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Influencing factors of urinary incontinence severity and its relationship with sexual function: a cross-sectional study

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https://www.eduzhai.net International Journal of Nursing Science 2014, 4(2): 17-21 DOI: 10.5923/j.nursing.20140402.01 Factors Contributing to the Severity of Urinary Incontinence and Its Association with Sexual Function: A Cross Sectional Study Momenimovahed Zohre1,*, Pakgohar Minoo2, Montazeri Ali3 1Msc of Midwifery Education, Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran 2PHD of Gerontology, Department of Gerontological nursing, Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran 3Professor of Public Health, Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran Abstract Urinary Incontinence (UI) is a common problem worldwide that affects all age groups. The prevalence of UI increases with age. This disorder affects various aspects of the quality of life and sexual function. Different levels of the severity of UI may have different effects on sexual function. Therefore, this study aimed to investigate factors contributing to the severity of urinary incontinence and to assess the relationship between the severity of UI and sexual function. This cross sectional study was conducted on 400 women with the complaint of UI. In this study, four questionnaires were used: a demographic information questionnaire, the questionnaire of urinary incontinence diagnosis (QUID), the Sandvik severity index (SSI), and the pelvic organ prolapse/ urinary incontinence sexual function questionnaire (PISQ-12). In all, 400 women were studied. Most subjects were in the age range 40-54 years. There was a significant difference between the severity of UI and sexual function (P<0.001). The results obtained from multiple regression analysis indicated that the most significant factors in the severity of UI were age and menopause status (P<0.001, P=0.001 respectively). The results of the study show a significant difference between the severity of urinary incontinence and the total score and all domains of PISQ (P<0.001). The relationship between the severity of UI and sexual function in women reflects the need to consider the severity of UI and its impact on other outcomes. Keywords Urinary incontinence, Sexual function, Severity of urinary incontinence 1. Introductions Urinary incontinence (UI) is a common health and social problem worldwide that affects all age groups [1]. The prevalence of UI increases with age [2-3]. This disorder is more common in women than men [4]. Nearly one in every five women reports that urinary incontinence has affected her daily life [5]. UI affects various aspects of health related quality of life. Urinary incontinence has negative effects on the women’s health and many different aspects of their lives. In different studies, the impact of this disorder on the quality of life has been shown [6-9]. UI significantly impairs sexual function as well as the quality of life [10-11]. Women with urinary incontinence suffer from low libido, vaginal dryness, pain during intercourse and infrequent orgasm [12]. * Corresponding author: momeni.z@gmail.com (Momenimovahed Zohre) Published online at https://www.eduzhai.net Copyright © 2014 Scientific & Academic Publishing. All Rights Reserved Different levels of the severity of urinary incontinence may have different effects on sexual function. Few studies have evaluated the factors contributing to the severity of urinary incontinence and its association with sexual function. Most of these studies have only assessed the relationship between urinary incontinence and the quality of life [13-14]. Therefore, this study aimed to assess the factors contributing to the severity of UI and the relationship between the severity of UI and sexual function. Determination of the risk factors can be useful in strategies for prevention, counseling, and coping with the complications of UI. 2. Methodology 2.1. Study Design A cross sectional discriptive design was used in this study to investigate factors contributing to the severity of urinary incontinence and to assess the relationship between the severity of UI and sexual function. 18 Momenimovahed Zohre et al.: Factors Contributing to the Severity of Urinary Incontinence and Its Association with Sexual Function: A Cross Sectional Study 2.2. Setting This study was conducted in urogynecology clinic of Imam Khomeini Hospital, Tehran, Iran. 2.3. Subjects In this study a convenience sampling method was used. This study was performed in a sample of 400 women complaining of UI who attended in the urogynecology clinic of Imam Khomeini hospital. Inclusion criteria were complaint of any type urinary incontinence including stress (SUI), urge (UUI), and mixed urinary incontinence (MUI) for at least 6 months, age at least 20 years, being married and sexually active, ability to read and write and lack of pregnancy. Exclusion criteria were reversible causes of incontinence, functional disability, mental disorders, and associated diseases. 