Prevalence, awareness and determinants of health care-seeking behaviour for urinary incontinence in Qatari women: a neglected problem?

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.

Prevalence and Influencing Factors of Help-Seeking Behavior Among Women with Urinary Incontinence: A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis aimed to investigate the mean (weighted) prevalence of help-seeking behavior among women with urinary incontinence (UI) in relevant subgroups and the related influencing factors. Materials and Methods: Six English and four Chinese databases were systematically searched between 1996 and July 10, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies. All statistical analyses were conducted using RevMan 5.4. Results: The mean (weighted) prevalence of help-seeking behavior based on the 41 included studies, including a total of 32,640 women with UI, was 28% (95% confidence interval [CI]: 22%-34%). We performed a subgroup analysis based on UI type, population, region, publication time, case definition of help-seeking, and use of validated tools to determine UI. The results of the subgroup analysis showed that the pooled prevalence of help-seeking behavior was 23% (95% CI: 14%-32%) among pregnant and maternity women, 27% (95% CI: 19%-35%) among menopausal women, 24% (95% CI: 14%-35%) among 20- to 50-year-old women, 31% (95% CI: 25%-36%) among those older than 50 years, 24% (95% CI: 17%-30%) in Asia, and 33% (95% CI: 22%-44%) in Europe. Meanwhile, the pooled odds ratio showed that education level, UI type, UI severity, and quality of life significantly influenced help-seeking behavior among women with UI. Conclusions: This systematic review revealed that the pooled prevalence of help-seeking behaviors among women with UI is 28%. These influencing factors have important implications for adapting to health care and social care systems.

Pelvic floor dysfunction: prevalence and associated factors

BACKGROUND

Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions.

OBJECTIVE

Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women.

MATERIAL AND METHODS

This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated.

RESULTS

One thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia.

CONCLUSIONS

The prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.

Urinary Incontinence Affects the Quality of Life and Increases Psychological Distress and Low Self-Esteem

Urinary incontinence is a common problem among women of reproductive age. The objectives of this study were to measure the prevalence of urinary incontinence and the association with quality of life, psychological distress and self-esteem in Saudi women in the city of Riyadh. A questionnaire-based cross-sectional study was conducted in primary healthcare centers with Saudi women aged between 30 and 75 years. The questionnaire consisted of Urinary Distress Inventory, Incontinence Impact Questionnaire, Kessler Psychological Distress Scale, Rosenberg Self-esteem Scale, and the Female Sexual Function Index. Around 47.5% of women were suffering from urinary incontinence. The most common type of incontinence was stress (79%), followed by urge (72%) and mixed type (51%). Multivariate logistic regression analysis found that stress (5.83 (3.1, 11.1)), urge (3.41 (2.0, 5.8)), mixed (8.71 (3.4, 22.4)) incontinence and severe urinary distress (8.11 (5.2, 12.7)) were associated with impaired quality of life. Women suffering from stress and urge incontinence were twice (2.0 (1.3, 2.2)) as likely of reporting moderate/severe mental distress. Women suffering from urge incontinence (1.92 (1.4, 2.7)) and severe urinary distress (1.74 (1.1, 2.8)) were at a higher prevalence of reporting low self-esteem. Urinary incontinence affects the physical, psychological, social, and sexual health of women. Healthcare providers should be knowledgeable about the adverse consequences of UI on women's personal and social life, and provide counseling and treatment accordingly.

Quality of Life of Saudi Women With Chronic Lower Urinary Tract Symptoms

Background Chronic lower urinary symptoms (LUTS) are reported to affect more than half of women of all ages and have a significant impact on their quality of life (QoL). We aimed in this study to assess the QoL of adult Saudi women with chronic LUTS. Methods A cross-sectional study was done on 390 female patients diagnosed with LUTS at three tertiary care hospitals in Riyadh, Saudi Arabia, from October to December 2021. LUTS are classified into three categories: symptoms related to bladder storage (increased daytime frequency, nocturia, and urinary incontinence [UI]), symptoms of bladder voiding (hesitancy, extended micturition time, and insufficient emptying), and symptoms involved in the post-urination phase such as post-micturition dribbling. The data was collected using a self-administered questionnaire which comprised demographic characteristics, International Prostate Symptom Score (IPSS) for assessment of LUTS severity, and King's Health Questionnaire (KHQ) for assessment of QoL. Results After analyzing the study results, we found that symptoms were mild, moderate, and severe in 11%, 51%, and 39% of participants, respectively. Increased age and parity were found to have a significant association with increased symptom severity (p-value <0.05). The current study reported a moderate effect of LUTS on QoL. There was a significant correlation between increased symptom severity and negative impact on QoL, excluding the personal relationships domain. The highest scores in KHQ, which indicate worse QoL, were found in the domains of incontinence impact and emotions, while the lowest scores, which indicate better QoL, were found in the domains of social limitations and severity measures. Employed females were found to have worse QoL in the severity measures domain, which refers to the degree of urinary symptoms affecting day-to-day functioning. In addition, younger age, below 45 years, was found associated significantly with better QoL, especially in the domains of general health, personal relationships, and severity measures. Conclusion In the current study, the majority of patients reported moderate symptoms severity. Chronic LUTS have a significant impact on the QoL of Saudi women in many aspects, including physical, social, and emotional health, especially for those who have moderate to severe symptoms. Healthcare providers should assess high-risk women for the presence of LUTS. Furthermore, we recommend evaluating the QoL of patients with LUTS as a part of routine management.

