Abstract
The study set out to find out how common urine incontinence was in the community and how it affected people’s quality of life and other relevant characteristics. Patients who applied to Family Medicine Outpatient Clinics were asked to complete a questionnaire as part of the study. Participants who consented to participate in the study were given access to a questionnaire that included the Incontinence Quality of Life Scale (I-QOL), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Three Incontinence Questions (3IS) form. There were 18.5% of male participants and 81.5% of female participants in terms of gender distribution. It was found that urine incontinence affected 29.9% of the individuals. The median ICIQ-SF Score values varied statistically significantly depending on whether incontinence was present (P < .001). The ICIQ-SF Score median values according to incontinence types showed a statistically significant difference (P < .001). The total score of the incontinence quality of life scale showed a statistically significant variation based on the presence of incontinence (P < .001). For people without incontinence, the median overall score on the incontinence quality of life scale was 82, whereas for people with incontinence, it was 67. Urinary incontinence (UI) is a frequent health issue that can have a significant negative impact on a person’s quality of life because of the psychosocial impacts, lifestyle limits, and social effects. As a result, it is critical to comprehend the impacts of urine incontinence, create support and treatment plans, and strive toward early patient detection to enhance quality of life.
Keywords: family practice, quality of life, urinary incontinence
1. Introduction
Urinary incontinence (UI) is a major health issue worldwide, affecting the quality of life, especially in the elderly population and among women. Epidemiological studies estimate that 25% to 45% of women and 11% to 34% of men are affected with UI worldwide, though prevalence rates vary significantly between continents and countries due to factors such as aging, genetics, and healthcare access disparities.[1,2] The prevalence of the problem among adult women in Turkey is estimated at about 30%, significantly increasing with age, childbirth, obesity, and chronic diseases. Unfortunately, despite its high prevalence, UI remains considerably underreported and undertreated due to cultural stigma, misconceptions about aging, and lack of proactive screening by healthcare providers.[3–6]
UI seems to become more frequent as people age, while it can develop at different rates in different age groups. Studies show that 25% to 30% of adults over 60 and 30% to 50% of people over 75 suffer from this illness.[1] These rates seem low when compared to the overall population, yet for the older population, they represent a severe health risk.
UI is a prevalent condition among the senior population, although the number of patients reporting symptoms and receiving treatment is low. Some potential causes include the false perception that incontinence is an inevitable part of aging and that it is a symptom that medical practitioners overlook when examining patients. UI not only limits 1 quality of life, but it can also lead to anxiety, social isolation, a decline in self-esteem, decreased sleep, sexual dysfunction, falls, fractures, and dermatitis if left untreated.[2]
This study will search for the prevalence of UI, risk factors, and the effects of UI on the quality of life and point toward the need for early diagnosis and appropriate treatment in Turkey.
2. Methods
On October 18, 2022, the Hacettepe University Non-Interventional Studies Ethics Committee gave its approval (decision number: 2022/16-18, meeting number: 2022/16, project number: GO 22/1006). As a part of our study, patients who applied to Family Medicine Outpatient Clinics were required to fill out a questionnaire. Every method carried out in research involving human subjects complied with the 1964 Helsinki Declaration, its subsequent amendments, and related ethical standards, as well as the ethical guidelines established by the Institutional and/or National Research Committee. Age above eighteen was the sole qualifying factor, while physical or mental impairment, a history of vaginal or cesarean delivery within the preceding 3 months, uropelvic surgical intervention, prostate surgery, or spinal surgery within the preceding 3 months were the only exclusion criteria.
Our study was a cross-sectional study. All patients aged 18 years and above who applied to the outpatient clinics of Family Medicine were evaluated according to the study criteria. The questionnaires of the patients who agreed and met the inclusion criteria were performed after obtaining their informed consent.
Sample size calculation was performed in the current study. In the present study, sample size calculation was performed to estimate UI prevalence and its impact on the quality of life. The total number of 4000 registered patients to Family Medicine was considered as a population. From the power analysis, it was estimated that at least 351 participants are required for a study using a 95% confidence interval with 80% power and a 5% margin of error. Our present study has involved a total of 438 participants.
The first section of the questionnaire asked about the patient’s age, gender, body mass index, history of prior ureteropelvic surgery, diagnosis of any chronic diseases, status regarding daily smoking and water consumption, and whether the patient had been questioned by a physician regarding UI in a clinical setting in the preceding year.
