Incontinence impact, symptom distress and treatment-seeking behavior in women with involuntary urine loss in Southern Taiwan

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Abstract

Urinary incontinence (UI) in women is common worldwide, but is studied more often in the West. This correlational study conducted in southern Taiwan employed two frequently used instruments, which were translated into Chinese. Incontinence impact, symptom distress, and treatment-seeking behavior were studied in 106 women with UI of whom 76 (72%) had not received UI treatment. Incontinence impact (mean=49.75; range=30–120) was significantly correlated (r=0.76, p<0.01) with symptom distress (mean=18.38; range=2–68). Women with high incontinence impact and symptom distress were more likely to seek treatment than those with lower impact and symptom distress.

Introduction

Urinary incontinence (UI) is a more common problem in women than in men. According to the definition of the International Continence Society, UI is defined as involuntary urine loss which is objectively demonstrable and a social or hygienic problem (Abrams et al., 1988). The prevalence of UI in community-dwelling United States (US) women aged 50 and above ranges from 39% to 67.5% (Goldstein et al., 1992; Keller, 1999; Lagro-Janssen et al., 1990), but it is as low as 12–24% in community-dwelling US men (Goldstein et al., 1992; Roberts et al., 1998). Likewise, the prevalence of UI in Taiwanese women ranges from 23% to 43% (Liao et al., 1999; Tseng et al., 2000; Yu et al (1994), Yu et al (1999); Yu, 1996) in comparison with 15% of Taiwanese men with incontinence (Tseng et al., 2000).

UI affects not only the physical health of women but also their body image, self-esteem and social life (Norton et al., 1988). Taiwanese women with UI had lower satisfaction with life than women without UI (Liao et al., 1999). According to Yu (1996), community-dwelling Taiwanese elders reported a high psychological impact of UI. The five most frequently identified psychological factors noted by incontinent women were “worry about deterioration of symptom,” “feelings of inferiority,” “offensive smell,” “nervousness” and “embarrassment” (Huang et al., 1997).

Studies have reported the significant changes in women's quality of life imposed by UI (Gallagher, 1998; Shumaker et al., 1994; Valerius, 1997). As a pioneer work, Shumaker et al. (1994) conducted a series of steps including a literature review and qualitative interviews with women and health care providers to generate 30 items for the incontinence impact questionnaire (IIQ) and 19 items for the urogenital distress inventory (UDI). The scales addressed the full ranges of issues related to life quality of women with UI, and they were written in a 4-point response scale format: 1—“not at all”; 2—“slightly”; 3—“moderately”; and 4—“greatly”. Factor analysis was used to examine the structure of IIQ and UDI. The four subscales generated in the IIQ were travel, physical, social activities and emotional well being. The three UDI subscales covered stress, obstructive and irritative symptoms. In the consequent studies, Valerius (1997) reported that symptoms of stress UI caused more distress than obstructive or irritative symptoms. Sixty percent of women reported moderate distress and 83% reported great distress from symptoms of stress UI. Moreover, UI affected travel activities more than physical, emotional and social activities (Valerius, 1997).

A significant correlation exists between UI symptoms and their influence on travel, social and physical activities and emotional well being among women with UI (Valerius, 1997; Gallagher, 1998). UI symptoms were moderately correlated with impact on physical, social and travel activities but were weakly correlated with emotional well being (Valerius, 1997). Similarly, Gallagher (1998) found a moderate to strong correlation between UI symptoms and impact on physical, social and travel activities. Both symptom distress and influence on daily activities were correlated positively with the severity of UI as represented by UI episodes and pad tests (Shumaker et al., 1994).

Despite the high prevalence and negative consequences of UI in women, a low percentage of women seek treatment across nationalities. The percentage of women seeking treatments varies from 7% to 27% among women with UI in the US, Japan and the United Kingdom (Harrison and Memel, 1994; Keller, 1999; Ushiroyama et al., 1999). Only 18.4% of women with UI in Taipei had sought treatments within the previous year (Yu et al., 1994). Barriers to treatment seeking included: (a) UI was not viewed as a medical problem, (b) UI caused only minor inconvenience, (c) expectation of the benefit of medical treatments was modest, and (d) embarrassment (Lagro-Janssen et al., 1990; Norton et al., 1988; Roberts et al., 1998; Reymert and Hunskaar, 1994; Tseng et al., 2000).