Spiritual Care Needs of Patients with Urinary Incontinence and Affecting Factors: A Cross-Sectional Descriptive Study in Turkey

This study was conducted to determine the spiritual care needs of patients with urinary incontinence and various influencing factors. Determining the spiritual care needs of individuals with urinary incontinence may make patients feel more hopeful, peaceful, and stronger. It can also encourage individuals towards positive health behaviors, and can help nurses in choosing appropriate coping methods. A descriptive and cross sectional study was conducted with 220 patients with urinary incontinence who applied to the urology outpatient clinic of a university hospital in Turkey. In the study, data were collected using the descriptive features form, the incontinence severity index, and the Spiritual Care Needs Inventory. Kruskal-Wallis test and Mann-Whitney U test were used to evaluate the data. This study is reported following the STROBE recommendations. In this study, mean scores of the patients' spiritual care needs scale and the severity of incontinence, age, gender, and the effect of urinary incontinence on daily life, determined that there was a statistically significant difference between the state of being disturbed by urinary incontinence, the state of performing religious rituals regularly, the state of incontinence affecting religious rituals, the importance of religious beliefs in daily life, and the level of defining spirituality (p < 0.05). In this study, it was determined that the spiritual care need scores of the patients with urinary incontinence were above the medium level, and the sub-dimension scores of meaning and hope, caring, and respect were high. In this context, it is very important to consider the spiritual care needs of patients with urinary incontinence problems.

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 of pelvic floor dysfunction in women in Riyadh, Kingdom of Saudi Arabia: A cross-sectional study

Objective:

Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the prevalence and risk factors of pelvic floor dysfunction in women in the Kingdom of Saudi Arabia.

Methods:

We conducted a cross-sectional study on literate non-pregnant women aged ⩾18 years who agreed to participate in our survey. We used the validated and translated Australian pelvic floor questionnaire and conducted a multivariate logistic regression analysis to assess the risk factors of pelvic floor dysfunction.

Results:

A total of 824 participants completed the questionnaire. While 60.2% of the participants had pelvic floor dysfunction, 67.7% reported signs of bowel dysfunction. Urinary dysfunction, prolapse, and sexual dysfunction were present in 44.1%, 67.7%, and 55.4% of the participants, respectively. Age, high body mass index, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bladder function problems. Meanwhile, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bowel dysfunction and prolapse. Age group and marital status were the independent factors associated with sexual dysfunction.

Conclusion:

We noted a high rate of pelvic floor dysfunction in the Kingdom of Saudi Arabia, which calls for the need to provide holistic approaches for the prevention and management of pelvic floor dysfunction among women.

Stress urinary incontinence among Jordanian women living in rural areas: Prevalence, associated factors and self-management behaviours

Objectives: To assess the prevalence of stress urinary incontinence (SUI) among Jordanian women aged 35–65 years living in in rural areas and its associated risk factors.

Patients and methods: A cross-sectional study utilising a convenience sample of 1000 non-pregnant women who were recruited from healthcare centres and community settings. Participants completed a structured questionnaire that included demographic and gynaecological data, and questions about SUI. Descriptive analysis and logistic regression were used to analyse the data.

Results: Overall, 551 women (55.1%) reported having SUI with a duration of 37.9–47.6 months. The mean age of the women was 45.38 years and 29.6% were post-menopausal. Moreover, 40.6% were overweight, 38.9% obese, and 16.9% were smokers. Married women comprised 81.8%; with 37.1% having four to six children and 92.8% had a normal delivery, whereas 28% had a history of caesarean section. Coughing was the major precipitating factor for SUI (87.7%). In addition, 64.8% of women with SUI did not avoid activities that precipitated SUI such as housekeeping and lifting, and 78.6% did not seek any medical care. The major significant correlates for SUI were: high body mass index (odds ratio [OR] 2.506, 95% confidence interval [CI] 1.744–3.600, P < 0.001), being aged >50 years (OR 1.716, 95% CI 1.183–2.489, P = 0.004), a history of gynaecological/pelvic surgery (OR 1.631, 95% CI 1.206–2.205, P = 0.001), and vaginal delivery (OR 1.052, 95% CI 1.004–1.101, P = 0.033).

Conclusion: SUI prevalence among Jordanian women is high with symptoms reported in more than a half of study participants. Older age, obesity, a history of gynaecological surgery, and history of vaginal delivery were the major correlates of SUI. Public awareness is needed to identify the condition for early diagnosis and treatment of SUI.

Abbreviations: BMI: high body mass index; OR: odds ratio; (M)(S)(U)UI: (mixed) (stress) (urge) urinary incontinence

Prevalence, social impact and help-seeking behaviour among women with urinary incontinence in the Gulf countries: A systematic review

BACKGROUND

Urinary incontinence (UI) in women is a common problem worldwide. It has a major impact on the physical and social activities and interpersonal relationships. The societies in the Gulf countries are conservative and favours large families, high parity and short inter-pregnancy intervals. Moreover, there is a high prevalence of gestational diabetes with many macrosomic babies. This study aimed to review the published literature on UI among women in this region.

METHODS

All published literature which investigated the prevalence, social impact and help-seeking behavior in women with UI in the Gulf countries was reviewed.

RESULTS

Nine studies met the criteria and were very heterogeneous. None of them was a true population-based study and all except one, investigated subjects from healthcare facilities. The prevalence of UI ranged from 20.3% to 54.5%. Stress UI was the main type reported. The main predisposing factors were chronic respiratory diseases and constipation. There was a large impact on the quality of life with major interference with prayers (34-90%) and sexual relationships (18-57%). The main reasons for not seeking medical advice were embarrassment to see doctors especially male doctors and the belief that UI is common, normal or incurable disease.

CONCLUSIONS

There is a need for true whole population-based studies of UI in this region with the use of validated international questionnaires. UI was shown to have a major impact on the act of prayers and sexual relationships. A large proportion of women are still embarrassed to discuss the issue with doctors especially male doctors.

Urinary symptoms in pregnant women in their third trimester-a cross-sectional study

INTRODUCTION AND HYPOTHESIS

Urinary symptoms are common in pregnancy. Our study aims to understand the extent of these symptoms in a cohort of pregnant women in the third trimester and their impact on quality of life (QOL) from the women's perspective.

