Urinary Incontinence: Its Prevalence, Risk Factors and Effects on the Quality of Life of Women Living in a Region of Turkey

Addressing urinary incontinence by gender: a nationwide population-based study in Turkiye

BACKGROUND

Urinary incontinence (UI), which usually occurs in women but affects both sexes, is a significant public health challenge. This study aims to comprehensively investigate the prevalence and determinants of UI in men and women, considering gender-specific factors.

METHODS

The study performed a secondary analysis on data obtained from 13,383 individuals surveyed in the 2019 Turkish Health Survey, providing a representation of the Turkish population. The dataset included sociodemographic and health-related variables like UI, body mass index (BMI), physical activity, smoking, and chronic diseases-statistical analysis employed chi-square tests and gender-stratified logistic regression models to identify UI-associated factors.

RESULTS

Our results showed that UI affected 8.8% of the population, with a striking gender disparity. Women had a notably higher prevalence at 11.2%, while men had a lower rate of 5.5%. Importantly, this gender gap narrowed with age. For example, in the 34-44 age group, the female/male ratio was 6.9, but it decreased to 1.4 in the 65-74 age group. Marital status and employment status played significant roles. Separated, divorced, or widowed individuals, particularly women, had the highest prevalence at 19.3%. Employment status influenced UI prevalence, with employed men having the lowest rate (2.1%), while retired women faced the highest rate (15.0%). Higher BMI, especially in obese individuals, significantly raised UI prevalence, reaching 7.9% for men and 15.8% for women. Physical inactivity, notably in women (17.0%), and prolonged sedentary hours (13.9%) were associated with higher UI rates. Former smokers, especially women (15.9%), had a notable impact on UI. Poor perceived health and chronic conditions like Chronic Obstructive Pulmonary Disease (COPD), hypertension, and diabetes were significantly associated with higher UI prevalence. Logistic regression analysis revealed that age, education, perceived health status, COPD, and diabetes were significant factors associated with UI in both sexes, while in women, BMI, physical activity, and smoking also played notable roles.

CONCLUSIONS

This extensive UI study has unveiled notable gender disparities and determinants. Notably, these disparities decrease with age, underlining UI's changing nature over time. Modifiable factors impact women more, while non-modifiable factors are linked to men. The study underscores the importance of tailoring healthcare strategies to address UI based on gender.

Prevalence of Stress Urinary Incontinence and Risk Factors among Saudi Females

Background and Objectives: Stress urinary incontinence (SUI) is involuntary urine leakage upon effort or physical exertion, sneezing, or coughing, and it is the most prevalent type of urinary incontinence (UI) in women. We aimed to estimate the prevalence of SUI and its risk factors among Saudi females. Materials and Methods: A descriptive cross-sectional study was conducted in the Kingdom of Saudi Arabia between March 2022 and July 2022, with a total of 842 respondents. We included Saudi females over the age of 20 years. Data were collected through an online questionnaire distributed to the target group and analyzed using SPSS software. Results: The prevalence of SUI was found to be 3.3% among Saudi women. Moreover, only 41.8% of the participants had at least one pregnancy; the majority had five or more pregnancies (29%). According to our findings, the majority of the participants diagnosed with SUI had the following risk factors: increased age, widowhood, a family history of SUI, and a history of pregnancy. The results revealed that the odds of SUI increased among Saudi females with a family history of SUI by 19.68-fold compared with those who had no family history of SUI, and this was statistically significant (p < 0.001). Conclusion: The prevalence of SUI among Saudi females was found to be relatively low. The above-listed associated factors should be considered in future research and interventions.

Effect of transcutaneous posterior tibial nerve stimulation and repetitive transcranial magnetic stimulation on neurogenic overactive bladder symptoms in female patients with multiple sclerosis: The study protocol of a randomized controlled study

INTRODUCTION

Neurogenic bladder is frequently seen in patients with multiple sclerosis (MS). Electrical stimulation methods (neuromodulation) can be used for patients that have persistent symptoms despite pharmacological treatment. This study aims to compare the effects of two different neuromodulation techniques used in the treatment of neurogenic bladder.

METHODS AND ANALYSIS

This is a single-center randomized controlled trial for MS patients with neurogenic bladder. Patients determined to be eligible according to the study criteria will be randomized into two treatment groups: the transcutaneous posterior tibial nerve stimulation (PTNS) and repetitive transcranial magnetic stimulation (rTMS) groups. Each group will include eight patients. The patients will be treated for a total of 10 sessions for two consecutive weeks. The pressure-flow study will be used to compare the initial and final urodynamic results as the primary outcome. All the participants will fill in a 3-day bladder diary before and after the treatments in each group. Patients will also be asked to complete specific questionnaires for incontinence and quality of life (QOL): Overactive Bladder Questionnaire-V8 score (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale score (I-QOL), International Incontinence Questionnaire (ICIQ-SF) score, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score) as the secondary outcomes.

