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

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.

An epidemiology study of fecal incontinence in adult Chinese women living in urban areas

Background:

Fecal incontinence (FI) has been shown to be a common symptom in Western countries; however, there is few researches focusing on its epidemic condition in Chinese women. We conducted this national population-based epidemiology study to estimate the prevalence and risk factors of FI among adult Chinese women living in urban regions.

Methods:

This is a subgroup analysis of a national population-based epidemiology study of FI. Total 28,196 adult women from urban regions of six provinces and municipalities participated in this research from 2014 to 2015. They finished the questionnaire under the direction of trained interviewers. FI was defined as accidental leakage of flatus and/or liquid or solid stool at least once in the past. The FI prevalence trend and risk factors were identified by the Cochran-Armitage test, Chi-square test, and multivariable logistic regression.

Results:

The prevalence of FI in adult females in urban China was 0.43% (95% confidence interval: 0.35%–0.51%). Among women with FI, 42.96%, 82.96%, and 42.22% reported having leakage of solid, liquid stool, and gas, respectively. The overall FI prevalence and the incidence rate of solid stool/liquid stool/gas leakage increased with age. The mean Wexner score was 4.0% and 12.0% FI patients reported Wexner score ≥9. Body mass index ≥24 kg/m², pelvic organ prolapses, chronic constipation, chronic cough, alcohol consumption, physical diseases including chronic bronchitis and cancer, gynecological diseases like gynecological inflammation are risk factors for FI. Vaginal delivery was the risk factor for FI in females with labor history.

Conclusions:

FI was not a common symptom in adult Chinese women living in urban areas and there were some potential modifiable risk factors.

Trial Registration:

Chinses Clinical Trial Registry: ChiCTR-OCS-14004675; http://www.chictr.org.cn/showproj.aspx?proj=4898

Prevalence of faecal incontinence and its related factors among patients in a Malaysian academic setting

Background

Prevalence data is essential for planning of healthcare services. The prevalence of faecal incontinence (FI) varies worldwide, and in Malaysia is not known. We sought to estimate its prevalence among patients with various conditions in a Malaysian academic setting.

Method

A questionnaire-based survey was conducted among a convenience sample of adult patients and relatives who visited the Obstetrics and Gynaecology and General Surgery Clinics of University of Malaya Medical Centre (UMMC) from June 2009 to February 2010. Data collected included patient demographics and pre-existing medical conditions known to be FI risk factors. Severity of FI was assessed using the Wexner Continence Scale (WCS).

Results

Among the 1000 subjects recruited into the study, 760 (76%) were female and the median age was 38 years with an inter-quartile range of 24 years. The prevalence of FI among the study subjects was found to be 8.3%. Among them, 63 subjects (75.9%) were determined to have mild FI as measured by the WCS. The proportions of patients with moderate and severe FI were 18.3% and 6.0%, respectively. FI was found to be significantly associated with older age, presence of diabetes mellitus and increased duration of defaecation. There was no statistically significant association between FI and sex, defaecation frequency, or history of surgery.

Conclusion

FI in our setting is prevalent enough to warrant targeted healthcare interventions, including the need to improve general public awareness of the condition in order to counter social stigma and embarrassment that may be faced by patients.

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.

Validation of an Arabic version of the global Pelvic Floor Bother Questionnaire

OBJECTIVE

To validate an Arabic version of the global Pelvic Floor Bother Questionnaire (PFBQ), a self-administered 9-item symptom assessment tool.

METHODS

The translation-back translation method was used to create an Arabic version of the PFBQ. Clarity of terms and face validity were ensured by modifying the translated version according to comments from a focus group. The Arabic PFBQ was completed by 130 Lebanese women, who were allocated to affected (n=65) or control (n=65) groups on the basis of 2 verbally administered screening questions. Validity was assessed by comparing the PFBQ scores of the 2 groups. Test-retest reliability was evaluated in a subgroup of women who completed the PFBQ on 2 separate occasions; the intra-class correlation coefficient (ICC) for paired items was then calculated.

RESULTS

Total PFBQ scores of the affected and control groups were significantly different (31.52 ± 16.80 vs 6.73 ± 7.50; P<0.001). Mean scores for individual PFBQ items were significantly different between the 2 groups, with the exception of dyspareunia. The ICC was above 0.7 for all individual items, thus confirming test-retest reliability.

CONCLUSION

An Arabic version of the global PFBQ was developed and found to be both valid and reliable in the target population.

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.

Menopausal symptoms among healthy, middle-aged Omani women as assessed with the Menopause Rating Scale

OBJECTIVE

The aim of this study was to analyze the prevalence and severity of climacteric symptoms and associated risk factors among a cohort of healthy, middle-aged Omani women.

METHODS

In this cross-sectional study, 472 healthy Omani women between 40 and 60 years old from the representative regions of Omani society were surveyed using the Menopause Rating Scale. The scores obtained were plotted against their demographic data and menopausal stage.

RESULTS

Overall, 39.6% of the participants were premenopausal, 15.2% were perimenopausal, and 43.6% were postmenopausal. The Menopause Rating Scale scoring showed that somatic and psychological symptoms occurred more frequently than did urogenital symptoms in all three stages. Muscle and joint pain was the most common symptom (73.3%), followed by mental and physical exhaustion (47.2%) and anxiety (46.6%). An increase in the mean scores for both somatic and psychological symptoms and their severity was observed when the following factors were present: progression of menopausal stage (mean ± SD, 22.5 ± 2.6, 3.6 ± 2.9, 4.5 ± 3.2), old age (4.2 ± 3.2) versus young age (2.9 ± 2.6), single (4.3 ± 3.3) versus married (3.3 ± 2.9), illiterate (3.9 ± 3.1) versus educated (2.7 ± 2.6), and sexually inactive (4.4 ± 3.4) versus sexually active (3.1 ± 2.7).

CONCLUSIONS

Omani women were found to exhibit highly atypical symptoms of menopause. Increased severity of symptoms was found to be related to age, advanced stage of menopause, and lower educational level.

Coexistence of constipation and incontinence in children and adults

The coexistence of constipation and fecal incontinence has long been recognised in paediatric and geriatric populations, but is grossly underappreciated in the rest of the adult population. In children, functional fecal incontinence is usually associated with constipation, stool retention and incomplete evacuation, and is frequently allied to urinary incontinence. Pathophysiology of the incontinence is incompletely understood, although both in children and adults, it is thought to be secondary to overflow, while in adults it may also be related to pelvic floor dysfunction and denervation. Incontinence has an important impact on quality of life and daily functioning, and in children may be associated with behaviour problems. The treatment of underlying constipation usually results in improvement in incontinence. This review broadly addresses the epidemiology and pathophysiology of coexistent constipation and incontinence in both children and adults, and also reviews clinical presentation and treatment response in pediatrics.