METHODS

A single-centre cross-sectional study of self-reported urinary symptoms of pregnant women in the third trimester conducted from August 2018 at the Diana Princess of Wales Hospital, Northern Lincolnshire, and Goole NHS Foundation Trust, Grimsby, UK. We used an international validated questionnaire (ICIQ-FLUTS questionnaire) (Brookes et al. Am J Obstet Gynecol. 191(1):73-82, 2004).

RESULTS

A total of 302 women were included in this study. Nocturia was the most common symptom, reported by 97%, affecting QOL in 80%. Urgency of micturition was the second most common, present in 83%, adversely affecting QOL in 75%. Our study showed a startling finding of bladder pain in 47% (95% CI 41.1%, 52.3%) of these women. There was a high prevalence of nocturnal enuresis in 9.9% (95% CI 7.05%, 13.8%). Straining during micturition is not a well-known symptom in pregnancy, however reported by 18.2% (95% CI 14.2%, 23.0%).

CONCLUSION

The high prevalences of bladder pain, nocturnal enuresis and straining in the third trimester of pregnancy are novel findings. Our study also confirms that the prevalence of all voiding, filling and incontinence symptoms in pregnancy is significantly higher than in the non-pregnant population, having a negative impact on QOL, and yet is not discussed as part of routine antenatal care.

Prevalence and risk factors of chronic kidney disease among Palestinian type 2 diabetic patients: a cross-sectional study

Background

Chronic kidney disease (CKD) is a global public health concern and diabetes is one of the main risk factors for its occurrence and progression. The aim of this research is to determine the prevalence of chronic kidney disease in a cross-sectional population of patients with type 2 diabetes in primary health centers in North West Bank.

Methods

Patient data including patient characteristics, creatinine level, blood pressure, HbA1c, and hypertension and period of diabetes were obtained from primary health care centers. The eGFR has been determined using the CKD-EPI equation. CKD was staged according to the 2012 Kidney Disease Improving Global Outcomes Framework (KDIGO) guideline. Both univariable and multivariable statistical analysis was conducted using SPSS.

Results

The prevalence of chronic kidney disease among diabetic adults in North West Bank was found to be 23.6% (95% CI: 19.4–28.1%) divided as follows: 19.7% had stage 3 CKD, 2.6% had stage 4 CKD and 1.3% had stage 5 CKD. In multivariable logistic regression, CKD was significantly associated with Age ≥ 60 years [adjusted OR: 3.2, 95% CI: 1.8–5.9], hypertension [adjusted OR: 5.7, 95% CI: 2.2–15.2], and smoking [adjusted OR: 2.3, 95% CI: 1.3–4.2].

Conclusions

CKD is very prevalent among diabetic adults in Palestine. Co-morbid hypertension, smoking and older age has been shown to increase the risk of developing CKD. Extensive screening for diabetic patients to diagnose CKD at an early stage and to follow more aggressive treatment methods for diabetes as well as other important risk factors, especially hypertension and smoking, is recommended.

The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia

Background

Saudi Arabia's healthcare sector is growing at a hasty stride; nevertheless, the quality of healthcare consumption remains challenged by the growing caseload in free public health facilities. Insurance could ease this pressure by moving some healthcare demand to private facilities conditional on its ability to enact health-seeking behaviour. These potential effects remain under-investigated. Therefore, the aim of this study was to investigate whether health insurance nudges health-seeking behaviour using data from Saudi Arabia.

Materials and Methods

The study used nationally representative secondary data, obtained from the Family Health Survey, conducted in 2018, in Saudi Arabia. Health-seeking behaviour was measured by individual attendance of medical check-up. To account for endogeneity due to non-random selection of individuals into insurance, the analysis employed the inverse propensity weighting and the instrumental variables methods.

Results

The results revealed that health insurance leads to increased chances of going for medical check-up. The effects are higher amongst non-Saudi nationals relative to citizens. Furthermore, people who purchase personal health insurance schemes are more likely to go for checks-ups, followed by individuals provided by the private sector and government sector. Finally, the study found that insurance positively nudges hypertension, diabetes, and cholesterol specific medical check-ups.

Conclusion

The findings indicated the need for health policy to increase access to health insurance in Saudi Arabia. A notable policy response is the introduction of national health insurance coverage, which has already proven in other countries as an effective measure to attain universal access to improved health. Nevertheless, results from this study highlighted variations in demand for health seeking based on type of insurance with highest returns in personal insurance. Policy should leverage on this behaviour response by introducing insurance packages that share premiums with citizens to incentivise utilisation. The results can also be used to design policy responses to demand for insurance, in the entire Arabian Gulf region, since these countries have similar health financing mechanism with Saudi Arabia.

Women's knowledge, attitude and practice related to urinary incontinence: systematic review

INTRODUCTION

Knowledge, attitude and practice (KAP) investigations lead to an understanding of what a particular population group knows, thinks and does in relation to a certain subject.

METHODS

This systematic review was conducted to identify women's KAP related to urinary incontinence (UI) described in the literature and the measurement/evaluation instruments used. A literature search, up to July 2017, was conducted in PUBMED, SCOPUS and BVS (Virtual Health Library) for articles dealing with women's KAP related to UI that described the validation procedure of any data collection instrument. Articles that investigated exclusively male subjects, provider performance or academic teaching strategies were excluded. Relevant studies were analyzed and briefly summarized.

RESULTS

Initially, 799 articles were retrieved. After applying the inclusion and exclusion criteria, 19 remained for reading and summarizing. There has been interest in identifying and evaluating some of the KAP elements related to UI since 1994, with a wide variety of validated instruments used. Knowledge was evaluated in 15 articles and all concluded that there was misinformation about UI in the populations studied. Seven articles studied the intention to seek healthcare for UI, among which only one evidenced an adequate attitude in more than 70% of the participants. All the articles that investigated practice revealed low rates of seeking care.

