Changing prevalence and knowledge of urinary incontinence among Hong Kong Chinese women

A territory-wide telephone survey was conducted in Hong Kong to assess the prevalence, knowledge, and treatment-seeking behaviour of Chinese women with urinary incontinence, using validated Chinese version of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Women, 540, aged between 17 to 77 years were interviewed. Of the respondents, 40.8% reported stress urinary incontinence, 20.4% had urge incontinence and 15.9% had mixed incontinence. Among these, 16.0% reported quality of life impairment; 9.3% felt frustrated with low morale, and 15.2% had nervous and anxiety problems. However, as many as 78.3% of the respondents did not know that stress urinary incontinence is a disease entity, and 60.6% thought that leakage of urine was a normal aging process. For those respondents having stress urinary incontinence, the first treatment of choice was physiotherapy. The second choice was medication, and surgical treatment was the last option. Respondents with stress urinary incontinence showed higher education level.     

Treatment-seeking behavior in Hong Kong Chinese women with urinary symptoms

 A pan-territory telephone survey was conducted in Hong Kong of Chinese women concerning urinary symptoms and their treatment preferences; 1500 women replied. One hundred and ninety-four (13%) of the 1500 subjects had urinary symptoms. Of these 194, 155 (10.3%) had stress incontinence, 64 (4.3%) had urgency, 10 (0.7%) had urge incontinence, 63 (4.2%) had frequency of urination, 64 (4.3%) had nocturia, 2 (0.1%) had enuresis, and 20 (1.3%) had incomplete emptying. Sixty-eight (35.1%) of the 194 symptomatic subjects sought medical advice (group 1) and 126 (64.9%) did not (group 2). In group 1, 28 (41.2%) sought medical advice from general practitioners, 26 (38.2%) from private specialists, 2 (2.9%) from Chinese herbalists and 12 (17.6%) from public hospitals. In group 2, 4 (3.2%) claimed they had no time, 119 (94.4%) did not think their symptoms were serious, and 11 (8.7%) did not know help was available. None of the subjects felt too embarrassed to seek medical advice, or felt that they could not afford medical attention. The strongest predictor for treatment-seeking behavior was the symptom of incomplete emptying (logistic regression, P=0.004). A substantial proportion of Hong Kong Chinese women with urinary symptoms seek medical advice for their symptoms. The symptom of incomplete emptying appears to be the strongest reason for them to do so. Received: 5 February 2002 / Accepted: 24 June 2002 Acknowledgment The research project was supported by the Health Services Research Committee/Health Care and Promotion Fund (HSRC number 531010).     

The prevalence of adult female urinary incontinence in Hong Kong Chinese

This was a community-based study to evaluate the prevalence and characteristics of female urinary incontinence in women aged 18 and above in the Shatin District of Hong Kong. Of a total of 1018 female households contacted, 362 individuals were successfully interviewed and 123 women (34%) reported they had experienced at least one episode of urinary incontinence as adults. Of these, 18.5% reported persistent incontinence and 15.5% reported absence of incontinence after a single episode of urine loss. The risk factors for incontinence revealed by this study were body mass index and parity. Women who had never been incontinent had a lower body mass index and were usually nulliparous. Most of the respondents (43.9%) who had urinary incontinence considered the condition to be a minor problem and did not seek professional advice. This investigation indicates that a territory-wide study should be carried out to determine the incidence of urinary incontinence throughout Hong Kong. EDITORIAL COMMENT: This article deals with a field study on the prevalence of urinary incontinence in a certain area of Hong Kong. There have been numerous articles on this subject from both occidental and oriental countries. As far as I can see, there is nothing new in respect of the prevalence and characteristics of those who lose or do not lose urine, but it is of interest to read the first formal study on a Chinese female population conducted by Chinese doctors. This clearly shows that prevalence in the Chinese population is essentially no different from that reported from other countries, and that the previous suppression of a lower incidence in the Chinese population was an error.     

Epidemiologie und Ätiologie der Harninkontinenz im Alter

Urinary incontinence is an important and common health problem, whose prevalence increases with age. Often quality of life is clearly affected for persons concerned. In the group of elderly individuals (≥60 years of age) 19.3% of women and 10.4% of men report urinary incontinence. Women most frequently describe urinary stress incontinence followed by incontinence with urge symptoms (urge incontinence, mixed incontinence). In men urinary incontinence without any symptoms of stress or urge incontinence is most common followed by incontinence with urge symptoms and stress incontinence. Urinary incontinence in the elderly is rarely due to a single reason but rather due to multiple factors. In urinary stress incontinence, a differentiation can be made between mechanical and functional problems of the sphincter mechanism caused by myogenic, neurogenic, hormonal, or iatrogenic factors as well as changes in connective tissue. In urinary incontinence with urge symptoms, geriatric detrusor function is mostly affected by neurogenic, myogenic, or urothelial factors whereas the detrusor muscle shows characteristic ultrastructural changes. In chronic urinary retention with consecutive urinary incontinence, especially in men infravesical obstruction is more often the reason than a geriatric bladder dysfunction.     

