https://doi.org/10.33698/NRF0219- Gurvinder Kaur,Nancy Bhambi ,Davinder Kaur,Avinash Goel
Abstract : Introduction: Stress Urinary Incontinence is one of the major problem that affect about one third of adult women’s quality of life. It is more common in women than men. The reported prevalence of stress urinary incontinence in India is about 12%. Objective: To assess stress urinary incontinence and its impact on quality of life among women in village Gajjukhera of district, Patiala, Punjab. Methodology: A descriptive study was undertaken on 119 women above 35 years, selected by door- to- door survey, that fulfilled defined inclusion and exclusion criteria. Structured Interview schedule was prepared to assess stress urinary incontinence & Modified King’s health questionnaire was used to assess the quality of life affected by stress urinary incontinence among women. Data was collected by interviewing women at their home setting and analyzed by using descriptive and inferential statistics. Results: Findings revealed that majority (84%) of them suffered from stress urinary incontinence. Further found that coughing was the most precipitating factor leading the condition. More than half (59%) of women’s stress urinary incontinence had an average impact on quality of life( 34.06±5.859) whereas 39% had slightly affected quality of life and in rest (2%) quality of life was a lot affected. Under Quality of life aspects; emotions (69.75%), sleep/energy (67.75%), other activities (55%), physical/social limitation (51.41%) were moderately affected whereas women’s role limitation and personal relationships were slightly affected due to stress urinary incontinence. Conclusion: Among women suffering from stress urinary incontinence, emotional aspect was moderately affected whereas personal relationship was least affected. So there is need to aware the women regarding prevention and management of stress urinary incontinence to prevent them from further complications and to improve their quality of life.
Keywords
Stress urinary incontinence, quality of life.
Correspondence at
Nancy Bhambri
H.No.462, Sec21 Panchkula Mob.9417845583
Mail: bhambrinancy@gmail.com
Introduction
Recent years have brought enormous changes in the health care system. Health for all is not an achievable goal without considering women’s health and their developments. An often neglected but important area of women’s health involves the pelvic floor muscles. However, the issues of pelvic floor health are often addressed only after symptoms have been presented.1 Urinary incontinence (UI) is an important and most neglected problems due to which women keep on suffering. It is defined by the International Continence Society as the involuntary loss of urine, which is a social and hygienic problem2 and may affect women at any age. The prevalence among adult women ranges from 17 to 45%3, with serious social implications, causing discomfort, loss of self-confidence and negative interference in quality of life (QoL) of several females.
Stress urinary incontinence is the most common form of urinary incontinence in women and is associated with high financial, social and emotional costs. Stress urinary incontinence as most recently defined by the International Continence Society is the complaint of involuntary leakage of urine during effort or exertion or during sneezing or coughing. Initial treatment includes behavioural changes and pelvic floor muscle training.4 Although it is not a life-threatening condition, but may lead to severe medical, social, psychological and economic implications, adversely affecting quality of life.
Nurses can play an important role in helping patients to understand and manage urinary incontinence and improve their quality of life because some people who have urinary incontinence become socially isolated because of the fear of wetting themselves or creating an unpleasant odour from the leakage of urine. Many suffer in silence and hide the problem from family and friends. Hence it is important to identify the problem of urinary incontinence so that preventive and management strategies can be planned accordingly.
Objective
To assess stress urinary incontinence and its impact on quality of life among women in selected community of District Patiala, Punjab.
Methodology
A descriptive study was carried out in village Gajjukhera of district, Patiala, Punjab. The sample consisted of 119 women above 35 years were selected by door- to- door survey that fulfilled defined inclusion and exclusion criteria. Structured Interview schedule was prepared to assess stress urinary incontinence which includes participant’s (women’s) present & past medical history, questionnaire related to stress urinary incontinence and most important Provocation test to confirm stress urinary incontinence. It is performed by asking the participant to relax and cough vigoursly for 5 times while the examiner observes the urethra for loss of urine. If leakage occurs instantaneously, then stress urinary incontinence is suspected. If leakage is delayed or persists after the cough, then urge incontinence is suspected. This test is performed when the patient has a full bladder in supine position. Modified King’s health questionnaire was used to assess quality of life affected by stress urinary incontinence among women. It included the aspects namely; role limitation, physical /social limitation, personal relationship, emotions, sleep/energy and other activities. It has 16 items, scored as not at all(1), slightly (2), moderately(3) and a lot (4).Maximum score was 64 and it was categorized into slightly, moderate& a lot affected with a score of 16-32, 32-48 & 48-64 respectively. The Reliability of the tool was established by equivalence method (interrater method) &it was found 0.88.The tool was validated by 9 experts from the field of community health nursing and medical surgical nursing. The ethical clearance was taken from Ethical Committee of Gian Sagar Medical College and Hospital. Anonymity of participants and confidentiality of information was maintained. Written Informed consent was taken from the subjects and provocation test was performed in their home setting by the researcher. The women suffering from urinary incontinence were interviewed by using interview schedule Modified King’s health questionnaire. Collected data was analyzed by using descriptive and inferential statistics.