CONCLUSIONS

The KAP elements are influenced by specific questions in each of the studied populations, leading to unique results, which indicates the importance of investigations using standardized data collection instruments that have psychometric validity tested in the target populations.

The degree of bother and healthcare seeking behaviour in women with symptoms of pelvic organ prolapse from a developing gulf country

Background

The healthcare-seeking behaviour of women with pelvic organ prolapse (POP) is affected by several factors including the cultural background. There is limited number of studies which addressed the healthcare-seeking behaviour in women with POP. The aim of this study was to determine the degree of bother, social impact and healthcare seeking behaviour of symptoms of POP in one of the Gulf countries and compare the results to published data from other areas.

Methods

All women who attended the three family development centres in our city between January 2010 and January 2011 and who had symptoms suggestive of POP were included in the study. The data was collected by well-trained interviewers.

Results

One hundred twenty-seven women reported symptoms of POP (mean age: 38.2 years; range: 18–71). Out of these, 111 (87.4%) had at least one activity (physical, social or prayers) or sexual relationship affected by POP symptoms. In 49 women (38%), the effect on at least one of these activities or relationships has been described as moderate and in 18 women (14%), the effect was severe.

Sixty-nine women (54%) did not seek medical advice due to: embarrassment to see medical doctors (51%), the belief that POP is normal among women (51%), hope for spontaneous resolution (48%), embarrassment to see male doctors (33%) and unawareness of the existence of medical treatment (30%).

On univariate analysis, the need to insert the finger in the vagina to empty the bladder or bowel and the interference of symptoms with physical activities, had significantly determined healthcare seeking attitude (P < 0.05 for all). However, on multivariate analysis interference with physical activities was the only significant determinant (P = 0.04).

Conclusions

Although POP had affected the quality of life in the majority of the affected women, unlike some other societies, more than half failed to seek healthcare advice mainly due to shyness and embarrassment and lack of proper knowledge about the condition. Interference of symptoms with physical activities was the main significant determinants of healthcare-seeking behaviour. Additional teaching campaigns designed according to cultural backgrounds in each society are required to address these sensitive issues.

Nonbiologic factors that impact management in women with urinary incontinence: review of the literature and findings from a National Institute of Diabetes and Digestive and Kidney Diseases workshop

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI)-defined as a complaint of involuntary loss of urine-is common in women, with major public health, financial, and quality of life (QoL) implications. Despite the high toll of UI and the availability of effective conservative treatments, many women with UI do not seek care. Those who do often continue to experience symptoms. Improving UI treatment may require a comprehensive approach to urology research, including a broad set of potentially influential factors beyond biologic.

METHODS

To explore the effects of nonbiologic factors (NBF) on UI management and treatment response, the National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop for clinical and psychosocial researchers. Participants proposed a UI treatment pathway: recognizing the problem, willingness to seek treatment, access to care, receiving quality treatment, engaging in self-management, and adhering to chosen treatments; discussed potential NBFs that may affect the pathway; and identified areas for future research. After the meeting, a rapid literature review was conducted to assess the current state of research on NBFs in women with UI.

RESULTS

Participants identified several patient-level NBFs that may influence the UI management pathway, including QoL and perceived bother; stigma, shame, and embarrassment; knowledge and perceptions; social determinants of health; cultural and language characteristics; personal characteristics and skills; and physical abilities. Additionally, participants acknowledged that provider- and system-level factors also play a role and likely interact with patient-level factors.

CONCLUSIONS

NBFs that potentially affect the UI management pathway are not well understood, and a comprehensive, interdisciplinary approach to research is needed to understand and appropriately support effective UI treatment.

Female urinary incontinence: quality of life comparison on reproductive age and postmenopausal period

Abstract Introduction: urinary incontinence (UI) is defined as any involuntary leakage of urine and their symptoms can affect women's quality of life (QoL). Objectives: to compare incontinent women's QoLin reproductive age (G1) with those in post menopausal period(G2). Material and methods: a descriptive and retrospective study involved 86 women with UI complaints. Clinical, sociodemographic, obstetrical and gynecological antecedents were collected. Pelvic floor evaluation was conducted by digital palpation and QoL was evaluated by King's Health Questionnaire (KHQ). Mann-Whitney and t Student test were used to compare QoL domains. Results: 36 women in reproductive age (G1) 42.9 (± 7,4) years and 50 women in postmenopausal period (G2) 61,6 (± 9,3) years were assessed. The G2 showed significantly more nocturia (p = 0,0057), urge incontinence (p = 0,0061) and enuresis (0,0021) symptoms, whereas in G1 bladder pain and voiding difficulties were more significant. KHQ domains showed statistical differences in: general health perception (G1 26,4 ± 16,8 versus G2 38,0 ± 16.2; p = 0,0019) and emotions (G1 15,1 ± 31,3 versus G2 38,9 ± 37,5; p = 0,0051). Conclusion: UI affects negatively QoLin women. Women on postmenopausal period showed higher impact on the QoLdomains related to general health perception and emotions.

Quality of life in women with urinary incontinence

The aim of this study is to examine the relationship among psychological, clinical and sociodemographic variables, and quality of life in women with urinary incontinence. The sample consisted of 80 women diagnosed with urinary incontinence (UI) followed in a Northern Central Hospital in Portugal. Participants answered the Incontinence Quality of Life (I-QOL); Satisfaction with Sexual Relationship Questionnaire (SSRQ); Hospital Anxiety and Depression Scales (HADS) and the Brief Cope. The results revealed that women with higher quality of life considered their symptoms of urine loss as mild or moderated compared to those with severe urine loss. The less severe urine loss was associated with greater sexual satisfaction and less use of religion and self-blame as coping strategies. In terms of coping, women who considered the loss of urine as severe expressed more feelings regarding UI. Stress urinary incontinence, high sexual satisfaction, and less use of denial, distraction, and religion as coping strategies, predicted higher quality of life. According to the results, UI has an impact on women's sexual satisfaction and quality of life. Therefore, intervention programs should target these women, including their partners, helping them to adjust to their condition and teaching effective coping strategies in order to improve their sexual satisfaction and quality of life.