2.4. Tools Tool I: Patient`s information (contributing factors) Patient`s information was collected by a questionnaire designed by the researcher. This information included age, educational level, employement status, height, and weight, menopause status, number of pregnancies and live child, mode of delivery, multiple pregnancy and duration of urinary incontinence. Body mass index (BMI) was calculated by the researcher using height and weight. Tool 2: Type of urinary incontinence UI was determined by the questionnaire for urinary incontinence diagnosis (QUID) were categorized to SUI, UUI and MUI [15]. Tool 3: Severity of urinary incontinence The severity of urinary incontinence was assessed by the Sandvik Severity Index (SSI). SSI is a valid questionnaire that includes two questions and its overall score is calculated by multiplying the frequency of urinary incontinence and the amount of urine leakage: mild (1-2), moderate (3-6), severe (8-9) and very severe (12) [16]. Table 1. Demographic characteristic of the study sample (n=400) Age groups (years) 25-39 45-54 55-69 Type SUI UUI MUI Education Elementary Secondary Higher Employment Employed Housewife BMI <18.50 18.50-24.99 25-29.99 ≥30 Menopause Yes No Mode of delivery NVD∗ C/S∗∗ Both of them Multiple pregnancy Yes No Total(n=400) No(%) 124(31) 188(47) 88(22) 223(55.8) 97(24.2) 80(20) 163(40.8) 177(44.2) 60(15.0) 95(23.8) 305(76.2) 3(0.8) 193(48.2) 190(47.5) 14(3.5) 128(32.0) 272(68.0) 305(76.2) 43(10.8) 52(13) 13(3.2) 387(96.8) Mild(n=109) No(%) 78(62.9) 31(16.5) - 74(33.2) 21(21.6) 14(17.5) 20(12.3) 55(31.1) 34(56.7) 44(46.3) 65(21.3) 1(33.3) 62(32.1) 40(21.1) 6(42.9) 109(40.1) - 54(17.7) 33(76.7) 109(72.2) 1(7.7) 108(27.9) Severity of UI Moderate(n=268) No(%) Sever(n=21) No(%) 46(37.1) 0 156(83.0) 66(75.0) 1(0.5) 20(22.7) 138(61.9) 69(71.1) 61(76.2) 10(4.5) 6(6.2) 5(6.2) 126(77.3) 116(65.5) 26(43.3) 51(53.7) 217(71.1) 2(66.7) 123(63.7) 136(71.6) 7(50.0) 17(10.4) 4(2.3) 0 0 21(6.9) 0 7(3.6) 13(6.8) 1(7.1) 163(59.9) 105(82/0) 0 21(16.4) 229(75.1) 10(23.3) 268(67.0) 20(6.6) 0 21(5.2) 11(84.6) 257(66.4) 1(7.7) 20(5.2) Very sever(n=2) No(%) 0 0 2(2.3) 1(0.4) 1(1.0) 0 0 2(1.1) 0 0 2(0.7) 0 1(0.5) 1(0.5) 0 0 2(1.6) 2(0.7) 0 2(0.5) 0 2(0.5) SUI: Stress Urinary Incontinence, UUI: Urge Urinary Incontinence, MUI: Mixed Urinary Incontinence, BMI: Body Mass Index, NVD: Natural Vaginal Delivery, C/S: Cesarean Section International Journal of Nursing Science 2014, 4(2): 17-21 19 Total PISQ Physical Behavioral- emotive Partner related Table 2. Comparison of PISQ-Score by Severity of UI Mild (n=109) 37.43(1.54) 11.45(0.05) 18.05(1.13) 7.94(0.24) Moderate (n=268) 30.88(4.56) 8.45(2.06) 15.16(2.51) 7.28(0.83) Sever (n=21) 21.00(2.75) 4.38(1.65) 10.52(1.53) 6.10(1.04) Very sever (n=2) 20.00(1.41) 3.50(0.70) 10.50(0.70) 6.00(1.41) P <0.001 <0.001 <0.001 <0.001 Table 3. The results obtained from logistic regression Type SUI UUI MUI Age Education Higher Secondary Primary Employment Employed Housewife BMI Menopause No Yes Pregnancy Child Mode of delivery Both NVD &C/S C/S NVD Multiple pregnancy No Yes duration of UI OR(95% CI) 1.0(ref) 1.72(1.0-2.95) 3.66(2.12-6.31) 1.51(1.38-1.66) 1.0(ref) 11.64(4.03-33.60) 3.70(1.26-10.86) 1.0(ref) 3.95(2.01-7.73) 1.08(0.98-1.19) 1.0(ref) 627.66(179.35-201.19) 2.05(1.68-2.50) 2.36(1.88-2.96) 1.0(ref) 3.52(1.53-8.08) 0.000 1.0(ref) 1.57(0.50-4.91) 1.40(1.19-1.64) P∗ <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.06 <0.001 <0.001 <0.001 <0.001 <0.001 0.21 <0.001 OR(95% CI) 1.0(ref) 1.38(0.36-5.2) 3.22(0.87-11.9) 1.21(1.08-1.36) 1.0(ref) 0.91(0.05-14.64) 1.21(0.08-17.48) 1.0(ref) 0.39(0.06-2.46) 1.17(0.91-1.52) 1.0(ref) 57.62(9.03-367.74) 0.92(0.31-2.78) 1.17(0.37-3.74) 1.0(ref) 2.92(0.31-27.33) 0.000 1.0(ref) 1.27(0.04-40.26) 0.84(0.64-1.09) ∗Obtained from univariate logistic regression analysis ∗∗Obtained from multivariate logistic regression analysis P∗∗ 0.63 0.79 <0.001 0.95 0.88 0.31 0.21 0.001 0.89 0.78 0.34 0.99 0.89 0.19 Tool 4: Sexual function Sexual function was measured using the pelvic organ prolapse/ urinary incontinence sexual function questionnaire (PISQ-12). PISQ is a valid, condition specific and self report questionnaire that assesses sexual function in women with urinary incontinence and pelvic organ prolapse. The short form of the questionnaire (PISQ-12) includes 12 items and three different domains: physical, behavioral- emotive and partner related. Each question is rated on a 5-point scale from 0-4, indicating worse to better conditions. Reverse scores are used for questions 1-4. The highest score is 48 that is achieved in people with better sexual performance [17]. Psychometric properties of the Iranian version of the questionnaire are well documented [18]. 