Prevalence of urinary incontinence in Andorra women
Reported, January 11, 2012
Urinary incontinence (UI) is a frequent public health problem with negative social consequences, particularly for women. Female susceptibility is the result of anatomical, social, economic and cultural factors. The main objectives of this study are to evaluate the prevalence of UI in the female population of Andorra over the age of 15 and, specifically, to determine the influence of socio-demographic factors. A secondary aim of the study is to measure the degree of concern associated with UI and whether the involved subjects have asked for medical assistance, or not.
Methods
Women aged 15 and over, answered a self-administered questionnaire while attending professional health units in Andorra during the period November 1998 to January 2000. A preliminary study was carried out to ensure that the questionnaire was both understandable and simple.
Results
863 completed questionnaires were obtained during a one year period. The breakdown of the places where the questionnaires were obtained and filled out is as follows: 32.4% medical specialists’ offices; 31.5% outpatient centres served exclusively by nurses; 24% primary care doctors’ offices; 12% from other sources. Of the women who answered the questionnaire, 37% manifested urine losses. Of those,45.3% presented regular urinary incontinence (RUI) and 55.7% presented sporadic urinary incontinence (SporadicUI). In those women aged between 45 and 64, UI was present in 56% of the subjects. UI was more frequent among parous than non-parous women. UI was perceived as a far more bothersome and disabling condition by working, middle-class women than in other socio-economic groups. Women in this particular group are more limited by UI, less likely to seek medical advice but more likely to follow a course of treatment. From a general point of view, however, less than 50% of women suffering from UI sought medical advice.
Conclusion
The prevalence of UI in the female population of Andorra stands at about 37%, a statistic which should encourage both health professionals and women to a far greater awareness of this condition.
Urinary incontinence (UI) has been defined as the complaint of any involuntary leakage of urine. In fact, this worldwide entity has negative influences on the quality of life as it may cause a socially unacceptable problem . Since many women accept it as a “normal” condition, they are unaware that, in many instances, it can be successfully treated. Socio-cultural factors, especially in certain geographical areas, mean that affected women do not dare to ask for medical advice .
The prevalence of UI ranges from 10 to 60%, depending on the countries and populations studied . Women are much more susceptible to UI than men. Anatomical and physiological differences , such as reproductive and hormonal changes associated with pregnancy and menopause, explain the differences prevailing between male and female. It is highly probable that socio-economic and cultural factors play a crucial role in UI. However the extent of the influence of these factors on women’s health remains relatively unknown.
The Andorran Women’s Research Group (WRG) has undertaken a task not only to evaluate the prevalence of UI in our country, but also to ascertain to what extent the socio-economic and cultural factors influence the outcome of UI in Andorran women.
Of the total of 863 women voluntarily answering the questionnaire, 320 (37%) manifested some kind of UI . Unconcious urinary incontinence is defined as those women who answered NO to question number 5 (Have you ever experienced involuntary urine loss, at present or in the past, that was out of your control?), but who answered in the affirmative subsequent questions on UI’s characteristics. Sporadic urinary incontinence (SporadicUI) and regular urinary incontinence (RUI) are categorized depending on the frequency of the UI episodes, RUI being at least once a week. Since unconcious urinary incontinence is nonetheless UI, we have included it. Moreover, if it is unconcious, we presume it must be uncommon, and therefore sporadic, and for the purposes of this study, it is included within Sporadic UI.
As expected, the prevalence increases with age, especially RUI. In women with UI we observed that the percentage reporting regular urine leakage increased with age, rising from 15% in the youngest group, 32% in women between 25 to 44 years old, 59% between 45 to 64 and to 71% among the women aged over 64. The sample shows no statistical differences to the age distribution of the Andorran population
Risk factors related to UI
The risk of Sporadic UI is greater in parous than in non-parous women. The risk is 1.67 higher (C.I. 95% 0.96 2.92) with one child, 1.86 (C.I. 95% 1.07 3.22) with two children and 2.76 (C.I. 95% 1.46 5.20) with more than two children. Taking any drugs is associated with a higher risk of Sporadic UI 1.90 (C.I. 95% 1.30 2.77).
The risk of self-reported RUI is also greater in parous than in non-parous women. The risk is 1.47 higher (C.I. 95% 0.64 3.34) with one child, twofold for women who have two children (OR = 2.71 C.I. 95% 1.25 5.87) and threefold for three and more children (OR = 3.18 C.I. 95% 1.35 7.47). Taking any drugs (OR = 1,73 C.I. 95% 1.08 2.77) or having any health problem (OR = 1,96 C.I. 95% 1.22 3.13) is also associated with a higher risk of RUI.
RUI and social status
For women who clearly manifested RUI, we tried to determine the existing relation between social status and the following factors: the degree of concern
Women in the middle class group appear more functionally limited and more concerned by UI. Curiously, this group is less inclined to seek medical advice on UI, but does follow the recommended treatment more consistently.
IU effects risk factors
After an adjustment for age and social class, if we compare women with Sporadic UI, with women with RUI, the latter are more concerned by UI (risk 6.5: CI 95% 2.07 20.41), are more limited (risk 5.8: CI 95% 3.08 10.90), have a greater tendency to ask for medical advice (risk 3.78:CI 95% 1.96 7.28), and are more inclined to follow treatment consistently (risk 6.68: CI 95% 2.60 17.16).
After an adjustment for age and UI level, middle class women are more limited by UI (risk 2.9: CI 1.34 6.31) than upper class women.
Finally, after an adjustment for UI level and social class, women aged 15 to 29 are more limited by UI (risk 5.26: CI 95% 1.51 18.12) than women aged 60 years and over. Women aged 45 to 59 are more inclined to follow treatment (risk 10.82: CI 1.28 91.30) than women aged 15 to 29.
The results of this study can be considered reliable, as well as a starting point to identify UI features in women of our country. Furthermore, the study itself could have a sensitizing effect on the participants (professionals and patients) and result in a better knowledge of the illness and its solutions. Some reports show consensus and indicate a need for an increased degree of awareness, both in the female population and among health professionals, as to the actual relevance of UI.
Credits:Mercè Avellanet1, Meritxell Fiter, Eva Cirera and Margarida Coll
More Information:
http://www.biomedcentral.com/1472-6874/3/5