Analysis of the usage of continence pads and help-seeking behavior of women with stress urinary incontinence in Poland

Background

Urinary incontinence (UI) in women is a chronic disorder which has a negative impact on health-related quality of life. Only 45 % of the affected individuals report the problem with continence to their doctor. The aim of the study was to assess the duration of stress urinary incontinence (SUI), time from disease onset to the first medical consultation and in-depth diagnosis, as well as the need for using continence pads in various grades of SUI.

Methods

We conducted a cross-sectional study in women who presented at the urogynecologic ambulatory center and reported urinary incontinence. A total of 420 subjects were interviewed and underwent urogynecologic and urodynamic examinations. A group of 147 patients with urodynamic SUI was enrolled in the study.

Results

All women were graded according to the Stamey severity score: grade 1 – 56 (38.1 %), grade 2 – 68 (46.3 %), and grade 3 – 23 (15.6 %). Mean time elapsed between disease onset and presentation at the urogynecologic ambulatory center was 17.4 ± 11.8 years (grades 1, 2 and 3 for 11.6 ± 11.8, 14.9 ± 10.8, and 22.2 ± 12.1 years, respectively; p = 0.0002). Patients with SUI started perceiving their condition as a problem 4.7 ± 5.4 years before referral to urodynamics; 58.3 % of the SUI patients reported their problems with continence to a physician. Average time between the onset of UI symptoms and seeking medical help was 13.28 ± 12.3 years. Mean duration of using continence pads during the day was 4.2, 5.4 and 10.2 years in grades 1, 2 and 3, respectively (p = 0.0002). The number of patients using continence pads in and outside the home, as compared to outside only, was: grade 1 – 44.6 % vs. 28.6 %, grade 2 – 77.6 % vs. 13.4 %, and grade 3 – 86.4 % vs. 9.1 % (p = 0.004). Mean use of continence pads at night was 3.3, 6.1, and 9.1 years in grades 1, 2 and 3, respectively. The differences were not statistically significant. Protective continence products were used at night by 26.7 % of the SUI patients: 16.1 %, 25 % and 59.1 % in grades 1, 2 and 3, respectively (p = 0.004).

Conclusions

Women with SUI delay seeking medical help for over a decade. The severity of SUI is associated with duration and increased use of continence pads.

Addressing information needs of vulnerable communities about incontinence: a survey of ten CALD communities

Urinary incontinence is a common and distressing condition. Using focus groups, we explored the views of ten ethnic language groups in Melbourne about knowledge and awareness of incontinence. The 218 participants (with or without incontinence) spoke with trained interpreters. Twenty focus group discussions of single and mixed sex groups were audio-recorded and transcribed into English. Narratives were analyzed using thematic analysis with open coding and also incorporated themes from literature. Participants' knowledge of incontinence was low and incontinence was thought to be an inevitable consequence of ageing. There was little understanding of treatments or assistance available under government-funded programmes. No group was aware of the national continence programme or phone helpline. Sensitivities of the topic plus language barriers in immigrant culturally and linguistically diverse communities may impose barriers to accessing help. Several groups thought they would cope with incontinence by themselves, while all groups suggested they would be able to discuss the condition with a doctor. Various preferences voiced about social limitations and permissible communications with others are described. Nurses should be aware of the needs and communication preferences of ethnic language groups regarding continence information and continence service delivery.

Effects of stigma on Chinese women's attitudes towards seeking treatment for urinary incontinence

AIMS AND OBJECTIVES

To examine whether and how stigma influences attitudes towards seeking treatment for urinary incontinence, and whether its effect varies by symptom severity.

BACKGROUND

Urinary incontinence is prevalent among women, but few seek treatment. Negative attitudes towards urinary incontinence treatment inhibit from seeking care. Urinary incontinence is a stigmatised attribute. However, the relationship between stigma and attitudes towards seeking treatment for urinary incontinence has not been well understood.

DESIGN

This was a cross-sectional community-based study.

METHODS

We enrolled a sample of 305 women aged 40-65 years with stress urinary incontinence from three communities in a Chinese city between May-October in 2011. Data were collected on socio-demographic characteristics, urinary incontinence symptoms, stigma and attitudes towards seeking treatment for urinary incontinence using a self-reported questionnaire. Effects of stigma were analysed using path analysis.

RESULTS

Attitudes towards seeking treatment for urinary incontinence were generally negative. For the total sample, all the stigma domains of social rejection, social isolation and internalised shame had direct negative effects on treatment-seeking attitudes. The public stigma domain of social rejection also indirectly affected treatment-seeking attitudes through increasing social isolation, as well as through increasing social isolation and then internalised shame. The final model accounted for 28% of the variance of treatment-seeking attitudes. Symptom severity influenced the strength of paths: the effect of internalised shame was higher in women with more severe urinary incontinence.

CONCLUSIONS

Stigma enhances the formation of negative attitudes towards seeking treatment for urinary incontinence; public stigma affects treatment-seeking attitudes through internalisation of social messages.

RELEVANCE TO CLINICAL PRACTICE

Stigma reduction may help incontinent women to form positive treatment-seeking attitudes and engage them in treatment. Interventions should specifically target the self-stigma domains of social isolation and internalised shame in women with urinary incontinence to most efficiently increase their use of health care.

Urinary incontinence in Qatar: A study of the prevalence, risk factors and impact on quality of life

Objective

To study the prevalence of and risk factors for urinary incontinence (UI) in Qatar, and its impact on quality of life (QoL).

