Prevalence and risk factors for urinary and anal incontinence in Tunisian middle aged women

Objectives

To estimate the prevalence of urinary incontinence and anal incontinence in Tunisian women and to identify their risk factors.

Reliability of the 24-h sensation-related bladder diary in women with urinary incontinence

Increased bladder sensation is the most troublesome symptom of overactive bladder. In clinical practice, reliable noninvasive evaluation of bladder sensation is needed. This study was designed to determine the reliability of a 24-h sensation-related bladder diary (SR-BD) in women with urinary incontinence including clinically relevant information regarding the bladder sensation. A total of 246 women with urinary incontinence filled out a SR-BD for 3 days. They graded the perception of bladder sensation at each micturition and measured the volume voided. The reliability of the 24-h SR-BD method is preserved, when taking into account the grade of bladder sensation. The 24-h SR-BD, which incorporates bladder sensation at each micturition, not only gives information on sensation-related micturition behavior but also shows good reliability. Grading of bladder sensation does not jeopardize this methodology but on the contrary provides added value, which is clinically relevant.     

The influence of obesity, constitution and physical work on the phenomenon of urinary incontinence in women

Urinary incontinence in women is a common and complex problem which can be defined and classified as stress, urge and mixed incontinence. Three of the eight most common risk factors are obesity, constitution and physical work, in addition to age, length of menstrual cycle, number of pregnancies, education and level of health awareness. Women with the diagnosis of urinary incontinence were invited to respond to questionnaires on a voluntary basis. The three factors found to be associated with urinary incontinence are increased body weight, strong osteomuscular structure and hard physical work. These indicate that the work of a health team must take a holistic approach to women even before the phenomenon of urinary incontinence occurs.Editorial Comment: This study is a statistical analysis of the risk factors for urinary incontinence in women. The authors find that obesity, hard physical work and strong osteomuscular structure are linked to the development of incontinence. Limitations to the study design and results include the absence of an appropriate control group and potential selection bias. Nevertheless, few investigators have attempted to study the impact of the type of daily workload on the development of urinary incontinence and, vice versa, the impact of urinary incontinence on a patient's employment and social life. These are important issues which deserve further investigation.     

Reasons why women with long-term urinary incontinence do not seek professional help: a cross-sectional population-based cohort study

The aims of this study were to investigate the reasons why some women with long-term urinary incontinence (UI) seek professional help whereas others do not, their experiences and satisfactions with the healthcare services, and how women deal with their incontinence. In total, 95 women aged 23–51 years with persistent UI (median 10 years, range 6–20 years) were included in this telephone interview survey. Seventy-four percent of the women with long-term UI had not sought help. The most common reason given was that the disorder was considered a minor problem, which they felt they could cope with on their own. When women did consult professional help they did so because they were afraid of the odor of urine and that they perceived the leakage as shameful and embarrassing. These women felt that the healthcare service offered appropriate care for their condition. Pelvic floor exercises were the most commonly used management methods for all participants. Abbreviations - UI Urinary incontinenceEditorial Comment: In this survey of 78 women aged 23–51 with reported urinary incontinence, only 20 (26%) sought professional help for this problem. Although the majority of women in this younger sample deemed their problem to be minor, increasing urinary leakage, embarrassment and fear of odor were the most frequent reasons given for seeking help. This study highlights the taboo regarding urinary incontinence.     

Do sensation-related bladder diaries differ between patients with urodynamically confirmed and non-objectivised urinary incontinence?

The aim of the study is to investigate whether sensation-related bladder diary (SR-BD) differs between women with symptoms of urinary incontinence (UI) in whom incontinence is not demonstrated during investigation and women with demonstrated UI. Two hundred and six patients with stress UI, urge UI and mixed UI filled out a SR-BD for 3days. They graded the perception of bladder sensation at each micturition and measured the voided volume. Incontinence episodes and the severity of leakage were recorded. All had cystometrogram. The patients were divided in urodynamically confirmed and non-objectivised UI within each type. More disturbed bladder sensation was present in urodynamically confirmed urge UI and to a lesser extent in mixed UI than in the respective non-confirmed groups. No such difference could be seen in stress UI. Close interpretation of the SR-BD may indicate to a certain extent the presence of detrusor overactivity in urge UI and to a lesser degree in mixed UI.     