The second component of the questionnaire contains the 3 Incontinence Questions (3IS) form. The 3IS was developed to classify incontinence (urge, stress, other, or mixed type) and point the primary care physician toward the initial treatment approach. Three hundred middle-aged women with mild incontinence participated in a multicenter study that established the 3IS questionnaire as the gold standard for urinalysis. The results showed that the sensitivity and specificity of the questionnaire were 0.86 and 0.60 for stress incontinence and 0.75 and 0.77 for urge incontinence, respectively.[3]
The Incontinence Questionnaire Short Form (ICIQ-SF) score of 8 or higher was found to be the most effective cutoff point for recognizing painful urine incontinence, according to the questionnaire’s third section. The urine incontinence quality of life is rated on a scale from 0 to 21. A low score indicates that UI has little effect on the quality of life, while a high score indicates a considerable influence. The ICIQ-SF scale was developed by Avery et al to assess the impact of urine incontinence on quality of life. It is accessible to all demographics, including men and women, children, and the elderly. Turkish validity and reliability analysis was conducted by Çetinel et al.[4,5]
The final component of the questionnaire scores the Incontinence Quality of Life Scale (I-QOL) items on a 5-category Likert-type scale (1 = very much, 2 = quite a bit, 3 = moderate, 4 = a little, and 5 = not at all). The I-QOL and its subscales are computed by summing the scores on each item and dividing the result by the total number of elements. To make scoring simpler to understand, the total score is converted into a scale value that ranges from 0 (lowest quality of life) to 100 (highest quality of life). Compared to lower scores, higher scores reflect a better level of life quality.[6]
In this study, data were analyzed by using IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk: IBM Corp. Mean, standard deviation, median, minimum (min) and maximum (max) values were determined as descriptive statistics. An independent sample t-test or Mann–Whitney U test was used depending on the compliance of 2 groups with normal distribution. The chi-square test was performed to compare ratios between groups. P < .05 was regarded as the limit of statistical significance.
3. Results
In terms of gender distribution, there were 18.5% of male and 81.5% of female participants. Regarding chronic illnesses, 43.4% of individuals reported having a chronic illness, whilst 56.6% reported not having 1. 3.2% of people with pelvic organ prolapse received a diagnosis, compared to 96.8% of people who did not. Even though 20.5% of participants claimed their doctors had inquired about it when they saw them for a symptom other than incontinence in the preceding year, when we asked them about their incontinence during our survey, we discovered that 29.9% of them had problems with it. Seventy-nine percent of the participants said that their doctors never asked them about their incontinence. It was shown that in the previous 3 months, 31.7% of the subjects experienced urine incontinence. Among those who coughed or sneezed while exercising, 20.3% of them reported having urine incontinence. This illustrates how physical activity affects incontinence in the urine. But 0.9% of people reported having urine leaks when they weren’t moving about or feeling pressed for time. Urge incontinence accounted for 7.5% of all incontinence types, stress-related or stress-induced incontinence for 12.8%, other-caused incontinence for 2.3%, and mixed type incontinence for 7.3%. Table 1 displays the participants’ sociodemographic details.
Table 1.
Descriptive statistics.
| Frequency (n) | Percentage (%) | |
|---|---|---|
| Gender | ||
| Female | 357 | 81.5 |
| Male | 81 | 18.5 |
| Chronic disease | ||
| Yes | 190 | 43.4 |
| No | 248 | 56.6 |
| Diagnosis of pelvic organ prolapse | ||
| Yes | 14 | 3.2 |
| No | 424 | 96.8 |
| History of previous uropelvic surgical intervention | ||
| Yes | 20 | 4.6 |
| No | 418 | 95.4 |
| History of previous spinal surgery | ||
| Yes | 28 | 6.4 |
| No | 410 | 93.6 |
| Prostate surgery history | ||
| Yes | 2 | 0.5 |
| No | 436 | 99.5 |
| Vaginal birth history | ||
| Yes | 122 | 27.9 |
| No | 316 | 72.1 |
| Pregnancy | ||
| Yes | 6 | 1.4 |
| No | 432 | 98.6 |
| Antidepressant use | ||
| Yes | 57 | 13 |
| No | 381 | 87 |
| Diuretic use | ||
| Yes | 24 | 5.5 |
| No | 414 | 94.5 |
| Regular use of drugs | ||
| Yes | 198 | 45.2 |
| No | 240 | 54.8 |
| Number of drugs, if any | ||
| 1 | 104 | 55 |
| 2 | 54 | 28.6 |
| 3 | 25 | 13.2 |
| 4 | 4 | 2.1 |
| 5 | 2 | 1.1 |
| Daily fluid intake | ||
| Does not know | 1 | 0.2 |
| <1500 mL | 156 | 35.6 |
| 1500–3000 mL | 270 | 61.6 |
| More than 3000 mL | 11 | 2.5 |
| Smoking | ||
| Yes | 83 | 18.9 |
| No | 295 | 67.4 |
| Quit smoking | 60 | 13.7 |
| Asked at least once in the previous year about urinary incontinence | ||
| Yes | 90 | 20.5 |
| No | 348 | 79.5 |
| Urinary incontinence in the last 3 mo | ||
| Yes | 139 | 31.7 |
| No. | 299 | 68.3 |
| Describe if you have missed urine in the last 3 mo | ||
| Urgent urge to urinate cannot reach the toilet | 31 | 7.1 |
| Sense of urgency + physical activity | 13 | 3 |
| Exercise coughing, sneezing | 89 | 20.3 |
| No physical activity, no sense of urgency | 4 | 0.9 |
| No | 301 | 68.7 |
| Incontinence type | ||
| Urge incontinence | 33 | 7.5 |
| Stress or stress-related | 56 | 12.8 |
| Other causes | 10 | 2.3 |
| Mixed type | 32 | 7.3 |
| None | 307 | 70.1 |
| Presence of incontinence | ||
| No | 307 | 70.1 |
| Yes | 131 | 29.9 |
| Mean ± S.Deviation | Median (Min-Max) | |
|---|---|---|
| Age (yr) | 45.53 ± 12.73 | 41 (21–80) |
| Height (cm) | 165.01 ± 7.9 | 164 (150–190) |
| Weight (kg) | 69.92 ± 14.11 | 67 (35–125) |
| Body mass index (kg/m²) | 25.89 ± 5.04 | 25 (16.3–52) |
Abbreviations: Max = maximum, Min = minimum, S.Deviation = standard deviation.