ETHICS AND DISSEMINATION

An ethical approval number was obtained from the Non-Invasive Clinical Research Ethics Committee of Istanbul Medipol University (ethical approval number: 768). Support was received within the scope of the Istanbul Medipol University Scientific Research Project with project number 2020-2017. The result of this study will be published in a peer-reviewed journal.

TRIAL REGISTRATION

NCT05312138.

A nomogram model predicting the risk of postpartum stress urinary incontinence in primiparas: A multicenter study

Stress urinary incontinence (SUI) is a common gynecological urinary system disease, and globally, 200 million or more people suffer from it. However, the existing literature mostly focuses on postpartum urinary incontinence (UI) or UI in middle-aged and elderly people, with little focus on primiparas. To analyse urinary incontinence prevalence and its risk factors in primiparas and establish a nomogram prediction model, 360 parturients were recruited from three hospitals between April and September 2021. A homemade electronic questionnaire was used to investigate the general demographic and perinatal characteristics of primiparas. The SUI was diagnosed by the physicians. Logistic regression analysis of independent risk factors for SUI and a nomogram prediction model were established. Ninety people were diagnosed as SUI. The number of pregnancies (OR = 3.322, 95% CI = 1.473-7.492), residence (OR = 5.451, 95% CI = 2.725-10.903), occupation (OR = 3.393, 95% CI = 1.144-10.064), education level (OR = 3.551, 95% CI = 1.223-10.308), delivery method (OR = 10.270, 95% CI = 4.090-25.789), and oxytocin use (OR = 2.166, 95% CI = 1.142-4.109) were independent risk factors for SUI. The C-index of the nomogram prediction model was 0.798 (95% CI = 0.749-0.846). The POPDI score, CRADI score, UDI score, and PFDI scores of women with SUI were significantly higher than those of non-SUI women, while I-QOL scores were significantly lower than those of non-SUI women. In conclusion, the prevalence of SUI among primiparas in Fuyang, China, was 25.00%, which exhibited a large impact on the quality of life of puerperae. The present study successfully established an individualized nomogram prediction model of SUI for primiparas with good discrimination and diagnostic efficiency, which was helpful for the early clinical identification of high-risk primiparas with SUI.

Risk Factors for Urinary Incontinence in Pregnancy: A Case Control Study

OBJECTIVE

 Urinay incontinence (UI) is a major public health problem that can harm women in any period of life, including during the gestational period. Urinary incontinence during pregnancy has been studied because this condition can reduce the quality of life and interfere in several aspects of the maternal-fetal binomial. The aim of this study was to determine the prevalence of UI in nullipara pregnant women and to identify risk factors associated with UI in this population.

METHODS

 This is a case-control study in which we invited nullipara women between 12 and 20 weeks of pregnancy to participate in the research. They were asked to answer a specific questionnaire, write a 3-day bladder diary, and undergo a urogynecological evaluation including pelvic organ prolapse quantification (POP-Q), empty stress supine test (ESST), and pelvic floor muscle assessment.

RESULTS

 A total of 70 out of 73 patients accepted to participate in the study, and the prevalence of UI in this population was 18.3%. Tobacco use was identified as an independent risk factor for UI in pregnant women (odds ratio 8.0). All other factors analyzed were not significantly associated to UI in pregnancy.

CONCLUSION

 Urinary incontinence can be a major problem in pregnancy. We identified the use of tobacco as a risk factor for developing UI in pregnancy, which provides an extra reason to encourage patients to quit smoking.

Urinary incontinence experiences of pregnant women: A qualitative study

OBJECTIVE

The research was carried out to determine the life experiences of pregnant women who have urinary incontinence problems.

METHODS

The type of the research is of qualitative type. Views of pregnant women were coded according to repeating frequencies; then thematic grouping was done. Both common views and individual repetitions of the pregnant women were coded. During the study, 52 pregnant women stated that they had urinary incontinence problems. However, five pregnant women did not want to participate in the study and six pregnant women wanted to leave during the interview. Interviews ended with 41 pregnant women.

RESULTS

In the study, the mean age of the pregnant women was determined as 29.75 ± 4.83, and the mean gestational week was 27.85 ± 5.60. The views of pregnant women are divided into five main themes and 16 sub-themes. The main themes for the urinary incontinence life experiences of pregnant women were determined as "strategies to take precautions, psychological effects, pregnancy and baby-specific effects, physical effects and changes in their relationship with the spouse."

CONCLUSION

As a result, it was determined that urinary incontinence problem negatively affected the life experience of pregnant women.

Sleep Quality and Quality of Life in Older Women With Urinary Incontinence Residing in Turkey: A Cross-sectional Survey

PURPOSE

The aim of this study was to evaluate sleep quality and quality of life in older women with urinary incontinence.

DESIGN

Cross-sectional.