Results
Fig 1 illustrates that out of 119 women taken as sample, majority (84%) were suffering from stress urinary incontinence whereas rest (16%) of them found to be non-sufferers. Socio- demographic profile of the subjects show that more than half, 63(52.9%) of the women were of 35-45 years age group and 4.2% were more than 65 years. Nearly half (47.9%) of them were illiterate and only 2.5% were graduate and above. All of the women were housewives. Majority (72%) of them were married. Half of them (51.3%) had 3-5 children and 82(68.9%) womens delivered their child at and 18(15.1%) had hospital deliveries. In home setting the delivery of 82(68.9%) women were conducted by untrained persons.
The results revealed that in straining activities; coughing was precipitating factor in 50% women followed by sneezing in 23% woman and laughing in 11% women whereas lifting was found in 2% of woman under exertional precipitating factors. Both straining and exertional activities were found in 14% of the women. Coughing was the most occurring precipitating for stress urinary incontinence among women
Table 1: Precipitating factors of urinary incontinence among women
|
N=100
Fig 1 : Prevalence of stress urinary incontinence among women
Table 2 revealed that majority (90%) of women had an episodes of stress urinary incontinence 2 times/ per week and 10% had 1-2 times/day. Regarding duration of incontinence 48% of women had stress urinary incontinence problem from <1 yr whereas 40%women had problem from 1-2 yrs and 11% for >2 yrs. Use of pads was practiced by 19% women and out of which 17% changed pad once and 2% change twice in 24 hrs. The per day water consumption of 34% women was 7-9 glasses, 35% were taking 10-12 glasses, 25% were taking only 4-6 glasses and 6% were consuming more than 12 glasses/ day.
Table 2: Characteristics of stress urinary incontinence
N=100
| Characteristics of Stress urinary incontinence | n/% | |
| Frequency of stress urinary incontinence | ||
| 2 times/week | 90 | |
| 1-2 times/day | 10 | |
| Duration of incontinence | ||
| ≤ 1year | 48 | |
| 1-2 years | 40 | |
| > 2 years | 12 | |
| Use of Pads | ||
| Yes | 19 | |
| No | 81 | |
| Frequency of changing pads/24hrs | ||
| Once | 17 | |
| Twice | 02 | |
| Daily Fluid intake | ||
| 4-6 | glasses | 25 |
| 7-9 | glasses | 34 |
| 10-12 | glasses | 35 |
| More than 12 | glasses | 6 |
It is depicted in Table 3 that 59% of women had an moderate impact of stress incontinence on the quality of life (34.06±5.859 mean score ) whereas 39% had slightly effect on quality of life and 2% had a lot affected quality of life. Stress urinary incontinence had moderately affected the quality of life of women. (Quality of life score ranged from 39-76% with mean percent score of 53.2+9.06%)
Table 3: Quality of life due to Stress urinary incontinence
N=60
| Quality of life due to Stress urinary incontinence | f | Score Range | Score Mean±SD |
| Slightly affected | 39 | 21-49 | 34.06±5.859 |
| Moderately affected | 59 | (36-76%) | (53.2+9.06%) |
| A lot affected | 2 |
Max. Score=64, Min. Score=16Higher the score, quality of life more affected
Table 4: depicts Quality of life including in different domains. The maximum affected quality of life was in the domain of emotions with mean percent score of 69.75%. This was followed by sleep/energy domain with mean percent score 67.75%. Other domains of quality of life affected due to stress urinary incontinence were physical/social limitation (mean percent score 51.41%) women’s role limitation ( mean percent score 48.75), and personal relationships( mean percent score 46.83) It was concluded that among women suffering from stress urinary incontinence, emotional aspects were moderately affected whereas personal relationship were least affected.
Table 4: Different domains of Quality of life score of among women with stress urinary incontinence
N=60
| Domains of Quality of life | Stress urinary incontinence score | ||
| Max.score | Mean score | Mean% score | |
| Role limitations | 8.00 | 3.90 | 48.75 |
| Physical/ social limitation | 12.00 | 6.17 | 51.41 |
| Personal relationships | 12.00 | 5.62 | 46.83 |
| Emotions | 12.00 | 8.40 | 69.75 |
| Sleep/Energy | 8.00 | 5.42 | 67.75 |
| Other activities | 8.00 | 4.40 | 55.00 |
As per table 5 it was found that the sleep was disturbed all the time among 10% women while another 31% felt worn out and tired all the times. It was further stated that 21% women needed to change their undergarments often as it got wet and 30 % were often worried about the smell. The problem of urine incontinence made the women moderately anxious (51%), depressed (53%)and felt bad about themselves (49%). It was told by 3% women that there was moderate problems in the relationship with partner, sex life and even family life. The house hold work was moderately affected due to SUI in 11% women and official and outside work of 5% women.