There was a substantial statistical difference (P < .001) observed in the median height values based on the forms of incontinence. For urge incontinence, the median height was 158; for stress or stress-induced type, it was 164.5; for other causes, it was 164; for mixed type, it was 160; and for none, it was 165. There was a substantial statistical difference (P < .001) observed in the weight median values based on the forms of incontinence. The median BMI values according to incontinence types showed a statistically significant difference (P < .001). The median values of the number of vaginal deliveries according to incontinence types showed a statistically significant difference (P < .001). Table 2 displays a comparison of sociodemographic traits based on the kind of incontinence.
Table 2.
Comparison of sociodemographic characteristics according to incontinence type.
| Incontinence type | Height (cm) | Weight (kg) | Body mass index (kg/m²) | Number of vaginal births | |
|---|---|---|---|---|---|
| Urge incontinence | Mean ± S.Deviation | 161.15 ± 6.87 | 74.06 ± 15.71 | 28.42 ± 6.83 | 1.58 ± 1.54 |
| Median (Min-Max) | 158 (154–180)b | 70 (57–125)ab | 26,4 (21–52)b | 1 (0–4)b | |
| Stress or stress-related | Mean ± S.Deviation | 164.04 ± 7.13 | 74.34 ± 10.37 | 27.71 ± 3.87 | 1.12 ± 1.19 |
| Median (Min-Max) | 164.5 (155–85)ab | 72 (60–110)b | 27.1 (21.5–38.1)b | 1 (0–3)b | |
| Other causes | Mean ± S.Deviation | 163.8 ± 4.26 | 76.7 ± 16.43 | 29.84 ± 6.82 | 1.2 ± 1.14 |
| Median (Min-Max) | 164 (160–172)ab | 78.5 (60–110)ab | 28.6 (23–38,1)ab | 1.5 (0–3)b | |
| Mixed type | Mean ± S.Deviation | 160.75 ± 7.34 | 79.75 ± 13.85 | 31.5 ± 5.42 | 1.47 ± 1.27 |
| Median (Min-Max) | 160 (152–175)b | 82 (52–105)b | 32,2 (21, 1–40)b | 2 (0–4)b | |
| None | Mean ± S.Deviation | 166.09 ± 8.01 | 67.43 ± 13.72 | 24.58 ± 4.18 | 0.26 ± 0.68 |
| Median (Min-Max) | 165 (150–190)a | 65 (35–125)a | 23.9 (16.3–47.9)a | 0 (0–4)a | |
| Test statistic | 28.279 | 44.711 | 80.673 | 94.993 | |
| P * | <.001 | <.001 | <.001 | <.001 |
Bold values are statistically significant.
Abbreviations: Min = minimum, Max = maximum, S.Deviation = standard deviation.
There is no difference between groups with the same letter.
Kruskal–Wallis H test.
Depending on whether incontinence was present, there was a statistically significant variation in the median height values (P < .001). There was a substantial statistical difference (P < .001) found in the weight medians based on the occurrence of incontinence. The median weight of individuals with incontinence was 75, compared to 65 for those without the condition. Depending on whether incontinence was present, there was a statistically significant variation in the median BMI values (P < .001). Those without incontinence had a median BMI of 23.9, whereas those who did had a median BMI of 28.5. The median values of the number of vaginal births according to the presence of incontinence showed a statistically significant difference (P < .001). The comparison of sociodemographic characteristics according to the presence of incontinence is shown in Table 3.
Table 3.