Multimodality pelvic physiotherapy treatment of urinary incontinence in adult women

The aim of the study was to evaluate the effectiveness of in-office physiotherapy for stress, mixed and urge incontinence. All subjects underwent urodynamics. Those with stress incontinence received pressure biofeedback pelvic floor exercises and electrical stimulation. Those with detrusor instability and mixed incontinence received bladder drills, anticholinergic medications, electrical stimulation and pressure biofeedback pelvic floor exercises. All those with atrophic vaginitis received vaginal estrogen. Weekly treatment sessions for 4 weeks and then monthly for 2 months were directed by a trained gynecologic nurse. Weekly bladder diaries were kept. Outcome measures included diary-recorded incontinence episodes and subjective reporting of continence. One hundred and four women completed the program. Weekly incontinence episodes decreased from 22 to 2 (<0.05) in both stress and detrusor instability/mixed incontinence groups. An average of 4.5 sessions over 6.1 weeks was necessary for optimal response; 86% reported subjective improvement. It was concluded that multimodality treatment of incontinence leads to a 90% reduction in incontinence episodes. The relative contribution of each treatment modality requires further study. Editorial Comment: The authors report their experience using a multimodality approach to the conservative management of urinary incontinence. They clearly outline their protocols in patients with stress, urge and mixed incontinence. They chose a subjective parameter of outcome with seemingly good compliance, probably as a result of their stressing the educational component of their approach. Such re-enforcement allows them to report relatively good results using their protocols. The exact role of each modality and its contribution to the management of these patients will have to await well controlled prospective and randomized studies.     

An assessment of the importance of pad testing in stress urinary incontinence and the effects of incontinence on the life quality of women

Our objectives in this study were to determine the severity of incontinence using pad testing and the effects of incontinence on the life quality of women with stress incontinence. Fifty women with a diagnosis of stress urinary incontinence were selected for the study. The Symptom Severity Index (SSI) and Symptom Impact Index (SII) were used to determine the severity and impact of incontinence. Afterwards the women were given a 1-h pad test. According to the pad tests 38% of women suffered severe to very severe incontinence. Women who showed severe incontinence on pad testing scored high in the SSI; on the other hand, no relationship was found between SII and pad test indicators. It was also observed that both SSI and SII scores increased with increasing age of the women (SSI: r=0.29, P<0.05; SII: r=0.30 P<0.05). It may therefore be concluded that the severity of incontinence makes no difference in the effects of incontinence on the life quality of women. Abbreviations SSI Symptom Severity Index - SII Symptom Impact IndexEditorial Comment: The authors have used the pad test as an objective measure of the severity of incontinence. The Symptom Severity Index (SSI) and Symptom Impact Index (SII) were used to look at the impact of the incontinence on lifestyle and compare this to the severity. The severity of incontinence made no difference to the quality of life of the women assessed.     

The prevalence of urinary incontinence in a randomized population of 5247 adult finnish women

A randomized study of the prevalence of urinary incontinence was performed among adult Finnish females. In 1986, 5247 women (aged 25–55 years) who participated voluntarily in a gynecological health study, anonymously completed a questionnaire concerning subjective symptoms and experiences with urinary incontinence. One-fifth of the studied population (20.1%) reported that they were handicapped by incontinence. The number of incontinent women increased significantly with increasing age up to 45 years. Stress urinary incontinence alone was reported by 73% of the women experiencing incontinence. Surprisingly, only one-third of the women stated that they needed treatment, and less than one-fifth of all had sought help for this disorder.     

Incidence of stress urinary incontinence among women in Turkey

The aim of this study was to determine the incidence of stress urinary incontinence among women at the age of 15 and above who applied to the primary health care centers in Ankara, Turkey. We applied the urinary stress incontinence questionnaire to 2,601 women at the age of 15 or above who consulted to the “mother–child health care and family planning centers” in January 2002. To evaluate the urinary incontinence status with respect to age groups and other risk factors, chi-square test was used. Stress incontinence prevalence was 16.1% in our population. Age was a statistically significant risk factor affecting the incidence of stress incontinence. As the number of gravida increases, the frequency of stress incontinence increases (p<0.05). Presence of a systemic disease was also an important risk factor (p<0.05). Alcohol use and smoking were not found to affect the incidence of urinary stress incontinence (p>0.05). As urinary incontinence greatly influences life quality and social and psychological status of the person, and also creates economic burden, predisposing factors of stress incontinence should be well defined and measures should be taken to encourage women experiencing this problem to visit a doctor and to get an efficient treatment.     

Difference in quality of life in women with urge urinary incontinence compared to women with stress urinary incontinence

Introduction  We evaluated whether women with urge urinary incontinence (UUI) have lower quality of life (QOL) than women with other forms of urinary incontinence. Methods  Patients completed three validated questionnaires when presenting for evaluation at a urogynecology practice and were divided into four groups based on their responses: those with symptoms of stress urinary incontinence (SUI), UUI, both SUI and UUI (mixed UI), and neither SUI nor UUI (controls). Results  A total of 465 women were included: 53 women with UUI (11.4%), 101 with SUI (21.7%), 200 with mixed UI (43%), and 111 controls (23.9%). Overall, there was a significant difference (p < 0.001) in PFIQ bladder scale scores as a function of UI group, with individual mean PFIQ scores of 17.1 for controls, 22.3 for SUI, 32.7 for UUI, and 36.8 for mixed UI. Individually, all seven questions in the PFIQ bladder domain were significantly different by group (p ≤ 0.001). Conclusions  Women with UUI and mixed UI have lower QOL scores than women without incontinence or with only SUI. The project was approved by the IRB at Hartford Hospital.     

