- Email: [email protected]
Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences
229
European Journal of Obstetrics & Gynecology and Reproductive Biology, 43 f 1992) 229-234 0 1992 Elsevier Science Publishers B.V. All rights reserved002th2243/92/$05.00
EUROBS
01280
Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences H. Rekers
‘, A.C. Drogendijk
2, H. Valkenburg
’ and F. Riphagen
’
’ International Health Foundation, Brussels, Belgium and ’ Department of Obstetrics and Gynaecology and .’ Department of Epidemiology and Biostatistics. Unirvrsity of Rotterdam. Rotterdam. The Netherlands Accepted
for publication
9 September
1991
Summary
We investigated the prevalence and the consequences of urinary incontinence in a group of 1299 women aged 35 to 79. Incontinence was present in 344 women (26.5%), in 5.9% the incontinence occurred at least once daily. The prevalence was highest in the younger age-groups and lowest between 65 and 69 years of age, thereafter it increased again. Almost half of the incontinent women used protective sanitary towels. In contrast to this, only 13.3% considered themselves handicapped by their symptoms, and only 28.2% had ever seeked medical help, although the symptoms had been present for as long as 7.5 years on average. The major reason for not seeking medical help was that the symptoms were not considered to be so serious. Urinary
incontinence;
Ep+miology
Introduction
Urinary incontinence is a common, often underreported disorder in women [l-5]. Over the past 10 years different studies have been dedicated to the prevalence of incontinence in nonhospitalized women, especially in the U.K., North America and Scandinavia [3-111. The reported prevalence of incontinence in these studies varies between 17 and 45%. This wide variation may be partly due to the different data-sampling methods, different definitions, different age-groups
studied or real differences between the populations studied. In any case, it severely restricts extrapolation of the prevalence rates found to other populations. No data are available on the prevalence of incontinence in the female population on the European continent. Furthermore, epidemiological data on the consequences of incontinence are scarse. We have therefore studied the prevalence and the consequences of urinary incontinence in women living in the community in The Netherlands. Population
Correspondence: H. Rekers, International Health Avenue Don Bosco 8, 1150 Brussels, Belgium.
Foundation,
and Methods
The study was conducted in the city of Zoetermeer (80.000 inhabitants) located in the industrial and business centre of The Netherlands. The
230
population of Zoetermeer is a mixture of the rural ‘original inhabitants’ and the urban ‘immigrants’ from the neighbouring larger cities. This population mix reflects the composition of the Dutch population at large. In coordination with the Bureau for Population Registration, a stratified sample of women between 35 and 80 years of age living in the community was drawn from the city register. Two-thirds of the selected women were between 45 and 64 years old. This stratification was done to obtain a sufficient number of women around the menopausal age and shortly thereafter, in order to minimize the risk of recall bias about the menopause. This because our study partially concentrated on the relation between the menopause and the onset of incontinence [12]. Women living in residential homes for the elderly or who were receiving institutional care for other reasons were excluded from participation. A letter explaining the study and a questionnaire in optical reader format were sent to each of the selected women. It contained questions on seven topics: general background, menopause, pelvic surgery, urinary incontinence, other symptoms of the lower urinary tract, deliveries and past and present diseases and drug use. After 2 months a postal reminder was sent to the non-responders and after 4 months another reminder, this time again accompanied by the questionnaire. All completed questionnaires were computed and analysed using the BMDP statistical programs [13]. The nature of the questions on urinary incontinence (defined in the questionnaire as ‘involuntary loss of urine’) enabled an interpretation at various levels of frequency and severity. In parts of the analysis an arbitrary division was made into ‘serious’ and ‘minor’ incontinence. For this purpose serious incontinence was defined as incontinence occurring at least once a week and in larger amounts than a few drops of urine. All other incontinence was regarded as minor. A section of the questionnaire was dedicated to the consequences of incontinence and included questions about the use of protective pads, social and financial consequences and medical consultation.