Comparison of sociodemographic characteristics according to the presence of incontinence.
| Presence of incontinence | Height (cm) | Weight (kg) | Body mass index (kg/m²) | Number of vaginal births | |
|---|---|---|---|---|---|
| Mean ± S.Deviation | 166.09 ± 8.01 | 67.43 ± 13.72 | 24.58 ± 4.18 | 0.26 ± 0.68 | |
| No | |||||
| Median (Min-Max) | 165 (150 - 190) | 23.9 (16.3 - 47.9) | |||
| 65 (35–125) | 0 (0–4) | ||||
| Mean ± S.Deviation | 162.49 ± 7.04 | 75.77 ± 13.28 | 28.98 ± 5.52 | 1.33 ± 1.3 | |
| Yes | |||||
| Median (Min-Max) | 162 (152 - 185) | ||||
| 75 (52–125) | 28.5 (21–52) | 1 (0–4) | |||
| test statistic | 14,509.5 | 12,329 | 9584.5 | 10,855.5 | |
| P * | <.001 | <.001 | <.001 | <.001 |
Bold values are statistically significant.
Abbreviations: Max = maximum, Min = minimum, S.Deviation = standard deviation.
Mann–Whitney U test.
The ICIQ-SF Score median values according to incontinence types showed a statistically significant difference (P < .001). The types of urge incontinence, stress or stress-induced types, other causes, mixed types, and those without incontinence had median ICIQ-SF Score values of 13, 12, 9, and 13, respectively. Groups with urge incontinence, mixed type, stress, and stress-induced incontinence were distinct from those without incontinence. The total score of the incontinence quality of life scale showed a statistically significant variation based on the kind of incontinence (P < .001). The comparison of ICIQ-SF score and incontinence quality of life scale total score according to incontinence type is shown in Table 4.
Table 4.
Comparison of ICIQ-SF score and incontinence quality of life scale total score according to incontinence type.
| ICIQ-SF Score Mean ± S.Deviation Median (Min-Max) |
I-QOL Score Mean ± S.Deviation Median (Min-Max) |
||
|---|---|---|---|
| Incontinence type | |||
| Urge incontinence | 12.85 ± 3.67 | 68.88 ± 8.21 | |
| 13 (5–19)b | 68 (57–84)b | ||
| Stress or stress-related | 12.77 ± 4.32 | 67.38 ± 7.99 | |
| 13 (6–19)b | 65 (56–84)b | ||
| Other causes | 12.7 ± 4.69 | 63.8 ± 7.57 | |
| 12.5 (7–19)ab | 62 (56–75)b | ||
| Mixed type | 12.06 ± 4.41 | 69.75 ± 7.39 | |
| 12 (5–19)b | 70 (56–84)b | ||
| None | 9.29 ± 4.37 | 82.35 ± 6.76 | |
| 9 (0–19)a | 82 (57–93)a | ||
| Test statistic | 45.309 | 181.815 | |
| P * | <.001 | <.001 |
Bold values are statistically significant.
Abbreviations: ICIQ-SF = International Consultation on Incontinence Questionnaire Short Form, I-QOL = incontinence quality of life scale, Max = maximum, Min = minimum, S.Deviation = standard deviation.
There is no difference between groups with the same letter.
Kruskal–Wallis H test.
Based on the occurrence of incontinence, a statistically significant difference (P < .001) was found between the median values of the ICIQ-SF Score. The median ICIQ-SF Score for individuals without incontinence was 9, but it was 13 for those who had the condition. The total score of the incontinence quality of life scale showed a statistically significant variation based on the presence of incontinence (P < .001). The median total score of the incontinence quality of life scale was 82 for those without incontinence and 67 for those with incontinence (Table 5).
Table 5.
Comparison of ICIQ-SF score and incontinence quality of life scale total score according to the presence of incontinence.
| ICIQ-SF score Mean ± S.Deviation Median (Min-Max) |
I-QOL score Mean ± S.Deviation Median (Min-Max) |
||
|---|---|---|---|
| Presence of Incontinence | |||
| No | 9.29 ± 4.37 | 82.35 ± 6.76 | |
| 9 (0–19) | 82 (57–93) | ||
| Yes | 12.61 ± 4.18 | 68.06 ± 7.94 | |
| 13 (5–19) | 67 (56–84) | ||
| Test statistic | 12,035 | 3845.5 | |
| P * | <.001 | <.001 | |
Bold values are statistically significant.
Abbreviations: ICIQ-SF = International Consultation on Incontinence Questionnaire Short Form, I-QOL = incontinence quality of life scale, Max = maximum, Min = minimum, S.Deviation = standard deviation.
Mann–Whitney U test.
According to the presence of incontinence, there was a statistically significant difference in the gender distributions (P = .001). Depending on whether incontinence was present, there was a statistically significant difference (P < .001) seen in the distributions of chronic illness status. The distributions of pelvic organ prolapse diagnosis status according to incontinence presence showed a statistically significant difference (P < .001). Every case under investigation has a different level of incontinence. Table 6 displays a statistically significant difference (P > .05) between the distributions of the other parameters based on the occurrence of incontinence.