Patients and methods

This study was conducted in two phases, as phase 1 from 2010 to 2011 and phase 2 from 2011 to 2012. In phase 1 we calculated the prevalence of UI in Qatar and its risk factors. In phase 2 we determined the frequency and severity of different types of UI and its impact on QoL, by using the International Consultation Incontinence Questionnaire – Short Form (ICIQ-SF).

Results

The total of women included in phase 1 was 521, among whom 108 (20.7%) confirmed that they had experienced UI during the previous 4 weeks, whilst 413 (79.3%) denied any type of UI. Women with UI were older and less educated. Bronchial asthma was the only statistically significant factor affecting UI. In phase 2, 1085 patients with UI were enrolled, of whom 454 (41.9%) had urge UI (UUI), 484 (44.5%) had stress UI (SUI) and 148 (13.6%) had mixed UI (MUI). This phase also showed a distribution of the type of UI according to the age of the patients. UUI was predominant in women aged <40 years, SUI in those aged <70 years and MUI in those aged 40–70 years. Of these women, 86% had a small amount of urinary leakage (requiring 1–2 pads per day) but this had a significant effect on their QoL.

Conclusion

In Qatar, 21% of women have UI, but bronchial asthma was a significant risk factor influencing the occurrence of UI. Social and religious factors have a significant effect on the QoL of incontinent women. A well-designed national health programme for both women in general and for those with UI, and for physicians and nurses in primary health centres, is highly recommended.

Predicting help-seeking intention of women with urinary incontinence in Jinan, China: a theory of planned behaviour model

AIMS AND OBJECTIVES

To develop and test a predictive model of women's help-seeking intention for urinary incontinence that was developed using the theory of planned behaviour and to identify factors that influenced women's help-seeking intention.

BACKGROUND

Urinary incontinence is a chronic progressive condition if left untreated, but few women seek help from healthcare providers. Reasons for not seeking help have been studied in Western countries while relatively little information is available from mainland China.

DESIGN

Questionnaire-based cross-sectional survey was performed in this study.

METHODS

From May-October 2011, a cross-sectional survey was conducted with a representative sample of 346 incontinent women from three communities in Jinan using strict inclusion and exclusion criteria. Data were collected via a self-administered pencil-and-paper survey that consisted of a multi-item questionnaire. Predictive model estimation was performed using structural equation model.

RESULTS

The resultant model demonstrated that incontinent women's help-seeking intention could be predicted by their perceived self-efficacy and perceived social impact from urine loss. Perceived self-efficacy was the negative predictor, while the perceived social impact was the positive one. Overall, the predictive model explained 36% of the variance for incontinent women's help-seeking intention.

CONCLUSION

The theory of planned behaviour can be used to predict help-seeking intention in women who have urinary incontinence. Community nurses should increase patients' help-seeking intention by addressing perceived social impact and perceived self-efficacy in managing incontinent symptoms.

RELEVANCE TO CLINICAL PRACTICE

Our findings suggest that high perceived self-efficacy in dealing with incontinent symptoms could hinder incontinent women from seeking help from healthcare providers. The strong social impact women perceived, however, facilitates intention to seek help. Nurses should understand and address these factors through education and evidence-based practices to increase help-seeking in incontinent women.

Social impact and healthcare-seeking behavior among women with urinary incontinence in the United Arab Emirates

OBJECTIVE

To determine the prevalence and social impact of urinary incontinence (UI) and healthcare-seeking behaviors among women in the United Arab Emirates (UAE).

METHODS

A study was conducted of 429 women who attended family development foundation centers in Al Ain, UAE, between January 1, 2010, and January 31, 2011. Data on sociodemographics, obstetric and medical history, and factors related to UI were obtained using a questionnaire.

RESULTS

The prevalence of UI was 42.2% (mean age, 37.8years). Aspects of daily life (praying, social activities, physical activities, or sexual relationship) were disrupted by UI among 78.0% of the women, with severe effects reported by 8.8%. Independent risk factors for UI were education level, history of "dragging" genital lump, and constipation. In all, 50.5% of the affected women did not seek medical advice, stating the following reasons: hoped for spontaneous resolution of UI (61.9%); embarrassed to visit a male or female clinician (35.9%); believed that UI was a normal occurrence among women (31.5%); embarrassed to visit a male clinician (29.3%); and unaware that treatment was available (23.9%).

CONCLUSION

Although UI was prevalent in the UAE and affected quality of life, less than half of all women with this condition sought medical advice.

The hopeless age? A qualitative exploration of the experience of menopause in Arab women in Qatar

OBJECTIVE

The aim of this study was qualitatively to describe and examine the expectations and experiences of the midlife transition in Arab women living in Qatar.

METHOD

Six focus groups were conducted with Arab women living in Qatar: three groups of local Qatari women, and three groups of non-Qatari Arab women originating from neighboring countries. A purposive sample of 41 pre-, peri-, and postmenopausal women aged 40-60 years participated. The semi-structured group format encouraged discussion around knowledge about menopause; physical, emotional and social experiences related to menopause; and cultural differences that may exist related to menopause.

RESULTS

The majority of women considered menopause as a maturing experience, although the term 'menopause' was considered to have negative connotations. Postmenopausal women described menopausal symptoms consistent with general knowledge, but many premenopausal women were unaware of symptoms, even if they knew someone who had experienced menopause. Postmenopausal women were more socially active than before and were able to participate in religious activities that they previously could not attend during menses. How a woman experienced menopause depended on the husband's level of support, and some women believed that Western women did not have the appropriate support from husbands and families that Arab women have; they felt this lack of support could lead to negative outcomes such as being at an increased risk for suicide caused by depression during menopause.

CONCLUSION

Qatari and non-Qatari women had many similarities in how they perceived and experienced menopause, although they collectively believed that the experiences of Western women are different.