Epidemiology and etiology of urinary incontinence in the elderly

Urinary incontinence is an important and common health problem, whose prevalence increases with age. Often quality of life is clearly affected for persons concerned. In the group of elderly individuals (> or =60 years of age) 19.3% of women and 10.4% of men report urinary incontinence. Women most frequently describe urinary stress incontinence followed by incontinence with urge symptoms (urge incontinence, mixed incontinence). In men urinary incontinence without any symptoms of stress or urge incontinence is most common followed by incontinence with urge symptoms and stress incontinence. Urinary incontinence in the elderly is rarely due to a single reason but rather due to multiple factors. In urinary stress incontinence, a differentiation can be made between mechanical and functional problems of the sphincter mechanism caused by myogenic, neurogenic, hormonal, or iatrogenic factors as well as changes in connective tissue. In urinary incontinence with urge symptoms, geriatric detrusor function is mostly affected by neurogenic, myogenic, or urothelial factors whereas the detrusor muscle shows characteristic ultrastructural changes. In chronic urinary retention with consecutive urinary incontinence, especially in men infravesical obstruction is more often the reason than a geriatric bladder dysfunction.     

Related factors of urge,stress, mixed urinary incontinence and overactive bladder in reproductive age womenin <Emphasis Type="Bold">Tabriz,Iran</Emphasis>: a cross-sectional study

Urinary incontinence remains a pressing problem, particularly for women. So this study was conducted to assess risk factors for stress, urge, mixed urinary incontinence and overactive bladder (OVB). Three hundred and thirty women aged 15–49, non-pregnant, non-breastfeeding who were referred to gynecologic clinics were surveyed. A questionnaire was used to collect data. Women with no symptoms related to urinary incontinence (UI) and OVB served as the reference group. The risk of all types of UI and OVB increased with constipation. Posterior pelvic organ prolapse was associated with stress and urge incontinence. Vaginal delivery was a predictor of stress, urge and mixed incontinence. BMI and PID were predictors of OVB. Pelvic muscle strength was a predictor of stress incontinence. Vaginal length was associated with mixed incontinence. Optimal weight gain, having a healthy lifestyle, treatment of constipation and pelvic organ prolapse, and improving pelvic floor muscle strength can be suggested as preventive measures against UI and OVB. Pelvic measurement can be included in evaluation of UI.     

Stress incontinence and cystoceles

We studied prospectively 62 women with cystoceles by video-urodynamics before and after operative repair. Of 29 women with grades 1 and 2 cystoceles 8 had residual urine, 14 had urge incontinence and 24 had symptoms of stress urinary incontinence. Of these women 23 had urodynamic evidence of stress incontinence, as did 3 of 5 without stress incontinence symptoms. Of 33 women with large cystoceles 22 had symptoms of stress urinary incontinence but 10 more had urodynamic evidence of stress urinary incontinence. Of these 33 women 18 had significant residual urine and 24 had urge incontinence. Operative repair resolved stress incontinence in 51 of 54 women, urge incontinence in 33 of 38 and residual urine in 24 of 26. Cystoceles recurred in 3 patients, and enteroceles developed in 3 and recurred in 2. These findings indicate that cystoceles may cause voiding dysfunction and lack of symptoms of stress incontinence is unreliable in patients with cystoceles. In addition, cystoceles are associated with other symptoms, most of which actually resolve after operative repair.     

The effect of urinary incontinence and overactive bladder symptoms on quality of life in young women

OBJECTIVE: To assess the consequences that the symptoms of urinary incontinence and an overactive bladder have on the quality of life in young, community-dwelling women. SUBJECTS AND METHODS: A population-based, cross-sectional cohort study was conducted in women aged 20-45 years. Urogenital symptoms and quality of life were assessed using standardized questionnaires, e.g. the Urogenital Distress Inventory and Incontinence Impact Questionnaire. RESULTS: The prevalence of symptoms of stress incontinence (39%), urge incontinence (15%) and an overactive bladder (12%) was high in this young population. Compared with urge incontinence, the symptoms of an overactive bladder similarly reduced the quality of life, but stress incontinence did not significantly affect the quality of life. Women with symptoms of an overactive bladder were especially limited in their mobility, whereas urge incontinence was especially associated with feelings of embarrassment. Although many women reported to be bothered by their symptoms, only a minority consulted their physician for them. CONCLUSIONS: The symptoms of urinary incontinence and overactive bladder are common among young adult women and have the same detrimental effect on quality of life as urge incontinence. The reduction in mobility associated with overactive bladder symptoms may be especially distressing for these young and active women.     