Table. 5: Quality of life among women with stress urinary incontinence
N=100
| ITEMS | QUALITY OF LIFE AFFECTED | |||
| 1 | 2 | 3 | 4 | |
| 1. ROLE LIMITATIONS | Not at all f | Slightly f | Moderately f | A lot f |
| A. Does your bladder problem affect your household tasks? (cleaning, shopping etc) | 7 | 82 | 11 | 0 |
| B. Does you bladder problem affect your job, or your normal daily activities outside the home? | 30 | 65 | 5 | 0 |
| 2. PHYSICAL/SOCIAL LIMITATION | ||||
| A. Does your bladder problem affect your physical activities (e.g. going for walk, running, sports, gym etc)? | 38 | 60 | 2 | 0 |
| B. Does your bladder problem affect your ability to travel? | 60 | 37 | 3 | 0 |
| C. Does your bladder problem limit your social life? | 35 | 63 | 2 | 0 |
| D. Does your bladder problem limit your ability to see and visit friends? | 45 | 52 | 3 | 0 |
| 3. PERSONAL RELATIONSHIPS | ||||
| A. Does your bladder problem affect your relationship with your partner? | 14 | 82 | 3 | 1 |
| B. Does your bladder problem affect your sex life? | 14 | 82 | 3 | 1 |
| C. Does your bladder problem affect your family life? | 25 | 71 | 3 | 1 |
| 4. EMOTIONS | ||||
| A. Does your bladder problem make you feel depressed? | 2 | 37 | 53 | 8 |
| B. Does your bladder problem make you feel anxious or nervous? | 3 | 26 | 51 | 20 |
| C. Does your bladder problem make you feel bad about yourself? | 0 | 33 | 49 | 18 |
| Never | Sometime | Often | All time | |
| 5. SLEEP/ENERGY | ||||
| A. Does your bladder problem affect your sleep? | 4 | 65 | 21 | 10 |
| B. Does your bladder problem make you\ feel worn out and tired? | 1 | 25 | 43 | 31 |
| 6. OTHER | ||||
| A. Change your underclothes because they get wet? | 13 | 64 | 21 | 2 |
| B. Worry in case you smell? | 6 | 62 | 30 | 2 |
Discussion
Stress incontinence is more common in females although it is not a life- threatening condition but it may lead to severe medical, social, psychological and economic implications, adversely affecting quality of life. Stress urinary incontinence (SUI) may also disturb sleep, which further exacerbates daily function. Hence it was important to document the quality of life affected by stress incontinence.
Urinary incontinence was found to be common and SUI has been said to be the most common type of Urinary incontinence. We have found 84% prevalence of SUI in our total sample of 119 women. Majority (90%) of women had an episode of stress urinary incontinence 2 times/ per week and 10% had 1-2 times/day. However, lower prevalence of 62.9%was reported among adult women(21-76) by Ladysmith5.In contrast Corccoles MB6 reported that a total 73 women ( 57.94%) had more than 10 urine leaks a day.
Furthermore, quality of life including emotions (69.75%), sleep/energy (67.75%), other activities (55%), physical/social limitation (51.41%) were moderately affected whereas women’s role limitation and personal relationships were slightly affected due to stress urinary incontinence. It was concluded that among women suffering from stress urinary incontinence, emotional aspects were moderately affected whereas personal relationship was least affected physical activity as moderately affected and role limitations were slightly affected. Scores in the scales of General health, impact on daily activities and emotions, were significantly higher in patients. The quality of life of female patients with SUI is affected, which limits both their physical activity and image. Similar results were reported by Corcoles MB6 that stress urinary incontinence limits both physical activites and image of women. The present study detected that in regard to duration of incontinence, 48% of women had stress urinary incontinence problem from <1 yr whereas women with problem from 1-2 yrs and >2 yrs were 40%and 11% respectively with regard to use of pads, 19% women uses pads out of with 17% women change pad once and 2% change twice for 24 hr. Similar findings revealed by Aslan E7. That pad usage was more common in women (88%) with urinary incontinence.
It was concluded SUI negatively affects the Qol of older people living in residential area. Different studies have reported that many of the women with SUI were not receiving any medical help despite the presence of a negative impact on QOL.9-11 The study outcome shows that 59% of women had moderately affected quality of life and only 2 women’s quality of life was a lot affected. In contrast Sensory N,8 revealed that 95.5% of the women described this problem as a negative impact on quality of life and 57.1 % accepted it a disease.
It was concluded that there was high prevalence of stress urinary incontinence among women and it had an average impact on quality of life. Hence it was further concluded that among women suffering from stress urinary incontinence, emotional aspect was moderately affected whereas personal relationship was least affected. So,there is need to aware the women regarding prevention of stress urinary incontinence to prevent them from further complications and to improve their quality of life. So, UI is a multifactorial health problem which affects women’s life quality negatively related to age, education, occupation and marital status. However, because of social, psychological and cultural problems, many of women with UI don’t admit to health centre to get support. Therefore, healthcare professionals should concentrate their efforts on improving the awareness of this problem among women and assure them that this is not a condition of humiliation and taboos while providing appropriate medical care, simple lifestyle changes and psychosocial support. There is a clear need for public health programs to address the problem of SUI in the community by providing education on strategies for prevention and treatment and to make women more aware of it as a medical condition that can be treated.
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