Effect of Urinary Incontinence on the Quality of Life of Older Adults in Riyadh: Medical and Sociocultural Perspectives

A mixed methods systematic literature review of barriers and facilitators to help-seeking among women with stigmatised pelvic health symptoms

BACKGROUND

Women's pelvic health is a globally important subject, included in international and United Kingdom health policies, emphasising the importance of improving information and access to pelvic health services. Consequences of pelvic symptoms are intimate, personal, and varied, often causing embarrassment and shame, affecting women's quality of life and wellbeing.

AIM

To understand the experience of seeking healthcare for stigmatised pelvic health symptoms by synthesising all types of published primary research and mapping the results to behavioural theory, to identify potential targets for intervention.

METHODS

Systematic search of MEDLINE, CINAHL, PsycINFO, SocINDEX, PubMED databases, CDSR and CENTRAL registers, from inception to May 2023 for all types of research capturing women's views and experiences of seeking help with stigmatised urogenital and bowel symptoms. Studies only reporting prevalence, predictors of help-seeking, non-health related help-seeking, or written in languages other than English, German, French, Spanish and Swedish were excluded. Reference checking and forward citation searching for all included studies was performed. A results-based synthesis approach was used to integrate quantitative and qualitative data. Themes were mapped to the Common-Sense model and Candidacy framework. The Mixed Methods Appraisal Tool was used for critical appraisal. Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative research for assessing certainty of review findings.

RESULTS

86 studies representing over 20,000 women from 24 high income countries were included. Confidence was high that barriers to help-seeking were similar across all study types and pelvic symptoms: stigma, lack of knowledge, women's perception that clinicians dismissed their symptoms, and associated normalising and deprioritising of low bother symptoms. Supportive clinicians and increased knowledge were key facilitators.

CONCLUSIONS

Using the Common-Sense Model to explore women's help-seeking behaviour with stigmatised pelvic symptoms reveals problems with cognitive representation of symptom identity, emotional representations of embarrassment and shame, and a subjective norm that women believe their symptoms will be trivialised by clinicians. Together these barriers frustrate women's identification of their candidacy for healthcare. Addressing these issues through behavioural change interventions for women and clinicians, will help to achieve universal access to pelvic healthcare services (United Nations Sustainable Development Goal 3.7).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021256956.

Evaluation of thirst severity, death anxiety, and complementary and supportive therapy use as predictors of urinary incontinence-related quality of life in older adults

PURPOSE

This correlational survey study aimed to evaluate thirst severity, death anxiety, and the use of complementary and supportive therapy as predictors of urinary incontinence-related quality of life in older adults.

METHODS

The study included 368 participants aged 60 or older. Data were collected by face-to-face interviews using a participant information form, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Visual Analog Scale for thirst severity, Death Anxiety Scale, a modified version of the Mini Mental State Examination, and questions about their use of complementary and supportive therapies.

RESULTS

The participants had a mean age of 70.5 ± 6.9 years (54.9% female). Mean ICIQ-SF score was significantly correlated with daytime frequency of urine leakage and thirst severity score. Multiple linear regression analysis indicated that thirst severity was a significant predictor of urinary incontinence-related quality of life. Most of the older adults said they had never used complementary or supportive therapies for urinary incontinence.

CONCLUSION

Thirst severity should be assessed in older adults with urinary incontinence in addition to other factors that may affect ICIQ-SF scores.

Représentations sociales de l’incontinence urinaire : une enquête auprès de la population française

INTRODUCTION

Urinary incontinence is a major public health problem. Although, as a condition, it is well documented in the literature, there is little information on its social representations. The study of its representations could make it possible to improve the way it is handled and the treatment suffers receive.

PURPOSE OF THE RESEARCH

The aim of this study was to understand the representations of the general French population on the subject of urinary incontinence.

METHODS

This involved carrying out a declarative quantitative study using questionnaires. To do this, 1803 people were surveyed all over France. First, a descriptive statistical analysis was carried out using the participants’ socio-demographic data. Second, a logistic regression-type association was made between the dependent and independent variables.

RESULTS

Urinary incontinence elicits a certain level of disgust in the general population. Still a taboo subject, it seems to be of little interest to some members of the population. The condition is also often poorly understood, especially by men, the younger generations, and the inhabitants of urban areas in western France.

CONCLUSIONS

This quantitative study helped shed key light on the French population’s perceptions of urinary incontinence and the methods of prevention available. It also helped determine the participant profiles associated with these representations. Going forward, it seems worthwhile to focus on informing and educating these populations on the subject.

The Experience of Women From Underrepresented Groups With Urinary Incontinence: A Systematic Review

INTRODUCTION

Urinary incontinence (UI) in women is a global public health issue. However, there is a limited understanding of the experience of women from underrepresented groups suffering from UI. The purpose of this systematic review was to examine current evidence regarding the experience of women with UI from these groups.

METHODOLOGY

A systematic search was undertaken to retrieve research studies that answered the research question. Four qualitative research studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review.

RESULTS

Four themes emerged from this review: the perceived origin of UI, the physical, psychological, and social impact of UI, the impact of culture and religion on UI, and vice versa, and the interaction of women with health services.

DISCUSSION

Social determinants of health, such as religion and culture, need to be considered by professionals providing care if women from underrepresented groups experiencing UI are to receive optimal care.

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.

Perceptions of pelvic floor dysfunction and rehabilitation care amongst women in southeast China after radical hysterectomy: a qualitative study

Objective

To investigate the perceptions of pelvic floor dysfunction (PFD) and rehabilitation care amongst women after radical hysterectomy and to explore ways to improve quality of care.

Methods

Thirty-six women who underwent radical hysterectomy at a hospital in southeast China were enrolled via purposive sampling. Semi-structured in-depth interviews were conducted. The texts were analysed via qualitative content analysis.

Results

Four themes were obtained: serious lack of knowledge, heavy psychological burden, different coping strategies and great eagerness to receive multiparty support on PFD rehabilitation care.

Conclusion

The society and professional staff should strengthen health education on PFD. Professionals should offer education before and after surgery and actively provide rehabilitation consultation to promote the availability of rehabilitation to support women with PFD rehabilitation care. In addition, family-centred care is an important way to support women to return to normal life, and women's need for family support should be more actively expressed. Moreover, knowledge of medical insurance should be popularised, especially in rural areas in China.

Psychosocial Experiences of Older Women in the Management of Urinary Incontinence: A Qualitative Study

Introduction

Urinary incontinence is a prevalent disorder amongst older women. Identifying the psychosocial experiences of older women in disease management can improve the patient care process. Hence, the present study aimed to determine the psychosocial experiences of older women in the management of urinary incontinence.

Methods

This qualitative study was conducted using conventional content analysis. The study data were collected via unstructured in-depth face-to-face interviews with 22 older women suffering from urinary incontinence selected via purposive sampling. Sampling and data analysis were done simultaneously and were continued until data saturation. The interviews were recorded, transcribed, and analyzed using the method proposed by Graneheim and Lundman.

Results

The results indicated that the older people with urinary incontinence had various psychosocial experiences while living with and managing this disease. Accordingly, four main themes were extracted from the data as follows: “problem incompatibility with the disease,” “mental impasse,” “facing social restrictions,” and “concealment and social escapism.”

Conclusion

The findings demonstrated that older people with urinary incontinence experienced significant psychosocial pressures while living with this disorder, which affected their psychosocial well-being. Thus, paying attention to these psychosocial experiences while supporting and taking care of these patients can positively impact their psychosocial health and quality of life.