SUBJECTS/SETTING

Women ages 65 to 84 years with reported urinary incontinence and were receiving care in the Gynecology and Obstetrics Polyclinic in Gynecology and Obstetrics Polyclinic, Medical Practice and Research Center, Ondokuz Mayıs University, Samsun, Turkey.

METHODS

Data were collected over a 3-month period during one-on-one interviews using the investigator-developed Personal Information Form to capture demographic data, and with questionnaires including the Incontinence-Quality of Life Instrument (I-QOL), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using nonparametric tests, Mann-Whitney U tests, and Kruskal-Wallis variance analysis. Written informed consent was obtained from all participants.

RESULTS

We approached 210 individuals, of which 140 were consented, enrolled, and completed the study. The mean age of participants was 70.3 ± 4.1 years. The mean sleep quality score measured with the PSQI was 9.6 ± 6.0, suggesting poor sleep quality, which affected 89.3% of the sample. The quality-of-life mean total score measured with the I-QOL was 67.8 ± 14.9, reflecting normal quality of life specific to urinary incontinence. However, quality of life was lower in the older age group, 75 to 84 years, who also reported at least one chronic condition, had not received treatment for urinary incontinence, and had irregular sleep patterns.

CONCLUSIONS

We found a strong correlation between sleep quality and quality of life in older females with urinary incontinence, raising awareness of the need for health care providers to inquire about sleep and quality of life and provide treatment options to ameliorate these negative health outcomes.

Prevalence of urinary incontinence in women aged 18 and over and affecting factors

The aim of study was to determine the prevalence of urinary incontinence (UI) in women aged 18 and over and the factors affecting it. The sample of the study consisted of the 1220 women. The results of the study showed that the rate of UI was 26.3%. Prevalence rose as age and body mass index increased. UI rates were also high in women who had long-term constipation and UTI, those who were in menopause, those with a high number of pregnancies, and in those who had undergone a vaginal birth. It is important that measures be taken to prevent UI.

Genitourinary syndrome of menopause: effects on related factors, quality of life, and self-care power

Introduction

This study aimed to determine the effects of genitourinary syndrome of menopause on related factors, quality of life, and self-care power.

Material and methods

This case-control epidemiological study included 300 postmenopausal women aged 48-60 years who were divided into two groups: the case group (141) with genitourinary syndrome and the control group (159) without genitourinary syndrome. Data were evaluated by chi-square and t-tests in independent groups and logistic regression analysis.

Results

The incidence of genitourinary syndrome of menopause was 0.61 times higher in women with a lower educational level than in those with a high educational level, 0.44 times higher in those with chronic disease than in those without, 2.54 times higher in those who continuously used medication than in those who did not, and 2.45 times higher in those with urinary incontinence than in those without. The mean Self-Care Power Scale score was significantly higher in the control group (101.52 ±21.50) than in the case group (83.96 ±25.64). The mean Menopause-Specific Quality of Life Scale score was significantly higher in the case group (65.52 ±33.47) than in the control group (37.06 ±25.81).

Conclusions

Low educational level, chronic disease, urinary incontinence, and continuous drug use are associated with genitourinary syndrome of menopause, which negatively affects the quality of life and self-care power in women.

The Impact of Urinary Incontinence on Quality of Life in Those Receiving Home Care Services

This study aims to evaluate the impact of urinary incontinence on the quality of life in those receiving home care services and the factors that influence this. This cross-descriptive study was performed in 180 patients who were served from Home Care Services between 01 and 28 February 2018. An International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) was implemented in person to those who gave their informed consent with orientation and cooperation. The mean age of a 180 patients was 74.40 ± 7.80 years (min = 18, max = 104), of which 55.2% were women. The mean ICIQ-SF score was found to be 12.42 ± 4.83 (min = 0, max = 21). The lowest points were given as responses to the question, “In your opinion, what amount of leakage do you experience?” The highest points, however, were given to the question of “How much does urinary leakage interfere with your everyday life?” It was seen that when quality of life is assessed with a visual analog scale within the ICIQ-SF, the quality of life for 66.6% of elderly individuals was affected moderately or significantly. The mean ICIQ-SF scores were higher in those with chronic diseases ( p < .005). Urinary Incontinence negatively affects quality of life to a moderate and significant degree in those receiving home care. The quality of life for those who have chronic diseases was worse. In this respect, there is a need to support patients in those receiving home care services.

Urinary incontinence and quality of life of women living in nursing homes in the Mediterranean region of Turkey

BACKGROUND

This study was conducted to determine the effect of urinary incontinence (UI) on the quality of life of women living in nursing homes in the Mediterranean region of Turkey.

METHODS

The study was conducted on 95 women living in nursing homes in the Mediterranean region. Data were collected from a questionnaire on sociodemographic characteristics, the Urinary Incontinence Quality of Life Scale, the Index of Activities of Daily Living, and the International Consultation on Incontinence Questionnaire Short Form.