Table 6.
Comparison of parameters according to the presence of incontinence.
| Presence of incontinence | Test statistic | P | ||
|---|---|---|---|---|
| No | Yes | |||
| Gender | ||||
| Female | 237 (77.2) | 120 (91.6) | 11.702 | .001 † |
| Male | 70 (22.8) | 11 (8.4) | ||
| Chronic disease | ||||
| Yes | 94 (30.6) | 96 (73.3) | 68.044 | <.001 * |
| No | 213 (69.4) | 35 (26.7) | ||
| Diagnosis of pelvic organ prolapse | ||||
| Yes | 0 (0) | 14 (10.7) | --- | <.001 ‡ |
| No | 307 (100) | 117 (89.3) | ||
| History of previous uropelvic surgical intervention | ||||
| Yes | 8 (2.6) | 12 (9.2) | 7.61 | .006 † |
| No | 299 (97.4) | 119 (90.8) | ||
| History of previous spinal surgery | ||||
| Yes | 19 (6.2) | 9 (6.9) | 0.003 | .957† |
| No | 288 (93.8) | 122 (93.1) | ||
| Prostate surgery history | ||||
| Yes | 2 (0.7) | 0 (0) | --- | 1‡ |
| No | 305 (99.3) | 131 (100) | ||
| Vaginal birth history | ||||
| Yes | 46 (15) | 76 (58) | 84.608 | <.001 * |
| No | 261 (85) | 55 (42) | ||
| Pregnancy | ||||
| Yes | 6 (2) | 0 (0) | --- | .185‡ |
| No | 301 (98) | 131 (100) | ||
| Antidepressant use | ||||
| Yes | 33 (10.7) | 24 (18.3) | 4.005 | .045 † |
| No | 274 (89.3) | 107 (81.7) | ||
| Diuretic use | ||||
| Yes | 6 (2) | 18 (13.7) | 22.404 | <.001 † |
| No | 301 (98) | 113 (86.3) | ||
| Regular use of drugs | ||||
| Yes | 105 (34.2) | 93 (71) | 50.174 | <.001 * |
| No | 202 (65.8) | 38 (29) | ||
| Number of drugs, if any | ||||
| 1 | 60 (61.2) | 44 (48.4) | 4.916 | .296* |
| 2 | 24 (24.5) | 30 (33) | ||
| 3 | 12 (12.2) | 13 (14.3) | ||
| 4 | 2 (2) | 2 (2,2) | ||
| 5 | 0 (0) | 2 (2,2) | ||
| Daily fluid intake | ||||
| Does not know | 1 (0.3) | 0 (0) | 5.773 | .123* |
| <1500 mL | 99 (32.2) | 57 (43.5) | ||
| 1500–3000 mL | 198 (64.5) | 72 (55) | ||
| More than 3000 mL | 9 (2.9) | 2 (1.5) | ||
| Smoking | ||||
| Yes | 52 (16.9) | 31 (23.7) | 7.526 | .023 * |
| No | 219 (71.3)a | 76 (58)b | ||
| Quit smoking | 36 (11.7) | 24 (18.3) | ||
| Asked at least once in the previous year about urinary incontinence | ||||
| Yes | 31 (10.1) | 59 (45) | 68.662 | <.001 * |
| No | 276 (89.9) | 72 (55) | ||
| Urinary incontinence in the last 3 mo | ||||
| Yes | 8 (2.6) | 131 (100) | 402.035 | <.001 * |
| No | 299 (97.4) | 0 (0) | ||
| Describe if you have missed urine in the last 3 mo | ||||
| Urgent urge to urinate cannot reach the toilet | 1 (0.3)a | 30 (22.9)b | 393.141 | <.001 * |
| Sense of urgency + physical activity | 0 (0)a | 13 (9.9)b | ||
| Exercise, cough, incontinence | 7 (2.3)a | 82 (62.6)b | ||
| No physical activity, no sense of urgency | 0 (0)a | 4 (3.1)b | ||
| No | 299 (97.4)a | 2 (1.5)b | ||
Bold values are statistically significant.
There is no difference between groups with the same letter.
Pearson chi-square test.
Yates Correction.
Fisher exact test.
The gender distributions according to the kind of incontinence showed a statistically significant difference (P = .007). The distribution of chronic illness status by type of incontinence showed a statistically significant difference (P < .001). The distributions of pelvic organ prolapse diagnosis status according to type of incontinence showed a statistically significant difference (P < .001). The incontinence-free group was distinct from the others. Table 7 shows that there was a statistically significant variation (P > .05) in the distributions of the other parameters based on the kind of incontinence.
Table 7.
