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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 3  |  Page : 955-960

Urinary incontinence among elderly women attending a rural family health center in Gharbiya Governorate, Egypt


1 Department of Urosurgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, El-Sheen Family Health Center, Qutur District, El-Gharbiya Governorate, Egypt

Date of Submission17-Oct-2017
Date of Acceptance03-Dec-2017
Date of Web Publication17-Oct-2019

Correspondence Address:
Heba Allah M. Abdelrahman
El-Gharbiya Qutur
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_701_17

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  Abstract 

Background
Urinary incontinence (UI) is considered as a distressing and debilitating condition in elderly women. It has a significant negative impact on quality of life.
Objective
The aim of this study was to assess the prevalence of UI among elderly women attending a family health center and identify the risk factors associated with the development of UI among the studied group.
Patients and methods
This was a cross-sectional study conducted in a rural family health center, Gharbiya Governorate. The study was carried out on 217 elderly women. A structured questionnaire sheet was used to determine the sociodemographic criteria of the studied participants and predesigned questionnaires for the diagnosis of UI and to assess its severity.
Results
The overall prevalence of UI among the studied participants was 67%. The prevalence of mixed, stress, urgency UI was 31, 27, 9%, respectively. Its severity among the studied women ranged from slight (11%) to moderate (55.5%), severe (30.1%), and very severe (3.4%). The mean age was significantly higher among the incontinent group (67.55 ± 7.12). There was a significant association between UI and diabetes mellitus, hypertension, and urinary tract infection (odds ratio = 20.44, 13.63, 6.07), respectively. Obesity and constipation were significantly associated with stress incontinence and mixed incontinence. No significant relationship was found between the different types of UI and obstetric history.
Conclusion
A high prevalence of UI (67%) was detected among the studied group. The most commonly associated risk factors were age, obesity, diabetes, hypertension, urinary tract infection, and constipation.

Keywords: elderly women, prevalence, risk factors, urinary incontinence


How to cite this article:
Elserafy FA, Shaheen HM, Khalil NA, M. Abdelrahman HA. Urinary incontinence among elderly women attending a rural family health center in Gharbiya Governorate, Egypt. Menoufia Med J 2019;32:955-60

How to cite this URL:
Elserafy FA, Shaheen HM, Khalil NA, M. Abdelrahman HA. Urinary incontinence among elderly women attending a rural family health center in Gharbiya Governorate, Egypt. Menoufia Med J [serial online] 2019 [cited 2019 Nov 14];32:955-60. Available from: http://www.mmj.eg.net/text.asp?2019/32/3/955/268832




  Introduction Top


As population aging increases in both developed and developing countries, Egypt like many other countries is undergoing a demographic transition toward an aging society. There were 4 400 000 persons aged 60 years and over, representing 6.9% of the total population in 2006, whereas the expected percentage of elderly population may reach 8.9% in 2016 and 10.9% in 2026, and finally 12% by 2030 [1].

Urinary incontinence (UI) has been defined according to the international continence society as 'the complaint of any involuntary loss of urine'. It is considered as a common problem among the adults living in the community. It presents more in women, increasing with age, and is predominantly common among those in residential care. It affects about 15–50% of community dwelling elderly women [2]. The Fourth International Consultation on Incontinence categorized UI into several types: stress, urgency UI, mixed UI, nocturnal enuresis, postmicturition dribble, and continuous incontinence [3].

UI represents a geriatric syndrome with multiple risk factors that include: age-related changes in physiology [4], comorbid conditions such as diabetes, obesity, constipation, urinary tract infection (UTI),  Parkinsonism More Details. Prescribed and over-the-counter medications also cause functional impairment in older persons [5].

The burden of UI is high in terms of human and financial issues. UI has significant physical, psychological, and social consequences [6].

Lower urinary tract symptoms are divided into three groups: storage symptoms (urgency, frequency, and nocturia), voiding symptoms (hesitancy, slow stream, intermittent stream, straining, and terminal dribbling), and postmicturition symptoms (feeling of incomplete evacuation and postmicturition dribble) [7],[8].

Physicians should explore this disorder through reviewing the patient's history and physical examination maneuvers [9]. Validated questionnaires are an adjunct to the urinary symptom history [10].