RESULTS

The quality of life of women who did not consider UI a health problem was significantly higher than that of those who considered otherwise. Mixed UI was the most common UI type among the women living in nursing homes, with a rate of 31.7%. According to the overall mean scores on the Urinary Incontinence Quality of Life Scale, quality of life was the most affected among women who had nocturnal incontinence. Quality of life was affected from most to least by the mixed type, stress type, and urge type of incontinence.

CONCLUSION

Early diagnosis and treatment of UI could be improved if health professionals, who have a unique role in changing the perception of society, offered training to women experiencing incontinence. Identifying this problem and determining and preventing the risk factors are important for enhancing women's quality of life.

Reliability and validity of the Incontinence Quiz-Turkish version

AIM

The aim of this study was to investigate the reliability and validity of the Turkish version of the Incontinence Quiz, which was developed by Branch et al. (1994), to assess women's knowledge of and attitudes toward urinary incontinence.

METHODS

Comprehensibility of the Turkish version of the 14-item Incontinence Quiz, which was prepared following translation-back translation procedures, was tested on a pilot group of eight women, and its internal reliability, test-retest reliability and construct validity were assessed in 150 women who attended the gynecology clinics of three hospitals in İçel, Turkey. Physical and sociodemographic characteristics and presence of incontinence complaints were also recorded. Data were analyzed at the 0.05 alpha level, using SPSS version 22.

RESULTS

The scale had good reliability and validity. The internal reliability coefficient (Cronbach α) was 0.80, test-retest correlation coefficients were 0.83-0.94; and with regard to construct validity, Kaiser-Meyer-Olkin coefficient was 0.76 and Barlett sphericity test was 562.777 (P = 0.000). Turkish version of the Incontinence Quiz had a four-factor structure, with Eigenvalues ranging from 1.17 to 4.08.

CONCLUSIONS

The Incontinence Quiz-Turkish version is a highly comprehensible, reliable and valid scale, which may be used to assess Turkish-speaking women's knowledge of and attitudes toward urinary incontinence.

What are the probable predictors of urinary incontinence during pregnancy?

Objectives. The frequency, predisposing factors and impact of urinary incontinence (UI) on quality of life (QoL) during pregnancy were investigated.

Materials and Method. A preliminary cross-sectional survey was studied among pregnant women between January and July of 2014. A total of 132 pregnant women were recruited using a questionnaire form for sociodemographic features, the Turkish version of the International Consultation on Incontinence-Short Form (ICIQ-SF), for the characteristics of UI and Wagner’s Quality of Life scale to assess impact on QoL. p < 0.05 was set significant.

Results.Urinary incontinence was present in 56 out of 132 pregnant women (42.4%, UI-present group): mean age, 26.7 ± 5.4y(p = 0.780); median height, 160 cm (min–max: 153–176, p = 0.037); median BMI, 28.7 kg/m²(min–max: 22.4–50.0, p = 0.881); urine leakage occurred per week once (n = 18, 32.1%), twice or thrice (n = 8, 14.3%); per day few times (n = 14, 25%), once (n = 5, 8.9%) and always (n = 8, 14.3%) with mainly a small amount of urine leakage (n = 33, 58.9%) or a moderate (n = 4, 7.1%). There were statistically significant relationships between QoL scores and frequency of UI (p = 0.002) or amount of leakage (p = 0.002). Impact on QoL scores ranged from mild (n = 33, 58.9%), moderate (n = 4, 7.1%) to severe (n = 4, 7.1%) levels in daily life. UI impacted the daily life activities of women by making them less likely to undertake activities outside their homes (23.2%), by affecting their working performance and friendships (8.9%), their daily home activities (7.1%), their general health status (12.5%), their sexual relations (12.5%), by making them more nervous or anxious (10.7%) and by the need to wear pads or protectors (25%). ANOVA, Tukey, and Tamhane tests as the minimal important difference model yielded significant relevance between statistical analyses and clinical outcomes by using standard deviations (p = 0.001, 0.001 and 0.005 respectively). The following features favored the occurence of UI: Age (OR = 0.845, 95% CI [0.268–2.669]), being a housewife (OR = 1.800, 95% CI [0.850–3.810]), anemia (OR = 0.939, 95% CI [0.464–1.901]), parity (OR = 0.519, 95% CI [0.325–0.829]), miscarriage (OR = 1.219, 95% CI [0.588–2.825]) and living in rural areas (OR = 1.800, 95% CI [0.887–3.653]). Height (p = 0, 037), educational status (0.016), miscarriage (0.002), parity (0.006) and place of living (0.020) were significant factors.

Conclusions.Many pregnant women are suffering from UI, which warrants a significant public health consideration in the region. Age, height, being a housewife or graduation level higher than primary school, living in rural, parity, miscarriage, and anemia were the factors in favor of the onset of UI. The authors plan a health promotion program in the region according to the results in order to provide information to health caregivers, especially family physicians, and to educate women about the predictors of UI and pelvic floor exercises for primary prevention and secondary relief of UI during and after pregnancy and provide some hygienic supplies to the poor in this aspect.