Voiding dysfunction in young,nulliparous women: symptoms and urodynamic findings

The objective was to determine urodynamic findings in young, premenopausal, nulliparous women with bothersome lower urinary tract symptoms and assess whether or not symptoms are predictive of specific urodynamic abnormalities. The records of 57 women were reviewed. Those with neurological disease or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent videourodynamics. Symptoms were compared in patients with and without bladder dysfunction and/or voiding phase dysfunction. Bladder dysfunction was diagnosed in 86% of patients with urge incontinence vs. 17% of those without (p<0.0001). Patients with voiding phase dysfunction had higher total and voiding AUASI scores. Occult neurological disease was later diagnosed in 4 women (24%) with urge incontinence and bladder dysfunction. Urge incontinence and voiding symptoms are frequently associated with urodynamically demonstrable abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the utility of urodynamics in this population.Editorial Comment: Voiding dysfunction in young women tends to be an incompletely described phenomenon. This patient cadre is often treated presumptively, and as we see from this study, incorrectly. The clinical tendency for minimalist evaluation represents a disservice to these individuals as accruing data supports the use of urodynamics as an intrinsic component in the evaluation of these women. Obviously, data on pressure / flow dynamics would provide further insight into subtle pelvic floor and sphincteric dysfunctions manifested in this group. The authors are to be commended for this opus     

Lower Urinary Tract Symptoms 5 Years after the First Delivery

The aim of the study was to estimate the prevalence and 5-year incidence of lower urinary tract symptoms after the first delivery. A total of 278 primiparae were questioned about lower urinary tract symptoms after their first pregnancy and puerperium, and again 5 years later. The prevalence of such symptoms in the study population increased significantly during the 5 years of observation. The prevalence of stress or urge incontinence 5 years after first delivery was significantly higher in women with onset during the first pregnancy or 1st puerperium than in those without incontinence before or during that period. The prevalence of urgency or frequent voiding 5 years after first delivery was not increased in the women with onset during that time compared to those without such symptoms. Stress or urge incontinence during the first pregnancy and puerperium predicts an increased risk of having the symptom 5 years later. Urgency and diurnal frequent voiding cannot be predicted from onset during that period.     

Female urinary incontinence: a cross-sectional study from a Thai rural area

The aims of this study were to investigate the prevalence and associated factors of female urinary incontinence in a Thai rural area and to investigate the impact of female urinary incontinence on quality of life. A population-based cross-sectional survey was performed from September 2003 to February 2004. A total of 1,126 women completed the questionnaires. The overall prevalence of urinary incontinence was 36.50%, i.e. stress urinary incontinence (33.60%), urge urinary incontinence (11.00%) and mixed urinary incontinence (8.07%). Urinary incontinence adversely affected quality of life; the mixed urinary incontinence group reported significantly greater impairment than the stress and urge urinary incontinence groups. Advancing age, labouring occupation, postmenopausal status, years since menopause, medical diseases, childbirth and vaginal delivery were associated with this problem.     

Urinary incontinence in familial dysautonomia

The aim of this study was to determine the prevalence of urinary incontinence in women with familial dysautonomia (FD). A telephone survey was conducted on 68 known surviving female FD patients over 13 years of age registered with the Dysautonomia Centers in the USA and Israel. The mean age of the surveyed group was 27.1+/-9.8 years and 99% of the patients were nulliparous. The overall reported prevalence of urinary incontinence was 82% (n=56). Of the patients with incontinence, 59% (n=33) reported stress incontinence, 11% (n=6) reported urge incontinence, and 30% (n=17) reported symptoms of both, or mixed incontinence. In most women urinary loss was both small and infrequent, but 36% of women (n=20) with incontinence experienced a loss sufficient to necessitate the use of protection (panty liners, pads or diapers); in 7% (n=4) such loss occurred daily. Twelve per cent of all women with FD surveyed experienced primary nocturnal enuresis and 26% experienced nocturia. The prevalence of urinary incontinence is high in young female patients with familial dysautonomia. Neurophysiologic testing in this population may provide a better understanding of the role of the autonomic nervous system in urinary incontinence.Abbreviations FD familial dysautonomia - MI mixed incontinence - MRI magnetic resonance imaging - SI stress incontinence - UI urge incontinence Editorial Comment: The authors report the prevalence of urinary incontinence in familial dysautonomia. This is fertile area for investigation, given the paucity of information currently available. The subtypes of incontinence bear further comparison to populations without dysautonomia. Additional investigators may wish to study this fascinating area further.     

