delivery, prolonged labour and increasing parity especially having 5 or more deliveries are associated with increased risk for developing UI.

Urinary incontinence as a cause of depression and sexual dysfunction: Questionnaire-based study

INTRODUCTION

Urinary incontinence is a severe and common health problem. In this study, we aimed to assess severity of sexual dysfunction and depression in patients with urinary incontinence.

MATERIALS AND METHODS

The study has been conducted between 2015 and 2017. Age, body mass index, accompanying health problems, Over Active Bladder (OAB) symptom score, Type of urinary incontinence, Beck Depression Scale were assessed for all patients. International Index of Erectile Function-5 (IIEF-5) was used for male patients in order to assess sexual dysfunction. Index of Female Sexual Function (IFSF) and Female Sexual Distress Scale (FSDS) were used in female patients in order to assess sexual dysfunction.

RESULTS

33 patients have been included in the study (Male-12: Urge-10/Stress-1/Mixed-1/Female-21: Urge-10/Stress-6/Mixed-5). Mean age of all patients was 47.9 (Male-49.3/Female-47.2). Mean Body Mass Index for all patients was 23.2 (Male-25.9/Female-21.8). Mean OAB score was 24.3 for all patients (Male-27.5: Urge-28.6/Stress-17/Mixed-27/Female-22.5: Urge-24.2/Stress:21.3/Mixed-20.6). Mean Beck Depression Result for all patients was 20.9 (Male-18.5: Urge-20.2/Stress-9/Mixt-11/Female-22.4: Urge-19.1/Stress-20.3/Mixed-31.6). Mean IIEF-5 score for male patients was 39.5 (Urge-41.4/Stress-55/Mixed-5). Mean IFSF score for female patients was 19.9 (Urge-17.9/Stress-21.3/Mixed-22.4) and mean FSDS score for female patients was 22.1 (Urge-22.3/Stress-23.1/Mixed-20.8).

DISCUSSION

Most of the patients that have been included in the study were diagnosed as urge incontinence. When assessing the OAB scores, they were higher in urge incontinence group. Beck depression results showed higher scores in female patients and it was higher in urge group of male patients and mixt group of female patients. Sexual dysfunction rates were found to be higher for both genders.

Physician Attitudes Toward Urinary Incontinence Identification

Urinary incontinence (UI) is a prevalent condition. Urinary incontinence impacts health, quality of life, and financial resources. Most barriers research is evaluated from the patient perspective. Research from physician perspective is needed to determine how best to address UI barriers.

OBJECTIVE

This study aimed to elucidate physician barriers to UI identification and treatment.

METHODS

After institutional review board waiver, we surveyed 78 NorthShore University HealthSystem primary care physicians. The survey was designed to assess physician comfort, familiarity with UI, and current practice patterns.

RESULTS

Fifty-five (71%) of the 78 physicians completed the survey. Most indicated that they clearly understood UI and that UI was a common problem in their practice. Fifty-six percent of the physicians were very comfortable inquiring about UI. Only 19% of the physicians were very comfortable diagnosing UI and 11% of the physicians were very comfortable treating UI. Fifty-nine percent of the physicians agreed that differentiating the different types of UI is difficult and 69% of the physicians believed that managing UI is difficult. However, only 26% of the physicians agreed that managing UI takes too much time. Overall, 65% of the physicians would like to diagnose and treat UI more in their practices. The most common barriers listed were (1) "not familiar with algorithm available for treatment," (2) "no good screening tool," and (3) "uncomfortable with diagnosis and treatment."

CONCLUSIONS

We initially thought that time would be the biggest barrier to care for UI, but we identified discomfort with diagnosis and treatment as barriers. The most common barrier was the lack of an accessible algorithm. Attention to physician education implementation of a screening tool algorithm for treatment of UI could improve UI identification.

Self-reported urinary incontinence and factors associated with symptom severity in community dwelling adult women: implications for women's health promotion

Background

Urinary incontinence (UI) continues to affect millions of women worldwide and those living in resource poor settings seem to be more affected. The purpose of this study was to determine the prevalence of UI and factors associated with UI symptom severity (UISS) among women in a selected district in India.

Methods

A cross-sectional design was used to collect data from a sample of 598 community dwelling women in the age range of 20 to 60 years. Data was collected using a questionnaire survey of participants who were found in their homes.

Results

The prevalence of UI was 33.8% and the majority of women had negative attitudes about the condition. For instance most women were in agreement with statements such as: UI cannot be prevented or cured (98%); women with UI are cursed (97%); women are not supposed to tell anyone about the problem (90%) and others. Of the 202 women with self-reported UI, the majority reported having moderate UISS (78%) and others rated the symptoms as mild (22%). The woman’s age at first birth (p<.01) was negatively associated with UISS, while the number of pregnancies (p<.01) and weight of the largest baby ever delivered (p<.01), were positively associated with UISS. The weight of the largest baby delivered had the strongest impact on predicting UISS.

Conclusions

Many community dwelling women are suffering from UI at proportions which warrant significant public health consideration. Therefore public health programs to prevent UI or worsening of symptoms are required and should emphasize health education, because of the pervasive negative attitudes among affected and unaffected women. The predictors reported here can be used to priotize care for affected women and to encourage early uptake of health actions and behaviors that promote pelvic floor strengthening in at risk women who may be reluctant to disclose UI.