The present study was conducted to achieve better health status among elderly female patients attending family health facilities.


  Patients and Methods Top


This was a cross-sectional comparative study. The study was carried out over a time frame of 14 months (from the beginning of April 2015 to the end of May 2016). The study was carried out in the El-Sheen Family Health Center which was randomly selected from 59 family health centers in Gharbiya Governorate.

The sample size was estimated according to the prevalence of UI among Egyptian women (54.8%) [11] and the target population (total number of females aged ≥60 years in El-Sheen village) which was 500 women according to the last residential census. It was calculated using Raosoft online sample size calculator with a relative error of 5% at the level of significance of 95%. A sample of 217 eligible participants was required. The study participants were collected from attendees to the family health center seeking treatment, follow-up, or accompanying a patient.

All participants in the study were evaluated through direct interviews using a questionnaire that consisted of three different parts.

The first part included the sociodemographic data, medical history, current medications, surgical history, obstetric and gynecological history, menopausal history, and family history of UI.

The second part included questions to diagnose UI and its types among the studied group using a questionnaire for urinary incontinence diagnosis (QUID) which included Q0: ask the patient if she has urine leakage or wets herself and if the answer was yes, three questions (Q1, Q2, Q3) focus on stress incontinence symptoms and three questions (Q4, Q5, Q6) on urge incontinence symptoms. The participants were classified into continent and incontinent groups [12].

The third part of the questionnaire was applied on the incontinent group to assess the severity of incontinence using 'the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form' (ICIQ-UI SF) which included three questions: how often do you leak urine, how much urine do you leak usually, how much does leaking urine interfere with everyday life [13].

After completion of the questionnaire, the participants were subjected to clinical examinations including height, weight, and blood pressure measurement. Some investigations were done including urine analysis, urine culture, fasting, and postprandial blood sugar.

Ethical consideration

The study was approved by the Ethics Committee of the Faculty of Medicine, Menoufia University; an official permission letter was obtained and directed to the administrators in the El-Sheen Family Health Center. Informed consent was obtained from all participants after simple and clear explanation of the research objectives.

Statistical analysis

Data entry, coding, and analysis were done using SPSS (20), IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, New York, USA). Quantitative data were expressed as mean and SDs and analyzed using the Student's t-test. Qualitative data were expressed as number and percentage and analyzed using the χ2-test. A P value equal to or greater than 0.05 was considered statistically nonsignificant, and less than 0.05 was considered statistically significant.


  Results Top


The current study has shown that the prevalence of UI among the studied group was 67% [Figure 1].
Figure 1: Prevalence of urinary incontinence among the studied elderly women.

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Mixed UI (31%) was the most prevalent type compared with stress (27%) and urge type (9%) among the studied group [Figure 2].
Figure 2: Prevalence of stress, urge, and mixed incontinence among the studied elderly women.

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As regards severity of UI, 55.5% of the studied participants were categorized as suffering from moderate UI [Figure 3].
Figure 3: Degrees of severity of urinary incontinence among the studied incontinence group.

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As per the sociodemographic characteristics of the studied group, the mean age was significantly higher among the incontinence group. Moreover, UI was significantly more prevalent among illiterates (88.4%) and housewives (92.5%) [Table 1].
Table 1: Sociodemographic characteristics of the studied groups

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All types of UI were significantly more prevalent among patients with hypertension (HTN) and UTI. The percentage of patients with urge (50%) and mixed (69.1%) incontinence were significantly higher among the uncontrolled diabetic patients. Mixed incontinence was significantly related to constipation (54.4%). Obesity was predominant among patients with stress incontinence (62.1%) [Table 2].
Table 2: Relationship between obstetric history and common health problems among the elderly participants and different types of urinary incontinence

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However, there was no significant relationship between the different types of UI and obstetric history of the studied group [Table 2].

