Hypothesis / aims of study
Urinary incontinence (IU) is a health issue with multidimensional repercussions that negatively interfere with women's quality of life (QoL) and its often underdiagnosed and untreated.
The aims of this study were: a) identify the prevalence of urinary incontinence among women in a municipality in the center region of Portugal; b) assess the impact of urinary incontinence on women’s quality of life across multiple dimensions, including daily activities, effort activities, self-image, emotional impact, sexuality and well-being.
Study design, materials and methods
This was an observational, cross-sectional and analytical study, conducted using a convenience sampling method, which received approval from the local institutional research ethics board. The sample size was calculated for a population of 11,459 women in the municipality, with 30% expected prevalence (1), a 95% confidence interval and a 5% precision, resulting in a sample size of 323.
Data were collected using a sample characterization questionnaire and the Contilife® measurement instrument, which was accessible in both online and paper form. The Contilife® assesses the impact of UI on QoL through 28 questions distributed across six distinct dimensions: daily activities, effort activities, self-image, emotional impact, sexuality, and well-being. Scores ranged from 0 (low QoL) to 10 (high QoL).
The local hospital, healthcare centers, and other regional institutions were contacted to distribute the survey, and the data collection took place between 29 November 2022 and 31 January 2023. The study included women who met the following inclusion criteria: being 18 years of age or older, residents in the municipality and have the intellectual capacity to complete the questionnaires. Women with neurological conditions such as stroke, multiple sclerosis, spinal cord pathology, bladder neurological pathology, Parkinson's disease, and those undergoing chronic catheterization were excluded from the study sample as per the research team's criteria.
The statistical analysis involved descriptive statistics and inferential statistics. To assess the internal consistency of the questionnaire used, i.e., the degree of interrelatedness among items, Cronbach's Alpha was used.
Results
Out of the 416 women responded to the questionnaire, 28.1% (n=117) reported have urinary losses.
The mean age, of the women with IU, was 51.1 years, ranging from a minimum of 20 to a maximum of 88 years. Stress urinary incontinence was the most common type, affecting 56.4% of the participants, followed by mixed urinary incontinence at 25.6%, and urge urinary incontinence at 17.9%. Only 37 women sought professional assistance, with the most frequently mentioned professionals being the Gynecologist/Obstetrician (n=12) or the General Practitioner (n=10). Notably, six women in 117, reported seeking help from a physiotherapist.
In the analysis of the Contilife® dimensions using Cronbach's Alpha, the internal consistency exhibited a range from a minimum coefficient of 0.591 within the Self-Image dimension to a maximum coefficient of 0.880 within the Sexuality dimension.
Concerning the assessment of overall QoL, the mean score was 7.59 ± 1.56, indicating a low impact (p=0.000). Specifically, in the dimensions of Daily Activities and Sexuality, mean scores suggested no impact on quality of life, while in the remaining dimensions, the impact was low based on the mean scores (p=0.000) (Table 1). Additionally, when considering the cutoff point for with impact/without impact, it was observed that 59% of women experienced an impact on their overall quality of life (Table 2).
Interpretation of results
Our results showed that 28,1% of the women in this sample self-reported IU, which is corroborated by the results found in both international and national studies (1–3).
Female UI has a significant impact on QoL, as evidenced by statistically significant values observed across all dimensions of Contilife®. Considering the established cutoff point (with impact/without impact) and the overall QoL measured by the Contilife® instrument, our findings suggest that urinary incontinence have impact on the QoL on the majority of women. Nevertheless, almost two thirds did not seek professional assistance, with only 6 out of 117 consulting a physiotherapist. It becomes important, on one hand, that different healthcare professionals, actively inquire about urinary losses in women, in order to guide them towards the best resolution of their complaints. Simultaneously, efforts should be made to raise awareness among physicians and the general population about the significance of physiotherapy in this condition.
Reflecting on all the results, a more concerted action can be undertaken by physiotherapists within the population. Pelvic physiotherapy is considered the first-line intervention in this condition, and it can also play a key role in prevention. Studies have demonstrated its effectiveness in improving the physical, psychological, and social well-being of women with urinary incontinence, resulting in an improved quality of life.
Concluding message
Almost one third of women, in our study, reported IU. Female UI has a statistically significant impact on QoL across all Contilife® dimensions, despite being classified as low impact. Only one third of these women sought professional assistance. Therefore, it becomes important that the healthcare professionals actively inquire about this topic, and promote urinary health literacy strategies.