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

Analysis of Characteristics and Quality of Life of Elderly Women with Mild to Moderate Urinary Incontinence in Community Dwellings

Introduction: The incidence of urinary incontinence (UI) increases with age. Mild and moderate UI have little impact on women and are easily ignored. This study reports the characteristics of non-severe UI and quality of life (QOL) in elderly women using data from a Development and Evaluation of a Senile UI Alert System study. Methods: 926 women aged ≥60 were enrolled from six subcenters across China, among whom 717 SUI patients and 209 UUI/MUI patients were grouped into Group A and Group B, respectively, according to leakage symptoms. Demographic and clinical data, pelvic organ prolapse quantification and pelvic floor muscle strength measurement (PFMS) were collected from participants, followed by evaluation of QOL and sexual life. Result: The major type of UI in community women was SUI (77.4%); MUI and UUI accounted for 20.63% and 1.94%, respectively. Weakened PFMS was detected in 78.2% of the participants. Group B was significantly higher in terms of median age, weight, BMI, waist circumference and menopausal years, and had the greater UI severity and impact on QOL, as well as less active sex live than group A (p < 0.05). Conclusion: SUI distributes dominantly in elderly community women, but UUI/MUI has greater impact on QOL and is related to a less active sex life, which requires more attention from medical staff.

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.

Long-Term Effects of a Self-management Program for Older Women With Urinary Incontinence in Rural Korea: A Comparison Cohort Study

PURPOSE

The purpose of the study was to examine the long-term effects of a urinary incontinence (UI) self-management program for older women on the severity, knowledge, and attitudes regarding UI.

DESIGN

This was a quasi-experimental design (nonrandomized trial) with intervention and comparison groups.

SUBJECTS AND SETTING

Participants were recruited from a primary health care facility in rural Korea. Forty-four older women with UI were assigned to either the intervention or the control group. Of 44 participants, 26 (17 experimental and 9 control) completed the study: 7 participants did not meet inclusion criteria (eligibility criteria partially relied on scores of a validated instrument measuring UI severity administered after initial consent to study participation), and 6 dropped out of the intervention group because of admission to hospital, hearing problems, difficulty traveling to meetings, and disinterest in the program. Five subjects in the comparison group were lost to follow-up.

METHODS

The intervention group (n = 17) underwent a 5-session UI self-management educational program held once weekly. Its contents included a lecture, instruction on pelvic muscle exercises, and assignments related to action plans (exercises and a daily bladder diary). The study's main outcome measures were the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, along with knowledge and attitudes toward UI measured by the UI knowledge scale (UIKS) and UI attitude scale (UIAS). Data were collected at baseline, immediately following the intervention, and at the 1-year follow-up. Repeated-measures analysis of variance was used to analyze changes in ICIQ-SF, UIKS, and UIAS scores over time.

RESULTS

A significant improvement in UI severity was found in the intervention group, who showed a gradually decreasing ICIQ-SF score from at pretest to 5 weeks and 12 months, while it increased over the 12-month period in the control group (main effect of group, F = 17.31, P < .001; main effect of time, F = 8.45, P = .001; interaction effect, F = 22.54, P < .001). There was no significant improvement in UIKS scores over time. Scores on the UIAS changed significantly over time in the experimental group (χ = 6.76, P = .034), but the mean score at 1-year follow-up (mean ± standard deviation: 2.61 ± 0.56) was lower than the mean score at baseline (2.64 ± 0.19).

CONCLUSIONS

Study findings suggest that the UI self-management educational program is effective for improving UI and related lower urinary tract symptoms and feasible to conduct as a long-term intervention program for older women living in communities. However, strategies for a systematic follow-up management are needed for long-term retention of improved UI knowledge and attitudes toward incontinence.

The Effect of Urinary Incontinence on Health-related Quality of Life: Is It Similar in Men and Women?

OBJECTIVE

To compare the association between self-reported urinary incontinence (UI) and health-related quality of life (HRQoL) in men and women while taking chronic comorbidities into account, on the hypothesis that UI might negatively affect HRQoL differently in each sex.