Influence of antimuscarinic therapy on cognitive functions and quality of life in geriatric patients treated for overactive bladder

OBJECTIVES

Incidences of overactive bladder (OAB) and cognitive dysfunction increase with aging. Treatment of OAB with antimuscarinic agents may result in cognitive decline, especially in patients with Alzheimer's disease (AD). The aim of this study is to evaluate the effect of antimuscarinic treatment on cognitive functions, depression, and quality of life (QOL) of patients with OAB.

METHODS

This non-interventional prospective observational study was conducted in a geriatric medicine outpatient clinic. Overall, 168 OAB patients were enrolled. Patients were followed up in five groups: oxybutynin, darifenacin, tolterodine, trospium, and control groups. Follow-up visits were done at second, third, and sixth months. Comprehensive geriatric assessment, cognitive and mood assessment, QOL scales (IIQ-7, UDI-6) were performed.

RESULTS

Mean age of the patients was 73.5 ± 6.1. Of the 168 patients, 92.3% were female, 83.3% benefited from the treatment, and 37.1% discontinued the medication. Discontinuation rate and frequency of side effects were more frequent in the oxybutynin group. Mini Mental State Examination scores did not decline after treatment, even in AD patients. Geriatric Depression Scale scores, Activities of Daily Living scores, and QOL scores significantly improved after treatment.

CONCLUSION

Antimuscarinic agents are effective in OAB treatment. They have a positive impact on daily life activities, depression, and QOL indices. Furthermore, they do not have a negative effect on cognitive function in older adults with or without AD.

An Investigation of Lower Urinary Tract Symptoms in Women Aged 40 and Over

OBJECTIVE

The objective of this study was to determine lower urinary tract symptoms (LUTS) and associated risk factors in women aged 40 years and over.

METHODS

The study was carried out with a total of 312 women. The data were collected between 1 January 2009 and 30 July 2010. As research instruments, an interview form of 19 questions that questioned personal characteristics and was developed by researchers, and the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) Questionnaire evaluating lower urinary tract symptoms were used. Linear regression analysis was used to detect associated risk factors.

RESULTS

The rates of urgency, urinary incontinence, nocturia, and frequency symptoms were 61.5, 52.2, 18.9, and 25%, respectively. BFLUTS total scores increased with age, but the present study has detected no statistically significant differences (P > 0.05). BFLUTS scores of the women demonstrated statistically significant differences according to several risk factors including menopause status (P = 0.03), presence of chronic illness (P = 0.000), medicine use (P = 0.000), recurrent urinary tract infections (P = 0.000), body mass index (BMI) (P = 0.004), delivery number (P = 0.005) and chronic constipation (P = 0.002). Multiple linear regression analysis determined that frequent urinary tract infections, presence of chronic illness, chronic constipation, BMI and number of deliveries were significantly related to LUTS development.

CONCLUSION

The most common LUTS was urgency in women aged 40 years and older. Recurrent urinary tract infection was determined as the most significant risk factor for LUTS, followed by chronic illness, chronic constipation, higher BMI and parity.

Prevalence of urinary incontinence in older Turkish women, risk factors, and effect on activities of daily living

PURPOSE

The study was conducted to determine the prevalence of urinary incontinence (UI) among older women, risk factors, and the effect on activities of daily living (ADLs).

METHOD

The study was conducted in family health centers located in a city in eastern Turkey. The study population consisted of 1094 women age 65 and older chosen with a simple random sampling method. The inclusion criteria were 65 years and older, female, and not diagnosed with mental or emotional diseases or conditions that obstruct communication. Data were collected in face-to-face interviews with the Questionnaire and Daily Life Activities Data Form created by the researchers based on the Roper, Logan, and Tierney model.

RESULTS

The prevalence of UI in women age 65 and older was 51.6%, and the most common type was urge incontinence. The number of births, number of abortions, age at last birth, and home births affected the development of UI (p<0.001). In addition, body mass index, constipation, urinary tract infection, cough, hormone replacement therapy, genital prolapse, cystocele, urogenital surgery, nocturia, and daily urine output were determined to be risk factors (p<0.001). Among the ADLs, 13.7% with UI reported that they had fallen when getting up from the toilet, 34.3% had experienced a sense of shame, 45.8% avoided coughing, and 46.5% restricted fluid intake.

CONCLUSION

Prevalence of UI in women age 65 and older was high, and the most common was urge incontinence. UI has many risk factors and affects many ADLs.

Prevalence, risk factors and quality of life in Turkish women with urinary incontinence: a synthesis of the literature

BACKGROUND

Urinary incontinence (UI) is not a life threatening condition but it adversely affects physical and mental health, sexual function and quality of life in women.