According to logistic regression for predicting the most significant risk factor for UI among the studied groups, uncontrolled diabetes mellitus (DM) [P = 0.003, odds ratio (OR): 20.44] was the most significant factor, followed by HTN (P = 0.000, OR: 13.63), then UTI (P = 0.005, OR: 6.07), and obesity (P = 0.000, OR: 3.75) [Table 3].
Table 3: Logistic regression for predicting different variables related to urinary incontinence among the studied groups

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  Discussion Top


UI is a common problem among elderly women. It significantly affects the quality of their lives. The current study reported the prevalence of UI among the studied group which was found to be 67%. This was in agreement with the results of a study by El-Azab et al. [11], conducted among Egyptian elderly women and that of Sensoy et al. [14], conducted among Turkish elderly women; they stated that the prevalence of UI was 70 and 67.5%, respectively. However, the study by Altaweel and Alharbi [15] in Saudi Arabia stated that the prevalence of UI was 80% (61–65 years) and 100% (>65 years). These results vary due to racial, environmental, socioeconomic conditions, and the cultural differences among countries.

In the present study, mixed UI was the most prevalent type (31%) compared with stress UI (27%) and urge UI (9%). These results come parallel to the results of the study by Reigota et al. [16], which found that mixed UI was the most prevalent type (26.6%) compared with stress UI (12.4%) and urge UI (13.2%).

As regards severity of incontinence, moderate UI (55.5%) was the most prevalent among the participants in this study. This result was consistent with Barentsen et al. [17], who found that most of their patients reported mixed UI (50.7%) and a moderate severity of symptoms (48.9%).

In the current study, the mean age for women with UI was (67.55± 7.12) SD years. This result comes in concordance with Harai et al. [18] study in Japan, who found that the mean age for UI among women aged (65–74 years old) was 69.8 years.

However, Omli et al. [2] study in Norway found that the mean age for UI among women (aged 70–80 years) was 73 years and among women (aged 83–92 years) was 84 years. This difference depends on the age of the study group assuming the studies.

In the current study, illiterate patients and housewives were more prevalent among the incontinence group. These results have been in line with the study by Danforth et al. [19] which stated that the increase in educational level helps to avoid the occurrence of UI. Lee et al. [20] study has shown that unemployed women experienced higher rates of UI symptoms. It may be due to the effect of sedentary life which has a negative impact on women healthcare.

On the other hand, Kim and Kwak [21] stated that UI was prevalent in working women compared with unemployed women and this may be related to various occupational environments such as unclean and uncomfortable workplace, feeling pressed during work time, hazardous jobs, and probability of accidents and carrying heavy weights.

In the current study, no statistically significant relationship was found between UI and number of pregnancies or mode of delivery. However, a study conducted in Turkey [22] found a statistically significant association between the presence of UI and the number of pregnancies. Also, theBasak et al. [23] study stated that parity and type of delivery are major risk factors for UI. This difference may be attributed to the fact that more than 90% of these study participants had greater than or equal to 3 children and normal deliveries.

Regarding the relationship between UI and comorbid conditions, this study showed a significant association between HTN and all types of UI. Also, uncontrolled DM showed a significant relation to urge and mixed UI. These results come in line with Reigota et al. [16] andDanforth et al. [24], who found that elderly women with HTN and DM were more likely to report UI which is mainly caused by microvascular damage involvement in diabetic patients and due to antihypertensive medication, such as β-blockers, diuretics, or α-adrenergic receptor blocking agent, which might have the side effect of increasing the probabilities of UI.

However, the study by Kwon and Lee [25] found that HTN and DM were not associated with UI. They stated that these results may be due to lack of data to study the subtypes of UI.

Obesity (BMI ≥30) among participants in this study was significantly more frequently associated with stress and mixed incontinence. This is in agreement with many studies [25],[26], which stated that BMI was significantly and independently related to UI, as higher BMI goes along with a higher intrapelvic pressure, which can lead to UI.

In the current study, constipation was more frequent among patients with mixed incontinence. These results come in line with the study by Li et al. [27], who found that constipation is a significant risk factor with mixed UI due to pelvic floor weakness caused by the severe straining that arises from constipation and may contribute to the development of stress urinary and urge incontinence.


  Conclusion Top


A considerably high prevalence (67%) of UI was detected among the studied group. The most associated risk factors were age, educational level, occupation, obesity, DM, HTN, UTI, and constipation.

Recommendation

Educational health programs are recommended to improve awareness about UI among elderly women. More training courses for primary healthcare physicians should be implemented for early detection of UI and for proper management strategy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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