Urinary incontinence during pregnancy in a racially mixed sample: Characteristics and predisposing factors

The objectives of the study were to assess the prevalence of urinary incontinence symptoms during pregnancy in a racially mixed sample and to identify potential predisposing variables. Five hundred and twenty-three women were interviewed in the hospital on postpartum day 2 or 3 and by telephone at 6-week follow-up. A significantly larger proportion of white women reported accidental loss of urine than did black women (62.6% vs. 46.4%;P<0.01). A breakdown by type of incontinence indicated that the race effect was largely attributable to the significantly higher prevalence of the symptom of stress incontinence among white women (P<0.0001). In stepwise logistic regression modeling, previous incontinence, education level, parity and nocturia were selected as the strongest predictors of incontinence in white women. Attendance at childbirth classes was the only predictor of incontinence for black women. The results raise the possibility that higher rates of incontinence among white women might be due to differences in the pelvic floor.Editorial Comment: Racial differences in the genesis of genuine stress incontinence have been discussed anecdotally for some time. Clinicians have the impression that white women have a higher prevalence than black women. Urodynamically controlled studies need to be performed to answer the question definitively using age-matched patient samples.     

Is there an association between depressive and urinary symptoms during and after pregnancy?

Depressive symptoms and urinary symptoms are both highly prevalent in pregnancy. In the general population, an association is reported between urinary symptoms and depressive symptoms. The association of depressive and urinary symptoms has not yet been assessed in pregnancy. In this study, we assessed (1) the prevalence of depressive symptoms, over-active bladder (OAB) syndrome, urge urinary incontinence (UUI) and stress urinary incontinence (SUI) during and after pregnancy using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Urogenital Distress Inventory (UDI) and (2) the association of depressive symptoms with urinary incontinence and over-active bladder syndrome during and after pregnancy, controlling for confounding socioeconomic, psychosocial, behavioural and biomedical factors in a cohort of healthy nulliparous women. Our data show a significant increase in prevalence of depressive symptoms, UUI, SUI and OAB during pregnancy and a significant reduction in prevalence of depressive symptoms, SUI and OAB after childbirth. UUI prevalence did not significantly decrease after childbirth. In univariate analysis, urinary incontinence and the OAB syndrome were significantly associated with a CES-D score indicative of a possible clinical depression at 36 weeks gestation. However, after adjusting for possible confounding factors, only the OAB syndrome remained significantly associated (OR 4.4 [1.8–10.5]). No association was found between depressive and urinary symptoms at 1 year post-partum. Only OAB was independently associated with depressive symptoms during pregnancy. Possible explanations for this association are discussed.     

The impact of detrusor overactivity on the management of stress urinary incontinence in women

The presence of overactive bladder symptoms, urodynamic detrusor overactivity, and urge incontinence can complicate the diagnosis and management of stress urinary incontinence in women. The exact pathophysiology of mixed incontinence is not well characterized; in some patients, the stress and urge etiology may be pathologically linked. The role of urodynamics in evaluating patients with mixed incontinence remains controversial. Conservative therapies, such as bladder training, pelvic floor exercise, biofeedback, and electrical stimulation, offer moderate success in women with mixed incontinence. Surgery (colposuspension, bladder neck pubovaginal slings, and midurethral slings) offers excellent subjective and objective cure rates in patients with mixed incontinence. Preoperative detrusor overactivity is cured consistently ≥ 50% of the time with colposuspension and slings. Overall, the presence of preoperative detrusor overactivity does not appear to significantly worsen the outcome of conservative and surgical treatments for stress urinary incontinence in women.     