AIM

To review the related literature to identify prevalence, risk factors and quality of life among only Turkish women.

METHODS

Computerized searches on PubMed, Turkish Medline, EBSCO Host; articles from indexed journals related to the topics in this review and published between 1996 and 30 April 2012 were evaluated. After completion of database searches, a final total of 20 studies were identified that fitted the inclusion criteria.

RESULTS

This review revealed that the prevalence of UI among Turkish women was reported by 16 studies ranged from 16.4% to 49.7%. The most common risk factors were age, number of births, body mass index > 25 kg/m(2), recurrent urinary infection, diabetes mellitus and vaginal delivery. The effect of UI on the quality of life was mild to moderate.

CONCLUSIONS

We found that the prevalence of UI of Turkish women showed a wide range. It is important for health professionals to be aware of the high prevalence of UI in women and to ask about its possible presence. Improving the quality of life in women with UI is an important issue and nurses should direct women to seek psychosocial support. The findings of this review could serve as a source of information for health systems that deal with UI, and it may help to inform health professionals and women with UI on early diagnosis, treatment and management.

Effect of urinary incontinence and its subtypes on quality of life of women in eastern Turkey

OBJECTIVE

To determine the bothersomeness and effect on quality of life (QOL) of different types of urinary incontinence (UI) in married women living in eastern Turkey.

MATERIALS AND METHODS

A total of 1049 married women was evaluated in the present population-based, cross-sectional study. QOL was assessed using a validated form of the Turkish version of the Incontinence Impact Questionnaire Short Form. The effects of UI subtype on the overall QOL score and on the individual domain scores were determined. The relationship between several demographic characteristics such as age, weight, education level, number of pregnancies, number of live deliveries, and presence of pelvic organ prolapse and the QOL changes was examined.

RESULTS

The mean age of the women was 44.62 ± 11.01 years (range 17-80). Of the women with UI, 76.2% stated that the UI had a negative effect on their QOL. Women with mixed UI and severe UI had the worst QOL scores. The QOL changes for the different domains revealed that entertainment activities were affected least, and emotional health and feelings of frustration were the 2 domains that showed the most significant deterioration. Furthermore, older and unemployed women, housewives, women living in urban areas, and women with multiple births, difficult labor, and increased weight experienced significant negative effects on their QOL.

CONCLUSION

Our results have shown that, regardless of different factors, UI has significant negative effects on QOL. The presented data emphasize the importance of the high prevalence of UI in our region and its negative effects on QOL. Thus, additional policies are needed for the prevention of the negative effects of UI.

Urinary incontinence among Turkish women: an outpatient study of prevalence, risk factors, and quality of life

PURPOSE

The aim of this study was to determine the prevalence and potential risk factors associated with urinary incontinence (UI) in women and to assess its impact on quality of life (QOL).

DESIGN

We undertook a cross-sectional study based on interviews, using a structured questionnaire.

SUBJECTS AND SETTING

Two hundred eighty-eight women, aged 19 years and older, from gynecology outpatient clinics attached to a university hospital in Ankara, Turkey, were interviewed.

INSTRUMENTS

Data were collected via a Turkish version of the international consultation on incontinence questionnaire short form (ICIQ-SF) and the Wagner's quality of life scale.

METHODS

Data were collected by face-to-face interviews with subjects and took approximately 30 minutes to complete. Potential risk factors were analyzed using logistic regression.

RESULTS

The prevalence of UI was 31.9%. Logistic regression analysis indicated that the number of pregnancies (odds ratio [OR] = 0.53, 95% CI: 0.28-0.99), UI in mother (OR = 2.46, 95% CI: 1.35-4.50) and sister (OR = 0.34, 95% CI: 0.16-0.77), previous UI during pregnancy (OR = 12.22, 95% CI: 4.11-36.36) and postpartum period (OR = 11.28, 95% CI: 3.66-34.76), and body mass index (OR = 0.49, 95% CI: 0.29-0.85) were associated with a higher likelihood of incontinence (P < .05). Ninety-two of 288 women (31.9%) stated that UI has a negative impact on their QOL and only 40 of 92 (43.5%) had asked for medical help. Impairment of QOL was related with the type of UI, frequency of UI episode, and amount of leakage.

CONCLUSION

Our study results determined that UI is common in Turkish women. The QOL of women was mostly mildly or moderately affected by UI.

Predictive risk factors for impaired quality of life in middle-aged women with urinary incontinence

PURPOSE

Urinary incontinence (UI) has substantial and important impacts on quality of life (QoL). The purpose of this study was to identify the associated risk factors of QoL in middle-aged women with UI.

METHODS

The participants were 127 women aged 40-64 years who experienced UI. Data were collected from October to November, 2008 using a self-reported questionnaires. The data were analyzed through t-test, one-way ANOVA, Scheffe test, and multiple linear regression with SPSS ver. 16.0 program.