2.5. Statistical Analysis The SPSS version 16 was used for statistical analysis. Data was analyzed using descriptive and analytical methods. Factors associated with the severity of urinary incontinence were studied using ANOVA and chi-square test. In addition, multivariate logistic regression analysis was used to determine potential confounding factors. The relationship between the severity of UI and sexual function was assessed using ANOVA. A P-value less than 0.05 was considered 20 Momenimovahed Zohre et al.: Factors Contributing to the Severity of Urinary Incontinence and Its Association with Sexual Function: A Cross Sectional Study statistically significant. 2.6. Ethics This article is part of master’s degree thesis and the Ethics Committee of Tehran University of Medical Sciences approved this study. All participants completed informed consent forms prior to entering the study. To maintain confidentiality a separate room prepared for the participants. 3. Results 3.1. Demographic Characteristics of the Study Sample In all, 400 women participated in this study and most subjects were in the age range 40-54 (47%). Most participants had secondary education (44.2%) and were housewives (76.2%) (Table-1). 3.2. Relationship between Severity of Urinary Incontinence and Sexual Function Evaluation of the relationship between UI and sexual function using ANOVA show a significant difference between the severity of urinary incontinence and the total score and all domains of PISQ (P<0.001) (Table-2). As shown in Table-3, the results of univariate regression analysis show a significant associations between the severity of urinary incontinence and the type of urinary incontinence, age, educational level, employment, menopause status, number of pregnancies and live child birth, mode of delivery, and the duration of incontinence (P<0.05). To find out the factors that affected severity of urinary incontinence, multivariate regression analysis was performed. The multivariate regression analysis revealed that only age significantly affected the severity of urinary incontinence (P<0.001, P=0.001 respectively) (Table-3). 4. Discussion This study was conducted to explore the factors contributing to the severity of urinary incontinence. The results of this study indicated that age and menopause status were the most important factors that influenced the severity of UI. It can be stated that the most important factor is age; because age can also affect the menopause status. The impact of UI and the higher severity in older age groups reflect the importance of screening in health care systems. The relationship between the severity of UI and sexual function was an important finding of this study. These findings indicate the need for considering the severity of UI in women and its impact on other outcomes. The findings of the present study are similar to the results of a study by Miller et al (2003). This study demonstrated that the severity of UI increased with age. According to their findings, young women had the lowest severity of UI. They concluded that age and BMI were associated with the severity of UI [19]. Casquet et al (2006) concluded that the severity of UI was associated with older age, longer duration of symptoms, more urinary symptoms, and changes in the quality of life [20]. Study conducted by Barentson et al (2012) showed that more severe UI affected the quality of life more [13]. Also, Saadoun et al (2006) conducted a similar study and concluded that more severe symptoms of UI were associated with more impacts on the quality of life [14]. Since sexual health is an important part of women’s health, UI can lead to the reduced quality of life and influences marital relationship. Sexual dysfunction involves physical, social and mental life [21]. Women with UI complain of sexual function to a greater extent [22]. Our study showed that in comparison with patients with mild UI, more severe UI was associated with a lower sexual function. Paick et al carried out a study in 2007. The severity of UI was assessed using the patient perceived incontinence severity (PPIS). Sexual function was measured with the female sexual function index (FSFI). The results of this study indicated that PPIS substantially affected different aspects of quality of life and sexual function [23]. Our study had some limitations which need to be addressed. Exclusion of illiterate women and conducting the study in the referral center were some of the limitations of this study. In order to have better finding, further studies are necessary. REFERENCES [1] Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. International Journal of Gynaecology and Obstetrics 2003; 82(3): 327-338. [2] Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU international 2004; 93: 324-330. [3] Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. 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