Comparison of parameters according to incontinence type.
| Incontinence type | Test statistic | P * | |||||
|---|---|---|---|---|---|---|---|
| Urge incontinence | Stress or stress-related | Other causes | Mixed type | No | |||
| Gender | |||||||
| Female | 31 (93.9) | 49 (87.5) | 10 (100) | 30 (93.8) | 237 (77.2) | 13.95 | .007 |
| Male | 2 (6.1) | 7 (12.5) | 0 (0) | 2 (6.3) | 70 (22.8) | ||
| Chronic disease | |||||||
| Yes | 22 (66.7)a | 40 (71.4)a | 7 (70)ab | 27 (84.4)a | 94 (30.6)b | 70.358 | <.001 |
| No | 11 (33.3) | 16 (28.6) | 3 (30) | 5 (15.6) | 213 (69.4) | ||
| Diagnosis of pelvic organ prolapse | |||||||
| Yes | 4 (12.1)a | 3 (5.4)a | 0 (0)ab | 7 (21.9)a | 0 (0)b | 55.89 | <.001 |
| No | 29 (87.9) | 53 (94.6) | 10 (100) | 25 (78.1) | 307 (100) | ||
| History of previous uropelvic surgical intervention | |||||||
| Yes | 3 (9.1)ab | 5 (8.9)ab | 0 (0)ab | 4 (12.5)b | 8 (2.6)a | 11.804 | .019 |
| No | 30 (90.9) | 51 (91.1) | 10 (100) | 28 (87.5) | 299 (97.4) | ||
| History of previous spinal surgery | |||||||
| Yes | 3 (9.1) | 6 (10.7) | 0 (0) | 0 (0) | 19 (6.2) | 5.039 | .283 |
| No | 30 (90.9) | 50 (89.3) | 10 (100) | 32 (100) | 288 (93.8) | ||
| Prostate surgery history | |||||||
| Yes | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (0.7) | 0.857 | .931 |
| No | 33 (100) | 56 (100) | 10 (100) | 32 (100) | 305 (99.3) | ||
| Vaginal birth history | |||||||
| Yes | 20 (60.6)a | 30 (53.6)a | 6 (60)a | 20 (62.5)a | 46 (15)b | 85.608 | <.001 |
| No | 13 (39.4) | 26 (46.4) | 4 (40) | 12 (37.5) | 261 (85) | ||
| Pregnancy | |||||||
| Yes | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 6 (2) | 2.596 | .628 |
| No | 33 (100) | 56 (100) | 10 (100) | 32 (100) | 301 (98) | ||
| Antidepressant use | |||||||
| Yes | 9 (27.3) | 13 (23.2) | 0 (0) | 2 (6.3) | 33 (10.7) | 15.254 | .004 |
| No | 24 (72.7) | 43 (76.8) | 10 (100) | 30 (93.8) | 274 (89.3) | ||
| Diuretic use | |||||||
| Yes | 4 (12.1)a | 5 (8.9)ab | 0 (0)ab | 9 (28.1)a | 6 (2)b | 43.727 | <.001 |
| No | 29 (87.9) | 51 (91.1) | 10 (100) | 23 (71.9) | 301 (98) | ||
| Regular use of drugs | |||||||
| Yes | 22 (66.7)a | 36 (64.3)a | 7 (70)ab | 28 (87.5)a | 105 (34.2)b | 54.964 | <.001 |
| No | 11 (33.3) | 20 (35.7) | 3 (30) | 4 (12.5) | 202 (65.8) | ||
| Number of drugs. if any | |||||||
| 1 | 2 (9.1)a | 20 (58.8)b | 4 (57.1)ab | 18 (64.3)b | 60 (61.2)b | 53.694 | <.001 |
| 2 | 8 (36.4) | 11 (32.4) | 3 (42.9) | 8 (28.6) | 24 (24.5) | ||
| 3 | 10 (45.5)a | 3 (8.8)b | 0 (0)ab | 0 (0)b | 12 (12.2)b | ||
| 4 | 0 (0) | 0 (0) | 0 (0) | 2 (7.1) | 2 (2) | ||
| 5 | 2 (9.1)a | 0 (0)ab | 0 (0)ab | 0 (0)ab | 0 (0)b | ||
| Daily fluid intake | |||||||
| Does not know | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.3) | 7.360 | .833 |
| <1500 mL | 15 (45.5) | 22 (39.3) | 5 (50) | 15 (46.9) | 99 (32.2) | ||
| 1500 to 3000 mL | 18 (54.5) | 33 (58.9) | 5 (50) | 16 (50) | 198 (64.5) | ||
| More than 3000 mL | 0 (0) | 1 (1.8) | 0 (0) | 1 (3.1) | 9 (2.9) | ||
| Smoking | |||||||
| Yes | 13 (39.4)a | 9 (16.1)ab | 3 (30)ab | 6 (18.8)ab | 52 (16.9)b | 27.067 | .001 |
| No | 11 (33.3)a | 35 (62.5)ab | 5 (50)ab | 25 (78.1)b | 219 (71.3)b | ||
| Quit smoking | 9 (27.3) | 12 (21.4) | 2 (20) | 1 (3.1) | 36 (11.7) | ||
| Asked at least once in the previous year about urinary incontinence | |||||||
| Yes | 11 (33.3)a | 25 (44.6)a | 5 (50)a | 18 (56.3)a | 31 (10.1)b | 74.052 | <.001 |
| No. | 22 (66.7) | 31 (55.4) | 5 (50) | 14 (43.8) | 276 (89.9) | ||
| Urinary incontinence in the last 3 mo | |||||||
| Yes | 33 (100)a | 56 (100)a | 10 (100)a | 32 (100)a | 8 (2.6)b | 402.035 | <.001 |
| No. | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 299 (97.4) | ||
| Describe if you have missed urine in the last 3 mo | |||||||
