Overactive bladder syndrome (OAB) and urinary incontinence (UI) are common conditions among adult women and have been associated with negative impact on quality of life (QOL), and despite the high prevalence and great impact of OAB and UI on QOL, many individuals do not seek treatment. 
There are several explanations for the low help-seeking for treatment, but we did not find studies assessing help-seeking behavior among women with OAB and stress urinary incontinence (SUI)  working in a hospital environment. Theoretically, female hospital staff have a greater opportunity to seek medical assistance and knowledge concerning diagnosis and treatments options for lower urinary tract symptoms (LUTS). Therefore, our objectives were to compare the help-seeking behavior and to analyze the QOL and the level of discomfort associated with these symptoms among employees of a public hospital presenting with OAB and/or SUI.

Observational, cross-sectional study, which included employees of a large tertiary university hospital, from April to December 2019 (convenience sample). The study was approved by the Research Ethics Committee (number 3.183.240).
Women aged 18 years or over, with OAB and/or SUI, registered and active in their function during data collection were included. Pregnancy, puerperium, concurrent neurological diseases, history of pelvic radiotherapy and/or previous major pelvic surgeries, and unavailability to answer the questionnaires were exclusion criteria. 
The employees were contacted at their workplace and invited to participate in the study. Interviews were scheduled in advance and carried out in a reserved place. 
For women who presented OAB or SUI and did not seek treatment, several alternatives were provided to illustrate their reasons: “I think it is normal for my age; I am afraid of surgery; the LUTS do not bother me; I am embarrassed; or others”. For those who responded that had sought treatment for their LUTS, the following question was asked: "Did the professional you sought managed to help you?" and the volunteer responded based on a visual scale ranging from zero (not at all) to ten (totally), values below 5 were considered as little help, from 5 to 7 moderate help, and above 7 a lot of help. For OAB confirmation, the Overactive Bladder version 8 (OAB-V8) questionnaire was applied. 
QOL was assessed using the International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF) and International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Average of the discomfort scores related to the four symptoms of OAB (urinary frequency, urgency, UUI, and nocturia) was used in the statistical analysis. In addition, WOAB and DOAB subtypes were defined according ICIQ-OAB question 6a: "Do you lose urine before reaching the bathroom?". If the patient chose the alternative “never”, then we considered it as DOAB and if she answered any of the alternatives, we consider it as WOAB.
For women who did not present OAB on the OAB-V8, question six of the ICIQ-SF was used (“When do you lose urine?”) to verify the presence of UI and its classification. If the patient answered the items “I lose when I cough or sneeze”, “I lose when I am doing physical activities”, and/or “I lose when I have finished urinating and I am dressing”, we considered it as SUI. The items “I lose before I get to the bathroom”, “I lose when I'm sleeping”, “I lose for no obvious reason” and / or “I lose all the time” characterized the IUU. Patients with urine loss on both effort and urgency were considered to have MUI.

There were 409 active employees in the hospital, 104 women declined participation. Ultimately, there were 187 without OAB-V8 score for diagnosis of OAB or SUI. Therefore, 118 female works participated in the study. 
Baseline characteristics are described in table 1. The majority of the volunteers were healthcare professionals (HCP), and only 26 (22%) sought treatment for LUTS. Regarding their satisfaction related to the specialized consultation, on a scale of zero to ten, the mean score was 4.23 ± 3.48. 
Among the 92 (78%) volunteers who did not seek treatment, the majority (56; 60.9%) could not specify why they did not seek help. There were a variety of reasons for not seeking treatment, with some women selecting more than one reason, the most frequent being that the symptoms did not bother the participant (12; 13%), a belief that their symptoms were ‘normal for their age’ (5; 5.4%), fear of surgery (4; 4.3%), lack of time (3; 3.3%), embarrassment (2; 2.2%), unwillingness (2; 2.2%), losing a small amount of urine (2; 2.2%), and other varied reasons (6; 6.5%). 
Table 2 shows that women with WOAB sought treatment more often (28.6%), but there were no significant differences among groups (p=0.429). Volunteers with WOAB presented worse QOL in comparison to DOAB (mean difference [MD] = 0.2; 95% CI = 0.2 to 0.3) and SUI (MD = 0.3; 95% CI = 0.1 to 0.3) (p<0.001) (Table 3). When comparing the degree of discomfort (Table 3), we observed that the WOAB group reported worst discomfort scores (p<0.0001). 
There was no difference regarding QOL scores between volunteers who sought treatment or not (p=0.093). In addition, there was no difference in the search for treatment according to the degree of discomfort (p=0.780).

To our knowledge, this is the first study to assess treatment-seeking behavior among employees of a hospital, most of them from the nursing team, presenting with either OAB or SUI. The help-seeking behavior among female hospital staff with OAB or SUI was very low (22%). In comparison to previous studies conducted in the general population, our findings demonstrated a trend toward lower treatment-seeking [1]. 
Despite the high prevalence of OAB (27.6%) and LUTS (89.6%) among nurses, we did not find researchers who investigated the treatment-seeking behavior for LUTS in this population. 
The high prevalence of LUTS, such as UI, among nurses is attributed to exposure to common risk factors. Moreover, inadequate urinary habits, such as not having time to use the toilet during work shift, reducing fluid intake, a heavy workload with activities requiring physical effort, and a stressful work routine, have also been reported as factors that may increase the frequency of LUTS within this group [2, 3]. 
However, our study presents inherent limitations. Volunteers have not been inquired about their knowledge about available treatments nor about the type of treatment received among those who sought it. 
Since OAB and SUI are still surrounded by several taboos, even among health-care workers, disease awareness initiatives are urgently needed. Digital media would be a process to demystify this issue and promote health education, however, future research must tackle this issue.

Treatment-seeking rate among hospital female staff was low. Although volunteers in the WOAB group reported worse QOL, there was no difference in treatment-seeking behavior among groups. The most frequent reasons for not seeking treatment were the lack of associated bother and the misleading belief that OAB and SUI could be considered normal in aging.

Schreiber Pedersen L, Lose G, Høybye MT, Jürgensen M, Waldmann A, Rudnicki M. Predictors and reasons for help-seeking behavior among women with urinary incontinence. Int Urogynecol J [Internet]. 2017;29(4):521–30.
Lopes LG, Vasconcelos CTM, Neto JAV, Oriá MOB, Saboia DM, Gomes MLS, et al. A systematic review of the prevalence, risk factors, and impact of pelvic floor dysfunctions in nurses. Neurourol Urodyn 2019;38(6):1492–503
Zhang, Chunfang; Hai, Ting; Yu, Luping; Liu, Shijun; Li, Qing; Zhang, Xiaowei; Xu, Tao; Wang X. Association Between Occupational Stress and Risk of Overactive Bladder and Other Lower Urinary Tract Symptoms: A Cross-Sectional Study of Female Nurses in China Chunfang. Neurourol Urodyn. 2013;32(3):254–60.

Continence 12S (2024) 101422
DOI: 10.1016/j.cont.2024.101422