Prevalence and risk factors of urinary incontinence among Jordanian women: impact on their life

We estimate the prevalence and type of urinary incontinence (UI), possible associated risk factors, and the impact of UI on women's social and psychological well-being. The sample consisted of women attending a family medicine clinic at Jordan University Hospital (JUH) who answered a self-administered questionnaire. More than one-third of the sample reported the presence of UI. Stress type was the most frequently reported risk factor, followed by mixed incontinence, then urge. Age, diabetes, chronic cough, parity, and hysterectomy were positively associated with the presence of UI. Incontinence caused low self-esteem in more than half of the women who experienced it.

Urinary incontinence: prevalence, risk factors, and impact on health related quality of life in Saudi women

AIMS

The aims of this study were to determine the prevalence, risk factors, and impact upon health related quality of life (HRQL) of urinary incontinence in Saudi women.

METHODS

We performed a clinic-based cross-sectional survey. 6,600 women aged 20 years and older were selected. The bother of urinary incontinence symptoms was assessed using the Arabic version of the short form of Urogenital Distress Inventory (UDI-6) questionnaire. We measured the impact of urinary incontinence on HRQL using the Incontinence Impact Questionnaire (IIQ-7).

RESULTS

The overall prevalence of urinary incontinence in our study was 29%. The prevalence of urinary incontinence according to its type was 50% stress urinary incontinence, 28% urgency urinary incontinence, and 22% mixed urinary incontinence. Older age, obesity, large baby birth weight, high parity, caesarean delivery, vaginal delivery, and diabetes were significant risk factors. Less than 10% of the women in this study reported a significant effect of urinary incontinence on their HRQL. In our study population, 9% sought medical care.

CONCLUSIONS

Twenty-nine percent of the women in Riyadh suffered from urinary incontinence. Diabetes is the most significant factor. Urinary incontinence affects women's HRQL. Most of the women did not seek medical care. We consider our study as an important step to start the plans for early detection, and treating urinary incontinence in Saudi Arabia.

Prevalence of urinary incontinence among Saudi women

OBJECTIVE

To estimate the prevalence of female urinary incontinence (UI) in Jeddah, Saudi Arabia; to determine associated risk factors; and to identify healthcare-seeking behavior among affected women.

METHODS

A cross-sectional study of women attending Ministry of Health primary healthcare centers in Jeddah, Saudi Arabia, was conducted. Participants completed a questionnaire that evaluated factors associated with UI.

RESULTS

The mean age of the 379 participants was 35 years and the median parity was 4. The overall prevalence of UI was 41.4% (95% CI, 36.6-46.5). Stress UI, urgency UI, and mixed UI were reported by 36.4% (95% CI, 31.7-41.4), 27.4% (95% CI, 23.2-32.1), and 22.2% (95% CI, 18.3-26.6), respectively. Urinary leakage was reported daily by 17.2%, and 25.5% experienced leakage more than once a week. Risk factors for UI included increased age (P<0.001); parity greater than 5 (P<0.001); menopause (P=0.004); and history of vaginal gynecologic surgery, chronic cough, or constipation (P≤0.001). Medical advice was not sought by 85.5% of women with UI. Many of the women with UI reported adverse effects on their daily activities.

CONCLUSION

Female UI is prevalent in Saudi Arabia; however, the majority of women with this condition did not seek medical advice.

Does urinary incontinence affect quality of life of Greek women less severely? A cross-sectional study in two Mediterranean settings

OBJECTIVE

Numerous studies have identified a reduced health-related quality of life (QoL) in patients with urinary incontinence (UI). The aim of this study was to assess and compare QoL in women with UI in the island of Crete, Greece, and in Turkey.

METHODS

Incontinent women from two community-based primary health care (PHC) groups (Greece and Turkey) and one outpatient clinic-based group were studied.

RESULTS

A total of 231 (24.7%) women out of 932 women from the PHC group in Greece and Turkey reported UI whereas another 38 incontinent women visited the secondary care outpatient clinic. Mean Incontinence Quality of Life questionnaire (I-QoL) total score of women visiting PHC centers was 73.8 (SD = 23.5). There was significant difference among the three groups regarding I-QoL total and subscale scores, with women from the Greek community-based group having the highest score (mean = 81.8, SD = 20.7, P < 0.001). Impaired QoL was significantly associated with severity (P < 0.001), incontinence type (P = 0.026), seeking secondary care, and Turkey as sample setting (P < 0.001).

CONCLUSION

Urinary incontinence is a frequent problem for women visiting PHC centers, affecting negatively their quality of life. Besides incontinence severity, Turkey as place of residence emerged as another essential predictor of impaired quality of life, suggesting that other social and cultural factors may also play an important role.

Prevalence, treatment and known risk factors of urinary incontinence and overactive bladder in the non-institutionalized Portuguese population

INTRODUCTION AND HYPOTHESIS

To quantify the prevalence (previous month) of urinary incontinence (UI) and overactive bladder (OAB), to assess its relation with known risk factors and to characterize UI awareness and treatment.

METHODS

Telephone interviews were conducted in 1,934 Portuguese subjects aged > or =40 years. UI was defined according to the International Continence Society definitions. OAB was assessed through the Overactive Bladder Assessment Tool.

RESULTS

The prevalence of UI was 21.4% (95% CI 19.0-23.9) in women, 7.6% (95% CI 4.8-10.4) in men. Diagnosis (ever in life) was reported by 4.5% (95% CI 3.3-5.7) of the participants, from which 73.0% reported to have been treated for UI. OAB was reported by 29.4% (95% CI 26.6-32.2) of women and 35.1% (95% CI 29.6-40.6) of men. Obesity, hysterectomy and asthma in women, and age in men, were significantly associated with the symptoms.

CONCLUSIONS

UI and OAB prevalences were high, but the proportion of individuals aware of their condition was low, emphasizing the need for better information among physicians and general population.