| Urgent urge to urinate cannot reach the toilet | 23 (69.7)a | 6 (10.7)b | 0 (0)bc | 1 (3.1)bc | 1 (0.3)c | 720.186 | <.001 |
| Sense of urgency + physical activity | 0 (0)a | 0 (0)a | 0 (0)ab | 13 (40.6)b | 0 (0)a | ||
| Exercise, coughing, sneezing | 8 (24.2)a | 47 (83.9)b | 9 (90)bc | 18 (56.3)ac | 7 (2.3)d | ||
| No physical activity. No sense of urgency | 2 (6.1)a | 1 (1.8)ab | 1 (10)a | 0 (0)ab | 0 (0)b | ||
| No | 0 (0)a | 2 (3.6)a | 0 (0)a | 0 (0)a | 299 (97.4)b | ||
Bold values are statistically significant.
There is no difference between groups with the same letter.
Pearson chi-square test.
There was no statistically significant relationship between the incontinence quality of life scale and ICIQ-SF score in urge incontinence type (P = .907). There was no statistically significant relationship between the incontinence quality of life scale and ICIQ-SF score according to other types (P > .05) (Table 8).
Table 8.
The relationship between ICIQ-SF score and incontinence quality of life scale according to incontinence types.
| Incontinence type | ICIQ-SF score | ||
|---|---|---|---|
| Incontinence quality of life scale | Urge incontinence | r | 0.021 |
| P | .907 | ||
| Stress or stress-induced incontinence | r | 0.084 | |
| P | .538 | ||
| Caused by other causes incontinence | r | −0.401 | |
| P | .25 | ||
| Mixed type | r | 0.152 | |
| P | .407 | ||
| None | r | 0.035 | |
| P | .536 |
Abbreviation: r = Spearman rho correlation coefficient.
There was no statistically significant relationship between the incontinence quality of life scale and ICIQ-SF score in patients without incontinence (P = .536). There was no statistically significant relationship between the incontinence quality of life scale and ICIQ-SF score in patients with incontinence (P = .603) (Table 9).
Table 9.
Association of ICIQ-SF score and incontinence quality of life scale according to the presence of incontinence.
| Presence of incontinence | ICIQ-SF score | ||
|---|---|---|---|
| Incontinence Quality of Life Scale | No | r | 0.035 |
| P | .536 | ||
| Yes | r | 0.046 | |
| P | .603 |
Abbreviations: ICIQ-SF = International Consultation on Incontinence Questionnaire Short Form, r = Spearman rho correlation coefficient.
4. Discussion
This study investigated the relationship between urine incontinence and incontinence quality of life. According to our research, a person’s quality of life may be negatively impacted by urine incontinence. Nonetheless, there are some important components in these findings that need to be considered.
Initially, the impact of urine incontinence on an individual’s quality of life may vary. The type, degree, and lifestyle of an individual with incontinence, as well as their general health, may all influence how severe this condition is. Customizing treatment regimens and accounting for these individual differences are crucial at this point.[7] UI has been reported to affect 25% to 30% of the population; our study indicated that the prevalence was 29.9%, with a statistically significant greater prevalence in the female gender, in line with previous research.[1] Studies reveal that symptoms of urine incontinence are never reported by patients, nor are they frequently treated. This could be the result of false beliefs, such as thinking of pee incontinence as a typical aspect of aging or feeling ashamed to notify doctors of problems until a serious medical problem develops.[8–12] Considering these findings, we concluded that it is imperative that medical professionals ask about urine incontinence in their patients. We found that 20.5% of participants said that at least once in the preceding year, when they saw a doctor for a symptom unrelated to incontinence, their urine incontinence was questioned.