The short-term prevalence of de novo urinary symptoms after different modes of hysterectomy

The aim of this study was to determine the short-term prevalence of de novo urinary symptoms after hysterectomy indicated by meno/metrorrhagia or dysmenorrhea/dyspareunia. The study group consisted of 451 women who had had a hysterectomy for reasons of meno/metrorrhagia or dysmenorrhea/dyspareunia. Fifty-three (12%) had a supracervical, 151 (33%) a total abdominal and 247 (55%) a vaginal hysterectomy. As a non-gynecologic background population we enrolled 110 women who had had their gallbladder removed laparoscopically. All women received a postal questionnaire 9-45 months after their operation. Specific questions were asked about their voiding habits, comprising significant stress incontinence, bothersome stress incontinence, significant urge incontinence, bothersome urge incontinence, pollakisuria, nocturia, use of pads, and the feeling of having a hygiene problem. To evaluate de novo symptoms or de novo cure, the women assessed the symptoms before as well as after the operation. Results showed that abdominal hysterectomy lasted longer, had heavier blood loss and required longer hospitalization than did vaginal or supracervical hysterectomy. Women scheduled for a supracervical hysterectomy had preoperatively more significant and bothersome urge incontinence, and postoperatively more significant urge, urgency, and feeling of having a hygienic problem than did women having a vaginal hysterectomy, a total abdominal hysterectomy or a laparoscopic cholecystectomy. When assessing de novo symptoms, supracervical hysterectomy was associated with more urgency and the feeling of having a hygienic problem. Some women experienced de novo cure, but these were almost exclusively in the study group and rarely in the control group. It was concluded that supracervical hysterectomy is related to more urinary symptoms than vaginal or total abdominal hysterectomy. De novo symptoms as well as de novo cure are common, which is why urinary symptoms after hysterectomy must be evaluated over time.     

Value of the patient's case history in diagnosing urinary incontinence in general practice

What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history-taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence. Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis. It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.     

The frequency of urinary symptoms during pregnancy and puerperium in the primipara

A total of 305 primiparae were questioned about their urinary symptoms before and during pregnancy, in the puerperium and 3 months after delivery. All symptoms appeared late in the first trimester and progressively worsened throughout pregnancy, reaching a maximum at term. In 7% (21/293) stress incontinence, and in 4% (12/293) urge incontinence began in the puerperium. Three months postpartum urinary symptoms in the form of frequency, urgency and urge incontinence had reached prepregnancy levels, while 9 of 88 women who developed stress incontinence during pregnancy and 6 of 21 who developed stress incontinence after delivery, respectively, still complained of this symptom. According to the definition of the International Continence Society only one woman had stress incontinence, while one had urge incontinence 3 months postpartum. None of the 2 women opted for treatment. It emerges that urinary symptoms occur as a natural consequence of pregnancy and delivery, and generally the symptoms disappear within 3 months postpartum. The risk of developing persistent symptoms seems to be relatively low in the primipara.     

How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study.

OBJECTIVE: To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions. Subjects and methods Data were collected using a population-based survey (conducted by telephone or direct interview) of men and women aged >/= 40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the proportion of participants who had sought medical advice for symptoms of an overactive bladder; and current or previous therapy received for these symptoms. RESULTS: In all, 16 776 interviews were conducted in the six European countries. The overall prevalence of overactive bladder symptoms in individuals aged >/= 40 years was 16.6%. Frequency (85%) was the most commonly reported symptom, followed by urgency (54%) and urge incontinence (36%). The prevalence of overactive bladder symptoms increased with advancing age. Overall, 60% of respondents with symptoms had consulted a doctor but only 27% were currently receiving treatment. Conclusion Symptoms of an overactive bladder, of which frequency and urgency are as bothersome as urge incontinence, are highly prevalent in the general population. However, only a few affected individuals currently receive treatment. Taken together, such findings indicate that there is considerable scope for improvement in terms of how physicians diagnose and treat this condition.     

A study of lower urinary tract symptoms for the Korean women aged 30 and over

The purposes of this study were (1) to identify the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) for Korean women, (2) to evaluate the LUTS scores of the subjects in relation with each UI patterns and general characteristics, and (3) to identify affecting factors developing LUTS by using self-administered questionnaire. Community-based cross-sectional study was conducted for 3,371 women aged 30 to 89 years old who were allocated at six provinces in South Korea. UI and LUTS were assessed by validated symptom scales including the International Prostate Symptom Score. Of all the respondents, 63.4% had experienced UI more than once a month during the prior 12 months. Among the respondents, 36.6% had no UI, 47.5% had stress UI, 0.4% had urge UI, and 15.5% had mixed UI. The mean LUTS score of the total respondents was 7.8±4.1. The LUTS was significantly predicted by age (p<.0001) and mixed UI (p<.0001), and 79.4% of variance in LUTS was explained. The highest LUTS scores were shown in the subjects with mixed UI, and we found that LUTS scores increased with age.