Treatment seeking was associated with increasing age, duration, severity, impact and UI symptoms in Canadian women (Hunskaar et al., 1996). In Valerius's study (1997), 71% of women with UI seek treatment within the first 2 years after onset, but 23% delay their treatments for 5 or more years after symptoms develop. Nevertheless, the relationship between the duration of UI and intention of seeking treatment was not reported by Valerius. A Japanese study has found types of UI and the duration of UI make differences on intention of treatment seeking. In desire for treatment group, women with urge UI have shorter duration of incontinence than those with stress and mixed UI. Within urge UI group, women had reported the desire for treatment show longer duration of incontinence than those reported no desire for treatment (Ushiroyama et al., 1999). On the other hand, women with severe UI are more likely to seek treatment than those with mild UI (Burgio et al., 1994; Dugan et al., 2001; Holst and Wilson, 1988; Lagro-Janssen et al., 1990; Rekers et al., 1992; Roberts et al., 1998; Roe et al., 1999). Seeking treatment is associated with a greater physical impact, change in activities of daily living, social restrictions and psychological distress (Burgio et al., 1994; Dugan et al., 2001; Hunskaar et al., 1996; Lagro-Janssen et al., 1990). Additionally, Tseng et al. (2000) reported that the elderly Taiwanese with elementary education or above had a 4.8 times greater likelihood for intention to seek treatment than those who were illiterate.

The purposes of this study are to understand the impact and symptom distress imposed by UI in Taiwanese women and to relate impact and symptom distress to treatment-seeking behavior. There are four aims of this study:

  • 1.

    To describe demographic characteristics and treatment-seeking behavior reported by Taiwanese women with involuntary urine loss.

  • 2.

    To describe the symptom type and duration of UI reported by Taiwanese women.

  • 3.

    To describe UI impact and symptom distress reported by Taiwanese women.

  • 4.

    To examine the correlation between incontinence impact, symptom distress and the presence of treatment-seeking behavior.

In this study, “UI” was defined as the self-report of experiencing involuntary urine loss. “Incontinence impact” was defined as the self-report of the interferences imposed by UI on physical, emotional, social and travel activities. “Symptoms distress” was defined as the self-report of the bothersomeness of stress, irritative and obstructive symptoms. Stress symptoms were comprised of activity-related leakage and small amount of leakage. Irritative symptoms were comprised of urgency, frequency, night-time urination, bedwetting and large amount of leakage. Obstructive symptoms were comprised of difficulty or incomplete emptying, pelvic discomfort or pain, abdominal pressure, feeling or seeing bulging and pushing on vaginal walls. “Treatment-seeking behavior” was defined as receiving a treatment including medication, regimen of pelvic floor muscle exercise (PFME), biofeedback, surgery or combination treatments.

Section snippets

Method

A descriptive, correlational design was used to examine the impact of UI on daily activities, the degree of UI symptom distress and the relationships among UI impact, symptom distress and the presence of treatment-seeking behavior. This study is a part of a sequential intervention study, which explores the effect of group education on performing PFME provided by a nurse-led UI team.

Results

The distributions of demographics, UI symptom type and duration, and treatment-seeking behavior among participants are shown in Table 1. Sixteen (15%) women were under age 40. The peak age was in the range of age 41–50 years. Three-fourths of the subjects had a moderate level of education, and only 22% had more than 12 years’ education. Forty-seven (45%) women were overweight. The most frequently reported range of vaginal delivery was 2–3 (63%).

Sixty (57%) subjects reported the symptom of

Discussion

Over half of the women in this study reported symptoms of stress UI, the most common symptom type in women over age 40. These results are consistent with Taiwanese reports by Tseng et al. (2000) and Yu et al. (1994). Only 29% of subjects had sought treatment before participating this study, a higher percentage than the 18% reported by Yu et al. (1994) and the 2% reported by Ushiroyama et al. (1999). This result can be due to the studying women mainly recruited from urology and gynecology

References (25)

  • K. Holst et al.

    The prevalence of female urinary incontinence and reasons for not seeking treatments

    New Zealand Medical Journal

    (1988)
  • Y.W. Huang et al.

    Psychosocial impacts and coping strategies of women with stress urinary incontinence

    Tzu Chi Medical Journal

    (1997)
  • Cited by (0)

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