Consistent with the literature, we found that the frequency of UI increased in women, patients with chronic diseases, pelvic organ prolapse, BMI and vaginal delivery.[13–16]
UI may lead to significant psychological and social complications, such as feelings of social isolation and lowered self-esteem. Studies indicate that UI often results in restricted social activities and altered self-concept, which can eventually lead to loneliness and decreased psychological well-being.[17] Other studies have also reported that UI is related to increased levels of depression and social withdrawal because the affected individuals tend to avoid social contact as 1 way of coping discreetly with their problem.[18,19]
We only examined the physical implications in this investigation. Subsequent research endeavors ought to concentrate more explicitly on these psychosocial elements within this setting. People who have incontinence may struggle with psychological problems such as social anxiety, shyness, and low self-esteem. Fear of becoming incontinent could lead to issues in the community. Many studies have shown that people who have urine incontinence are more prone to suffer from mental health conditions such depression and anxiety.[17,20,21]
UI has a major influence on daily quality of life. People might have to cut back on their physical activity and postpone routine activities like traveling. People’s overall well-being and quality of life may suffer because of these limitations. For example, as some studies,[22] have shown, a person with urine incontinence may avoid social situations because they must use the restroom frequently, which could have a detrimental effect on their quality of life. The ICIQ-SF and the incontinence quality of life scale both demonstrated the detrimental impact of urine incontinence on quality of life in our study.
According to research by Minassian et al, urge and mixed type incontinence were more upsetting and had a worse impact on quality of life than stress-related or stress-related incontinence and other forms of incontinence.[19] All forms of urine incontinence were demonstrated to have a significant detrimental impact on quality of life, and our investigation revealed no significant statistical difference between the categories in terms of how they affected quality of life.
It’s important to discuss other options for treating urine incontinence. Therapy procedures have the potential to enhance an individual’s quality of life. Nonetheless, there are benefits and drawbacks to each therapy plan. People should have access to trustworthy and unbiased information to make the optimal treatment decision. Consideration should be given to how urine incontinence affects a person’s quality of life as well as society at large. The quality of life for those who experience incontinence can be enhanced by increasing knowledge, lowering stigma, and providing support. UI can have an impact on both individuals and society. The need for healthcare services may rise, yet job productivity may decline. Some research also shows that because urine incontinence is widely stigmatized, patients may be reluctant to seek therapy. As a result, things can get worse.[12,19,23–26]
A limited sample group was used in the investigation, which was carried out in a single center. For generalization to the broader community, multicenter studies are required. Among the drawbacks of the study is its descriptive nature. There is a margin of error because the data gathered are based on individual statements.
5. Conclusion
Urine incontinence clearly has a negative effect on quality of life, even though the effects are multifaceted. Urine incontinence can be treated well; however, diagnosis and treatment are not always the best options for people who experience this issue. One of the most common causes is the low incidence of patients seeking care. The negative effects of UI on quality of life would undoubtedly decrease if symptoms were not hidden, regular physical examinations were carried out, and physicians were made more aware of the prevalence of the problem.
Author contributions
Conceptualization: Tugba Guler Sonmez, Duygu Ayhan Baser.
Data curation: Tugba Guler Sonmez, Izzet Fidanci.
Formal analysis: Tugba Guler Sonmez.
Funding acquisition: Tugba Guler Sonmez.
Investigation: Tugba Guler Sonmez.
Methodology: Eda Gul Sahin, Hilal Aksoy, Duygu Ayhan Baser.
Resources: Tugba Guler Sonmez, Eda Gul Sahin, Hilal Aksoy.
Software: Eda Gul Sahin.
Supervision: Tugba Guler Sonmez, Izzet Fidanci, Duygu Ayhan Baser.
Visualization: Ebru Ugras.
Writing – original draft: Tugba Guler Sonmez, Ebru Ugras.
Writing – review & editing: Tugba Guler Sonmez, Ebru Ugras.
Abbreviations:
- 3IS
- 3 incontinence questions form
- BMI
- body mass index
- cm
- centimeter
- ICIQ-SF
- International Consultation on Incontinence Questionnaire Short Form
- I-QOL
- incontinence quality of life scale
- Max
- maximum
- Min
- minimum,
- p
- P-value,
- r
- Spearman rho correlation coefficient
- S.Deviation
- standard deviation
- SPSS
- statistical package for the social sciences
- UI
- urinary incontinence.
Informed consent was obtained from all individual participants included in the study.
All patients signed an informed consent form, and the medical ethics review board approved the study.
Informed consent was obtained from all individual participants included in the study.
The Hacettepe University Non-Interventional Studies Ethics Committee granted its clearance on October 18, 2022; meeting number: 2022/16; project number: GO 22/1006; and decision number: 2022/16-18. Patients who applied to Family Medicine Outpatient Clinics were asked to complete a questionnaire as part of our study.
The authors have no funding and conflicts of interest to disclosure.
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
How to cite this article: Güler Sönmez T, Uğraş E, Gül Şahin E, Fidanci I, Aksoy H, Ayhan Başer D. The prevalence of incontinence and its impact on quality of life. Medicine 2024;103:52(e41108).
This article does not contain any studies with human participants or animals performed by any of the authors.
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