RESULTS

The distribution of UI severity was mild 18.1%, moderate 40.2% and severe 41.7%. In univariate analysis, differences in the score for QoL according to participants' characteristics were statistically significant on the type of delivery, number of births and severity of UI. In multiple linear regression analysis after adjustment of other variables, the most powerful predictor of QoL is severity of UI. Number of births was also significant predictor. These two variables explained 25% of variance in QoL of women with UI.

CONCLUSIONS

UI is highly prevalent and causes suffering and impaired QoL among middle-aged women, but it stands beyond our attention. The results of this study suggest that women with moderate to severe UI should be screened for QoL by health care providers regularly. Further research is needed to determine comprehensive factors including psychosocial factors predicting the QoL for incontinent women.

Urinary incontinence in pregnant women and their quality of life

AIMS AND OBJECTIVES

The aim was to investigate the prevalence of urinary incontinence during pregnancy and the related risk factors as well as to assess its influence on the quality of life.

BACKGROUND

Although urinary incontinence is common during pregnancy and can have a substantial impact on quality of life, women rarely seek help for this symptom.

DESIGN

This study was designed as a cross-sectional and descriptive survey.

METHODS

A total of 393 pregnant women participated in the study between March and June 2007. The data was collected using the International Consultation on Incontinence Questionnaire Short Form and Wagner's quality of life scale. Potential risk factors were investigated through logistic regression analysis.

RESULTS

The prevalence of urinary incontinence was 27% (106/393). Factors significantly associated with urinary incontinence included age group, parity, previous urinary incontinence, constipation, urinary incontinence in mother and sister, previous urinary incontinence during pregnancy and postpartum.

CONCLUSION

According to the results of our study, urinary incontinence is common in women during pregnancy. The quality of life of pregnant women was found to be either unaffected or affected very little by urinary incontinence.

RELEVANCE TO CLINICAL PRACTICE

This study reveals that the prevalence of urinary incontinence during pregnancy is very high. The findings will help increase the awareness of health care workers involved in the care of pregnant women about urinary incontinence and aid the design of more intensive education programmes directed towards the prevention of urinary incontinence during pregnancy.

Predictors of female urinary incontinence at midlife and beyond

Urinary incontinence (UI) is an important middle age health issue and approximately 20% of women over 40 years of age have problems with continence. Urinary incontinence poses a significant negative impact on social functioning and quality of life to many individuals. It is estimated that around three million people are regularly incontinent in the UK with a prevalence of about 40 per 1000 adults. There are various factors which can cause incontinence such as pregnancy, childbirth, obesity, menopause, or just inherent connective-tissue weakness. All of these factors can cause pathophysiology changes in the muscular and fascial structures of the pelvic floor and lead to pelvic support defects and possibly pelvic floor dysfunction. We aim with this review article to highlight predictors or predisposing factors of incontinence; in order to help clinicians during their decisions and put in place a policy of a preventive strategy to decrease the incontinence rate in the general population.

Impact on quality of life of urinary incontinence and overactive bladder: a systematic literature review

The paper provides a systematization of the scientific evidence on quality of life of patients affected by urinary incontinence (UI) and overactive bladder (OAB) through a systematic literature review. A single search strategy was performed through the databases and papers collected are reviewed by independent researchers finally, including 39 papers. A strong heterogeneity of studies emerged from the evidence. The multidimensionality of the consequences produced by UI and OAB increased the attention on the identification of the most affected dimension of life quality (i.e. physical, emotional) and on the attempt of predicting life quality impairment through specific variables.

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.

The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China

OBJECTIVE

The aim of this study was to evaluate the prevalence and associated risk factors of urinary incontinence (UI) in Chinese women.

METHODS

In the cross-sectional survey, 20,000 Chinese women 20 years or older were randomly selected and interviewed with modified Bristol Female Lower Urinary Tract Symptoms questionnaires to estimate population prevalence rates and identify potential risk factors.

RESULTS

A total of 19,024 women were included in the analysis and 976 excluded; qualified rate is 95% (19,024/20,000). Of the Chinese women aged from 20 to 99 years (mean +/- SD, 45 +/- 16 y), the overall prevalence rate of UI was 30.9%. Estimates of stress urinary incontinence (SUI), urge urinary incontinence, and mixed urinary incontinence prevalence were 18.9%, 2.6%, and 9.4%, with a corresponding proportional distribution of 61%, 8%, and 31%, respectively. The prevalence of mixed urinary incontinence increased with aging, whereas the prevalence of SUI peaked in the group of women aged 50 years and that of urge urinary incontinence in the group of women aged 70 years. Only 25% of women have consulted doctors on this issue. Through multivariable logistic regression analysis, we identified age, vaginal delivery, multiparity, alcohol consumption, central obesity (women's waist circumference, >/=80 cm), constipation, chronic pelvic pain, history of respiratory disease, gynecological events, pelvic surgery, and perimenopause and postmenopause status as potential risk factors for SUI, among which age, vaginal delivery, and multiparity are three major risk factors.

