Background: Urinary incontinence (UI) is an unintentional or involuntary loss of urine. Stress and urge incontinence are the most common types. Many women feel embarrassed to seek medical care, and it affects their quality of life to a greater extent and is usually a neglected problem among rural communities.
Objective: The objective of the study was to estimate the prevalence and to determine the factors associated with UI among peri- and postmenopausal women.
Methodology: A community-based cross-sectional study was done among 200 peri- and postmenopausal women of age ≥40 years. The sample size was calculated using a prevalence of 25% from previous studies with a 95% confidence interval and absolute precision of 6%. A simple random sampling technique was employed. A semi-structured questionnaire consisting of the Questionnaire for Urinary Incontinence Diagnosis scale was used for data collection. Data analysis was performed in SPSS version 20.0. P ≤ 0.05 was considered statistically significant.
Results: The prevalence of UI was 24% (48 out of 200 women), of which stress incontinence was seen in 15% and urge incontinence in 17% of women. Mixed incontinence was seen in 8% of women. Factors such as increasing age, attainment of menopause, chronic constipation, diabetes, and recurrent UTIs were significantly associated with UI.
Conclusion: Two out of every ten peri- and postmenopausal women were found to have UI. Identification of women at risk, educating them regarding preventive measures, following a healthy diet, and encouraging them to seek medical care can greatly reduce their chance of developing UI and aid in improving their quality of life.
Keywords: Menopause, prevalence, Questionnaire for Urinary Incontinence Diagnosis questionnaire, rural, urinary incontinence
|How to cite this URL:|
Divyasri R, Jha PK, Bhavani R, Kuchana SK, Kode R. Prevalence of urinary incontinence and its associated factors among peri- and postmenopausal women of Bollikunta village, Warangal. MRIMS J Health Sci [Epub ahead of print] [cited 2023 May 29]. Available from: http://www.mrimsjournal.com/preprintarticle.asp?id=377174
| Introduction|| |
Urinary incontinence (UI) is an unintentional or involuntary loss of urine. The most common types of UI in women are stress UI and urge UI. Population studies from numerous countries have reported that the prevalence of UI ranged from approximately 5% to 70%, with most studies reporting a prevalence of any UI in the range of 25%–45%. It largely affects the older women of rural communities. The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item UI symptom questionnaire, to distinguish stress and urge UI is a valid tool and can be easily employed at the community level.
| Methodology|| |
This was a community-based cross-sectional study done among 200 peri- and postmenopausal women of age ≥40 years. The study was performed for a duration of 3 months from January 2022 to March 2022 in Bollikunta village in the rural Warangal district. The sample size was calculated using a prevalence of 25% (P) from the previous studies, with a 95% confidence interval (standard normal deviate, Z = 1.96) and absolute precision (d) of 6%.
After obtaining a village map from the gram panchayat office, all houses in the village were line listed. There were 1038 houses in Bollikunta village. Houses were selected by a simple random sampling technique using a random number table. One woman belonging to peri- or postmenopausal age from each selected house was interviewed. If a woman of age ≥40 was not present, the adjacent house was visited. This procedure was repeated till the entire sample was obtained.
Women aged ≥40 years of age who have given informed consent to participate in the study were included in the study. Those who were <40 years of age, bedridden, chronically ill, or not given consent to participate in the study were excluded from the study.
A pretested semi-structured questionnaire with a QUID scale incorporated was used for data collection. QUID, is a 6-item questionnaire. The first three questions (1–3) help to assess stress incontinence, and the next three questions (4–6) help to assess urge incontinence. Questions include leakage of urine (even small drops) or wetting (1) on coughing/sneezing/laughing, (2) on bending down/ lifting something, (3) while walking quickly/jogging/ exercising, (4) while undressing to use the toilet, (5) before reaching toilet because of strong and uncomfortable need to urinate, and (6) rushing to the bathroom because of a sudden strong need to urinate. Each question was given a Likert scale from 0 to 5 to assess the severity of the problem (0 = none of the time, 1 = rarely, 2 = once in a while, 3 = often, 4 = most of the time, and 5 = all of the time). Other tools used for the study were a measuring tape and a weighing machine to take the anthropometric readings. Sociodemographic details and relevant antenatal, natal, postnatal, surgical, menopausal, and comorbidity profiles, mainly gynecological complications, were collected.
Analysis of QUID scores was done to assess the presence of incontinence. If the score was ≥4 (out of 15, the maximum score that can be obtained for questions 1–3), it indicated the presence of stress incontinence. If the score was ≥6 (out of 15, the maximum score that can be obtained for questions 4–6), it indicated the presence of urge incontinence. All these scores and the remaining data collected were entered into MS Excel and exported to SPSS for analysis. Descriptive statistics and Chi-square tests were performed in SPSS version 20.0 (IBM SPSS Statistics for Windows, Armonk, NY. IBM Corp.). P ≤ 0.05 was considered statistically significant.
| Results|| |
The prevalence of UI among peri- and postmenopausal women of rural Warangal was found to be 24% [Figure 1]. Out of 200 women, stress incontinence was seen in 30 (15%) women, urge incontinence in 34 (17%) women, and both types (mixed incontinence) in 16 (8%) women [Figure 2].