The physical finding of stress urinary incontinenceamong African women in Ghana

The aim of this study is to determine the proportion of women with the physical sign of stress urinary incontinence in a sample of Ghanaian women. Two hundred randomly selected women from attendants at a convenience selected ultrasound clinic were interviewed about symptoms of urinary incontinence. A paper towel test was performed to objectively demonstrate the physical sign of stress urinary incontinence as leakage on coughing. Forty-two percent of the women had a positive paper towel test. The two major symptoms reported by the women with positive paper towel test were (1) loss of urine while waiting to use the toilet (48.2%) and (2) loss of urine on coughing (43.4%) in daily life. The physical sign of stress urinary incontinence could be present in up to 42% of Ghanaian women.     

Quality of life in women with stress urinary incontinence

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity. Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from the National Institute of Child Health and Human Development and the Office of Research on Women’s Health, National Institutes of Health.     

Treatment of urinary incontinence in cystic fibrosis

BACKGROUND: Urinary incontinence (UI) is a newly recognised problem in cystic fibrosis. Whilst prevalence is well documented, there are no reports of assessment and treatment of the problem. METHODS: A previous study reports the prevalence of UI in women with CF to be 51/75 (68%). Nineteen women subsequently requested help for the problem and were referred to a physiotherapist specialising in women's health. A digital assessment was performed to measure pelvic floor muscle strength and endurance. An individualised programme of pelvic floor muscle exercises (PFME) was taught based on the assessment. A questionnaire addressed issues of assessment and treatment. RESULTS: 12 women were assessed. The median (range) age, FEV1% predicted and BMI were 20.9 (19.3-46.1) years, 45.9 (14.8-82.7) and 20.5 (16.1-26.0), respectively. The median strength of the pelvic floor muscle was moderate (Oxford Scale grade 3) with a hold time (endurance) of 5 s. At reassessment (median time 13.1 weeks), there was an improvement in endurance (P = 0.04), with no change in strength. This was supported by a subjective improvement in symptoms. Patients found the exercises were difficult to perform, difficult to fit into their treatment programme and adherence was poor. CONCLUSIONS: PFME are effective at improving endurance and reducing leakage over the short-term. Women are reluctant to be assessed and the CF team should provide support and encouragement with treatment. Long-term outcome and the mechanisms of UI in this group of patients need further evaluation.     

Physicians' perception of urinary incontinence as a health care problem in women

A mailed questionnaire was sent to 1500 family physicians and general practitioners in Ontario, Canada, to determine the primary care physician's perception of urinary incontinence as a health care problem. Questions involved their exposure to female patients with urinary incontinence, management of urinary incontinence, estimation of the extent of urinary incontinence as a health care problem, and the estimation of treatment success. The response rate to the survey was 18%. Fifty per cent of physicians see more than 1 patient per week with incontinence; 85% of physicians underestimated the prevalence of incontinence in the female population aged 25–64; 29% do not routinely ask about incontinence. In those patients complaining of urinary incontinence, 71% of physicians perform a physical examination and 32% try to demonstrate incontinence. Seventy per cent refer on to local urologists, and 58% to local gynecologists. The mean estimation for cure or significant improvement is 68%. It was concluded that, there is room for improved education of primary care physicians regarding the health care problem of female urinary incontinence.     

Urinary incontinence in primary care: A comparison of older African-American and Caucasian women

Urinary incontinence is a common problem for aging women. Little is known about urinary incontinence in nonwhite populations. A telephone survey was used to compare the prevalence and severity of urinary incontinence as well as common risk factors for urinary incontinence in 194 African-American (AA) and Caucasian (C) women over the age of 50 who made a visit to a primary care practice within the prior 2 years. A high prevalence of UI was found among these women (62%AA, 67%C), though no significant difference was noted among the two groups. More Caucasian women than African-American women reported symptoms of stress incontinence. For both groups, the use of HRT was associated with reporting urinary incontinence. Higher body mass index and prior hysterectomy was associated with urinary incontinence for African-American women only. For both groups, low rates of 'botheredness' (28%AA, 32%C) and treatment seeking (39%AA, 52%C) were found.     

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.     