METHODS

In 2006, a total of 10,723 men (aged 57-67 years) and 3777 women (aged 52-67 years) participating in the GAZEL cohort (www.gazel.inserm.fr) completed a self-administered questionnaire including the Nottingham Health Profile to assess HRQoL. UI was defined as self-reported involuntary loss of urine in the past 12 months. Adjusted logistic regression models were fitted to estimate the association between impaired HRQoL and UI, taking age, chronic conditions, and other confounders into account. For each QoL dimension, we compared the strength of the associations between UI and HRQoL between the sexes by tests of interaction.

RESULTS

Women were more likely than men to report both UI (13.9% vs 2.7%) and impaired HRQoL. UI was associated with impaired HRQoL in both sexes, mainly in the dimensions of energy (OR = 3.17 in men [95% CI 2.49-4.04] and 2.11 in women [1.75-2.54]), social isolation (OR = 2.29 in men [1.74-3.02] and 1.75 in women [1.44-2.12]), and physical mobility (OR = 2.05 in men [1.62-2.60] and 2.27 in women [1.88-2.74]). There were no significant interactions between the sexes after adjustment.

CONCLUSION

UI was associated negatively with HRQoL in both sexes, mostly in the dimensions of energy, social isolation, and physical mobility. The association was similar in men and women after we took age, sociodemographic characteristics, and chronic diseases into account. The cross-sectional design of the analysis prevents any conclusion that UI induced an impairment of HRQoL, and no causal relation can be inferred.

Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model

PURPOSE

To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI).

METHODS

A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI.

RESULTS

Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles.

CONCLUSIONS

The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.

The Effect of Urinary Incontinence on Quality of Life of Women at Childbearing Age in Jeddah, Saudi Arabia

To estimate the prevalence of urinary incontinence among women of childbearing age at Maternity and Children’s Hospital (MCH), Jeddah, 2012, and to assess its impact on the quality of their life. A cross– sectional analytic approach was carried out among women of childbearing age seen at MCH, Jeddah. Systematic random sampling technique was followed. Each woman fulfilling the inclusion criteria was invited to enroled in the study, the inclusion criteria were women aged 15-50 years, agreed to participate in the study, the exclusion criteria were pregnant women and patients who are seriously ill. Self-administered questionnaire using the King’s Health Questionnaire was utilized to measure Health Related Quality of Life (HRQOL) of patients with UI. Out of 1200 patients attending the gynecology clinic in the MCH, 412 (34.3%) were diagnosed as having UI. Their age ranged between 15 and 50 years with a mean of 34.3 + 7.2 years. Almost 50% indicated that UI affected them badly as wife, mother, their emotions, and their physical and social activities. The most commonly occurring problems were frequent micturition (88.3%), nocturnal enuresis (87.9%). The least occurring, were kidney problems (38.6%) and dripping during sexual activities (40.8%). Increasing age and higher parity were significantly associated with limitations in different life domains. Urinary incontinence is common and often disturbing for Saudi women. It adversely impaired their quality of life.

Degree of bother from pelvic floor dysfunction in women one year after first delivery

OBJECTIVE

To investigate rates and range of pelvic floor dysfunction complaints, including anterior and posterior compartments and sexual function, in an unselected population of primiparous women one year from delivery, and examine the degree of bother they cause.

STUDY DESIGN

Cross sectional study. Primiparous women who delivered their first child in our delivery wards 10-14 months previously, were approached by phone and asked to complete the Pelvic Floor Symptom Bother Questionnaire (PFBQ) and provide general demographic information. Details regarding participants' labor and delivery were extracted from electronic medical records. PFBQ score was correlated to demographic and labor and delivery parameters.

RESULTS

198 women completed the questionnaire. Response rate was 94%. Scores ranged from 0 to 44.4 (out of a possible 100). At least one symptom of PFD was reported by 64% of respondents. Various degrees of urinary incontinence were reported by 9.1-12.1% of women. Some degree of fecal or flatus incontinence was reported by 10.1% of women; 11.1% reported some degree of obstructed defecation. Severe degree of bother from one or more PFD symptoms was reported by 40.1-90.9%. Some level of dyspareunia was reported by 37.3%. A "dose response" trend between mode of delivery and rate of dyspareunia was observed.

CONCLUSIONS

Two-thirds of primiparous women one year after delivery suffer PFD symptoms that cause some degree of bother. When asked, women are willing to discuss pelvic floor function; caregivers should initiate discussion and refer women promptly to interventions where necessary.

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.