Women's perceptions about the etiology of urinary incontinence

OBJECTIVE

Incontinent women have low rates of care seeking and treatment, some of which may be explained by their beliefs about the causes of their own urine loss. As little is known about these beliefs, our aim was to qualitatively assess what women perceive as the etiology of their urinary incontinence (UI).

METHODS

In a written survey on urinary symptoms administered to female HMO enrollees aged 30-90 years, incontinent women were asked the open-ended question: "Why do you think you lose urine?" Qualitative analyses of the responses identified themes, which were quantified and organized into major categories. Subjects were assigned multiple themes/categories as indicated. Relationships between major categories and subject/incontinence characteristics were explored.

RESULTS

Of the 1458 women with incontinence who completed the survey, 1192 (82%) responded to the open-ended question. Qualitative analyses identified 23 themes, with 5 themes cited by >or=10% of subjects: pelvic floor/bladder muscles (31%), pregnancy/childbirth (18%), age (14%), exertional triggers (12%), and waiting too long to void (10%). The 23 themes were organized into 5 major categories: pelvic floor/bladder related (53%), uncontrollable factors (23%), part of being female (21%), personal/lifestyle attributes (21%), and don't know (12%). Subjects expressed a range of 1-4 themes/categories. Major categories differed by age, and significant associations were seen between major categories and incontinence severity.

CONCLUSIONS

Women attribute their UI to a number of causes, which can be condensed into workable themes and categories. By understanding women's beliefs about the etiology of incontinence, clinicians may improve their ability to educate, counsel, and treat women with incontinence.

Prevalence and determinants of fecal incontinence in premenopausal women in an Arabian community

OBJECTIVES

The aim of this study was to determine the prevalence, awareness and determinants of fecal incontinence among Qatari women.

METHOD

In the cross-sectional community-based study in primary health-care centers, using a multistage sampling design, a representative sample of randomly selected 776 Qatari women aged from 40 to 48 years were approached from January to August 2007; only 596 women, with a response rate of 76.8%, gave consent and were included in the analysis. Participants completed a questionnaire assessing fecal incontinence in the previous 12 months and health care-seeking behavior for fecal symptoms. Fecal incontinence, determined by self-report, was categorized by frequency. Females reported the level of bother of fecal incontinence and their general quality of life. Potential risk factors were assessed by self-report, interview, physical examination, and record review.

RESULTS

Of the studied Qatari women, 62 (10.4%) were found to have fecal incontinence. There was a significant difference between fecal incontinent and continent groups with regard to menopause (p < 0.0001), surgical repair of genital prolapse (p < 0.0001) and constipation (p < 0.0001). Only 31 incontinent patients (50%) had sought medical advice. Of the fecal incontinent women, 77.4% felt embarrassment in consulting a doctor and 77.4% believed their condition was worth reporting to a doctor. Aging (51.6%) was the major cause of fecal incontinence in women, followed by childbirth (40.3%), then menopause (25.8%) and lastly paralysis (14.5%). Most of the sufferers were troubled by their inability to pray (64.5%). Their relationship with their husband (41.9%) was the significant consequence for fecal incontinent Qatari women (p = 0.02); 37.1% isolated themselves from social activities and going out to shop.

CONCLUSIONS

The study findings revealed that fecal incontinence is a common symptom among women in the community. There was a correlation between fecal incontinence and menopause. Overall, most of the fecal incontinent women reported that fecal incontinence significantly affected quality of life and only half of the studied women had consulted a physician for the symptom.

Premenopausal women with sexual dysfunction: the need for a bladder function history

INTRODUCTION

Despite the high prevalence of both female sexual problems and bladder dysfunction in the premenopausal population, sexual history forms used in primary care offices rarely include questions about the impact of bladder dysfunction on sexual health.

AIM

To provide a review of the literature that illustrates the relationship between bladder problems and sexual performance of premenopausal women.

MAIN OUTCOME MEASURES

To objectively support by a review of the literature the need for a complete bladder history in when evaluating premenopausal women with female sexual dysfunction.

METHODS

Pubmed was searched for all articles (from November 1980 to June 2007) that reported on the effect bladder dysfunction has on premenopausal female sexual function.

RESULTS

The scant literature available strongly suggested that bladder dysfunction is a contributor to sexual dysfunction and that this medical concern should be considered in all women, regardless of age who present with sexual complaints.

CONCLUSION

Further studies need to be conducted in order to solidify a direct causal relationship between bladder dysfunction and premenopausal female sexuality. These studies should include a larger sample size, clearly defined types of sexual dysfunction and bladder dysfunction, and appropriate follow-up of patient responses using validated objective and subjective outcome modalities to confirm that the patient responses are factual.

Care seeking and treatment for urinary incontinence in a diverse population

PURPOSE

We examined care seeking and treatment for urine leakage in the Boston Area Community Health Survey, a racially and ethnically diverse, community based study of urological and gynecological symptoms and their correlates.

MATERIALS AND METHODS

Boston Area Community Health Survey used a multistage, stratified cluster design to enroll 5,506 black, Hispanic and white adults. Subjects were 30 to 79 years old and residents of Boston, Massachusetts. Data were obtained during a 2-hour in home interview. Analyses for this report include the 331 women and 128 men who reported weekly incontinence, defined as urine leakage that occurred 1 or more times weekly in the last year.

RESULTS

Of women 45% and 22% of men with weekly incontinence reported ever having sought care for it. Of those who sought care 60% reported receiving treatment and half of those who were treated continued to have daily leakage. Of treated women 50% and 40% of treated men reported moderate to great frustration with continued urine leakage.

CONCLUSIONS

This study demonstrates that the majority of men and women who experience weekly urinary incontinence do not seek care for it, many who sought treatment believe that none was provided and many who received treatment continue to have troubling symptoms. The public should be educated to seek care for urine leakage, health care providers should take the initiative to ask their patients about urinary symptoms and more attention should be given to ensuring that, when treatment is given, it is appropriate and effective.