The menopause and urinary incontinence

The objective was to study the possible role of the menopause in adult female urinary incontinence (UI) etiology, using a cross-sectional population study comprising a random sample of adult females and self-reported data based on postal questionnaires.The study group comprised 915 women who reported continued menstruation and 636 women who had stopped menstruation after the age of 39; in total, 1551 women aged 40–59 years, from the Municipality of Aarhus, Denmark. Ooophorectomized or hysterectomized women not reporting menstruation were excluded.The main outcome measures were the period prevalence in 1987 of episodes of stress and urge urinary incontinence; prevalence of menopause and exposure to childbirth, gynecologic surgery, cystitis and obesity as indicated by body mass index more than 29; prevalence relative risks, as indicated by odds ratio of UI conditional on menopause and other prevalence risk indicators.The 1987 period prevalences of stress and urge urinary incontinence were 15.9% and 8.7%, respectively. Forty-one percent had ceased to menstruate. Irrespective of the UI risk indicators mentioned, UI prevalence was significantly raised from 1 year before until 1 year after the year of final menstruation. The findings suggest perimenopausal processes rather than the menopause in general to be responsible for an increased risk of developing UI. The elevation of UI prevalence in the perimenopause may reflect the adjustment of the female continence mechanism to function with a lower estrogen level than previously. Perimenopausal processes seem to contribute much less than surgical operations, for example, to the amount of UI in middle-aged women. This may affect assessment of the relevance of estrogen supplementation of menopausal UI patients aged 40–59.     

Competences for self-care and self-control in diabetes mellitus type 2 in primary health care

The purpose of the guidelines of self-care and self-control of type 2 diabetes mellitus proposed by the Brazilian Ministry of Health is to strengthen and qualify users and health care professionals through the integrality and longitudinality of care with this disease. This article aims to present the self-care and self-control of people with type 2 diabetes mellitus in objective terms, taking into account the current recommen-dations based on scientific evidence and also from the subjective point of view, that is, emphasizing the aspects related to experience and subjectivity of these people. Next, we present the essential skills for self-care and self-control of users and professionals working in primary health care.     

Utility of urine reagent strip in screening women with incontinence for urinary tract infection

The aim of this study was to determine the utility of urine reagent strips in screening women with urinary incontinence for urinary tract infections. Subjects were all women presenting with urinary incontinence. A urine specimen was screened for urinary tract infection with a urine reagent strip and urine culture. Using the urine culture result as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the urine reagent strips were calculated. A total of 265 pairs of reagent strips and urine cultures were evaluated. Thirty-one cultures grew out of a single organism; nine of these had a positive urine reagent strip, yielding a sensitivity of 29%. The specificity of the urine reagent strip was 99%, the positive predictive value was 82% and the negative predictive value was 92%. For women presenting with urinary incontinence, the sensitivity of a urine reagent test for diagnosing urinary tract infection was low.This study was performed without extramural financial support. This study was presented in poster format at the 32^nd Annual Meeting (August 28–30, 2002) of the International Continence Society in Heidelberg, GermanyEditorial Comment: The authors demonstrate the lack of utility of urine reagent strips. It has often been noticed that a discrepancy exists between office reagent strips and a urine culture. This study supports the routine use of a urinalysis and urine culture in the initial evaluation when evaluating women for urinary incontinence and voiding symptoms. This helps identify not only patients with urinary tract infections, but also those patients needing further evaluation for microscopic hematuria. Most commonly, patients present with both stress and urge incontinence, requiring an evaluation for all possible causes of their incontinence.     

The risk of anal incontinence in obese women

The objectives of this study was to estimate the risk of anal incontinence in morbidly obese women and to identify risk factors associated with anal incontinence in an obese population sample. A case-control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index > or = 35 (obesity class II) was randomly matched by age, gender and residential county to control subjects using the computerised Register of the Total Population. Data were collected by a self-reported postal survey including detailed questions on medical and obstetrical history, obesity history, socioeconomic indices, life style factors and the validated Cleveland Clinic Incontinence Score. The questionnaire was returned by 131/179 (73%) of the cases and 453/892 (51%) of the control subjects. Compared to the control group, obese women reported a significantly increased defecation frequency (p < 0.001), inability to discriminate between flatus and faeces (p < 0.001) and flatus incontinence (p < 0.001). Compared with non-obese women, the adjusted odds ratio (OR) for flatus incontinence in morbidly obese women was 1.5 [95% confidence interval (CI) 1.1-4.1]. A history of obstetric sphincter injury was independently associated with an increased risk of flatus incontinence (OR, 4.3; 95% CI, 2.0-9.2) and incontinence of loose stools (OR, 6.6; 95% CI, 1.4-31.4). Other medical and life style interactions did not remain at significant levels in an adjusted multivariable analysis. Obese women are at increased risk for mild to moderate flatus incontinence.