The mean age of participants was 55 years (55.13 ± 10.93), with a minimum age of 40 years and a maximum age of 90 years. The mean body mass index (BMI) was 23 kg/m2 (23.43 ± 3.82), with a minimum BMI of 14.1 and a maximum of 32.3. The mean age at first childbirth was 20 years (20.13 ± 3.73) with a minimum of 13 years and a maximum of 35 years. The mean maximum birth weight of the child born to the women was 2.8 kg (2.85 ± 0.43), a minimum of 2 kg, and a maximum of 4.5 kg [Table 1].
36.1% of women aged ≥60 years were found to have UI. 28.9% of women who attained menopause were found to have UI when compared to women who did not attain menopause in whom the prevalence was only 9.8%. 71.4% of women suffering from constipation had UI. 45.8% of women having diabetes were found to have UI. 75% of women who suffered recurrent urinary tract infections have UI present in them. All these associations were statistically significant at P ≤ 0.01 [Table 2].
|Table 2: Distribution and comparison of the factors associated with urinary incontinence|
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Other factors such as BMI, type of delivery (normal vaginal delivery or cesarean section), prolonged labor, age of the woman at first childbirth, maximum birth weight of the child, engaging in postpartum heavy work, parity, abortions, hysterectomy, chronic illnesses such as chronic cough and hypertension, and childhood enuresis were not found to be significantly associated.
| Discussion|| |
UI, also known as involuntary urination, is any uncontrolled leakage of urine. QUID was a reliable tool for the diagnosis of stress and urge incontinence in the community. The sensitivity and specificity of the questionnaire were 85% and 75%, respectively, for stress incontinence diagnosis, whereas it was 79% and 79%, respectively, for urge incontinence diagnosis.
The prevalence of UI in Bollikunta village was found to be 24%, with urge incontinence constituting the greatest number of cases (17%). These results were similar to studies conducted by Prabhu and Shanbhag where the prevalence of UI was reported to be 25.5%. In their study, the prevalence of UI has shown a significant association with increasing age. Obstetric factors such as high parity, early resumption of heavy work in the postpartum period, and prolonged labor were associated. On performing regression analysis, the risk factors such as chronic cough, constipation, diabetes, and hypertension were found to be the important predictors of their study. The health-care-seeking rate was 14.4%.
In a study conducted by Singh et al., which was a hospital-based cross-sectional study, stress incontinence was found to be more followed by mixed and urge incontinence. Multiparity, age >40 years, attainment of menopause, obesity with a BMI of more than 25, history of diabetes, tobacco smoking, and smokeless tobacco chewing were found to be the risk factors associated with an increased prevalence of UI on univariate analysis. In addition, vaginal delivery and hysterectomy were found to be associated with UI in multivariate analysis. Delivery-related complications might not have shown a significant association in the current study, as most of the children in rural communities are low birth weight born babies. Seventy-five percent of babies were <4 kg of weight, whereas ≥4 kg weight is a risk factor for UI.
Advanced age and menopause were majorly associated with UI. Chronic illnesses such as chronic constipation and diabetes stood out to be important determinants. Recurrent infections of the urinary tract were also found to be one of the associated factors in as high as 75% of women. Recurrence might be because of the lower help-seeking behavior of the women and the stigma associated with genitourinary infections as addressed by Koch. According to his integrative literature study, <38% of women seek help for problems related to UI which might be attributed to the severity of UI and the embarrassment to share their concerns.
In a review of population studies from various countries conducted by Milsom and Gyhagen, the prevalence of UI ranged between 5% and 70%. Most studies reported a prevalence of 25% to 45%. The number of women with urge and mixed incontinence increased with an increase in the age of the women. Family history studies have shown a greater prevalence of stress UI among first-degree relatives of women with stress UI compared to the first-degree relatives of continent women. Most women believe that incontinence is a normal part of aging and is a normal sequela of childbirth due to which they do not seek medical care. The difference in the study results can be attributed to different sampling methods used, whether it is a community or a hospital-based study, and the setting of the study whether urban, rural, or tribal communities where the discrepancies might have forced in.
Limitations of the study include a small sample size. Nonresponse rate was not considered while calculating the sample size, but the nonresponse rate was found to be very low in the study. Minimal recall bias might have been introduced in the study as the subjects had to recall events from their past, which was tried to combat by giving more time for the participant to recollect the information. Selection bias was addressed and was kept to a minimum by employing a probability sampling technique for the selection of houses. The investigators were trained to interview the participants before the commencement of the study. Participants were interviewed privately so that they are comfortable answering the questions regarding incontinence.
| Conclusion|| |
UI is a bothersome and neglected problem, mainly in the rural communities of India. It is most commonly seen among elderly women and those suffering from chronic constipation and ailments such as diabetes. Postmenopausal status is one of the aspects that predispose the woman to develop UI. Recurrent urinary tract infections also play a pivotal role as a predictor.
I would like to acknowledge the sincere efforts of interns posted in the Community Medicine department of Kakatiya Medical College, Warangal, in the house-to-house collection of data from the participants in the field. I thank each and every woman who participated in the study and made this study possible.
Institute Ethical Committee approval was obtained before the commencement of the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Department of Community Medicine, Kakatiya Medical College, Warangal, Telangana
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2]