CONCLUSIONS

Our findings suggest that the prevalence of UI is high in China, with SUI as the most common subtype. Age, vaginal delivery, and others are risk factors for SUI.

Mixed urinary incontinence: greater impact on quality of life

PURPOSE

We compared the impact of mixed, stress and urge urinary incontinence on quality of life in middle-aged or older women.

MATERIALS AND METHODS

We analyzed cross-sectional data from a population based cohort of 2,109 ethnically diverse middle-aged or older women. Among participants reporting weekly incontinence, clinical type of incontinence was assessed by self-reported questionnaires and disease specific quality of life impact was evaluated using the Incontinence Impact Questionnaire. Multivariable logistic regression was used to compare the odds of greater quality of life impact from incontinence, defined as an Incontinence Impact Questionnaire score in the 75th percentile or greater in women with stress, urge and mixed incontinence.

RESULTS

More than 28% (598) of women reported weekly incontinence, including 37% with stress, 31% with urge and 21% with mixed incontinence. Unadjusted Incontinence Impact Questionnaire scores were higher for women with mixed vs urge or stress incontinence (median score 29 vs 17 and 13, respectively, p <0.01). Adjusting for age, race/ethnicity, health status and clinical incontinence severity, women with mixed incontinence were more likely to report a greater overall quality of life impact compared to those with stress incontinence (OR 2.5, 95% CI 1.4-4.3), as well as a greater specific impact on travel (OR 2.2, 95% CI 1.3-3.7) and emotional (OR 1.8, 95% CI 1.0-3.4) Incontinence Impact Questionnaire domains. The overall impact of urge incontinence did not differ significantly from that of stress (urge vs stress OR 1.6, 95% CI 0.9-2.7) or mixed incontinence (mixed vs urge OR 1.6, 95% CI 0.9-2.8) in adjusted models.

CONCLUSIONS

In middle-aged or older women mixed incontinence is associated with a greater quality of life impact than stress incontinence independent of age, race, health or incontinence severity. Identification of women with mixed incontinence symptoms may be helpful in discovering which women are most likely to experience functional limitations and decreased well-being from incontinence.

The association between diabetes mellitus and urinary incontinence in adult women

Introduction and hypothesis

The purpose of the study was to investigate the relationship of diabetes mellitus and urinary incontinence in adult women.

Methods

We conducted a cross-sectional, comparative study with a case-control design. One thousand three hundred eighty-one women (aged 20–87 years) attending six Primary Healthcare Centers in Turkey were enrolled in this study, after giving their informed consent. Subjects were dichotomized into cases and controls according to presence of diabetes mellitus (DM) and were matched for the confounding factors age, body mass index (BMI), and reproductive history.

Results

Nine hundred ten women were included: 273 diabetics and 637 non-diabetics. Diabetes was shown to be associated with a 2.5-fold risk increase for urinary incontinence (UI), and age and BMI were weakly associated with UI. UI was significantly more prevalent in diabetic women: 41% diabetic and 22.1% non-diabetic women reported UI (p < 0.001). Age, BMI, and DM were revealed as independent determinants of UI in adult women. Urge incontinence was more prevalent in non-diabetic women, whereas stress and mixed incontinence were more prevalent among diabetic women.

Conclusions

DM is the most important independent determinant of UI.

Urogenital symptoms of postmenopausal women in Turkey

OBJECTIVE

The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey.

DESIGN

The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice.

RESULTS

The mean age of participants was 58.64 +/- 8.14 years. The mean age of menopause was 47.21 +/- 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency.

CONCLUSIONS

Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.

Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life

OBJECTIVES

To determine the prevalence and risk factors of urinary incontinence (UI), and to assess its impact on quality of life (QOL) in Turkish women.

METHODS

In this cross-sectional study, 1012 women aged over 18 years were interviewed through a questionnaire including 'International Consultation on Incontinence Questionnaire Short Form'.

RESULTS

The overall prevalence of UI was 23.9% (n=242). Among these women, 62 (25.6%) had urge, 80 (33.1%) stress and 100 (41.3%) mixed type UI. The prevalence rate increased with advancing age. Eighty-nine women (36.8%) stated to have urinary leakage at least once a day or more, while 153 (63.2%) women were experiencing less than twice a week. UI was significantly associated with fecal incontinence, hypertension, history of nocturnal enuresis, and recurrent urinary tract infections. Overall, 211 (87.2%) women stated that UI have negative impact on the QOL. This effect remained mostly at the mild or moderate level. Although many (87.2%) had intention for medical assistance, only a few (14.9%) had realized it. Women with urge UI and aged 40 to 50 years looked for more assistance than others.

CONCLUSIONS

UI affect approximately one of four Turkish women. The results emphasize the need for taking preventive measures and policy development for UI.