Results
Of the 1920 women selected, 22 were unable to respond. 13 had moved house, and two had died in the time-interval between drawing the random sample and the sending out of the questionnaire, seven were too ill or demented. 135 women actively refused to fill out the questionnaire and 464 women did not respond. In order to establish whether a more active pursuit of the non-responders would be useful, an attempt was made to approach 139 randomly chosen non-responders by telephone. From the answers we learned that this approach might increase the response rate by 4-5% and further attempts were stopped. Completed questionnaires were returned by 1299 women (67.7%). Table I gives the response in each 5-year age-group. There were no consistent age-dependent differences in the response rate. The slightly lower response rates in the 60-64 and 75-79 year groups are unexplained. 72% of the respondents were married, 9% divorced, 14% widowed and 5% single. 1284 women (98.9%) took care of household matters themselves, 15 women (1.1%) were living in with family or relatives. A large majority of the women took care of daily shopping themselves (94.7%). These figures are in agreement with those of the Dutch female population in this age-group. As a consequence of the age stratification, 27.3% of the respondents were premenopausal
TABLE Response
I by age-group
Age
No. sent
group
out
Response
%
35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
128 128 320 320 320 320 128 128 128
93 98 219 216 221 198 90 86 78
72.6 76.6 68.4 67.5 69.1 61.9 70.3 67.2 60.9
Total
1920
1299
67.7
231 TABLE
II
Frequency
TABLE incontinence
and amount
of urine lost
n
Frequency < 1 x /month < 1 X/week
(still
having
macteric strual
(no bleeding
menopausal
a regular regular in the (last
% of all women
past
menstrual
Age group 35-39 40-44 45-49 50-54 55-59 60-63
174 148
13.4 11.4
65-69 70-74 75-79
93 98 219 216 221 19X 90 X6 78
16
1.2
Total
1299
91 242
7.5 1X.6
cycle),
but
at least
year)
and
bleeding
6.6% one
cli-
men-
66.1% post1 year
ago
(26.5%) reported involuntary loss In Table II a subdivision is made according to frequency and amount of urine lost. More than half of the incontinent women lost urine at least once a week and 22.4% (5.9% of all women> at least once every day. Only 16 women lost so much urine that it necessitated change of clothing. For further analyses the incontinence was subdivided in serious and minor incontinence. According to the used definitions, 97 women had serious incontinence (at least once a week a little or more urine was lost) and 242 minor incontinence. The prevalence of incontinence in the various age-groups is given in Table III. The highest prevalence was found in the younger age-groups (approximately 30%) and the lowest (14.4%) in the 65-69 years age-group. In the oldest agegroup the prevalence increased again to 25.6%. This age effect was not affected by the frequency or the severity of the incontinence. Both for serious and minor incontinence the prevalence was highest in the younger women in the study, lowest between 65 and 69 and higher again in the women between 75 and 79 years of age (Fig. 1). However, 344
women
incontinence
Respondents
6.9 6.1 7.5 5.9
or longer). of urine.
of urinary
90 19 9X 77
menstrual cycle,
Prevalence
III by age Incontinent
q
29 26 70 61 61 47 13 17 20
31.7 26.5 32.0 28.2 27.6 23.7 14.4 19.x 25.6
344
26.5
in the older age-groups the prevalence of serious incontinence was proportionally higher than in the younger women. This trend is further illustrated in Table IV: both for ‘daily incontinence’ and ‘larger amounts of urine lost than drops’ there is a trend towards higher prevalences in the oldest age-group. The same trend was also seen between other arbitrarily chosen age-groups. On average, the incontinence had been present for 7.5 years at the time of the survey. In younger women this period was shorter than in older women. In 24 women the incontinence had been present for more than 20 years. No duration effect could be noticed on either the frequency of incontinence or the amounts of urine lost. From the time of onset, the frequency had remained
35-39
45-49 10-14
Fig. 1. Prevalence
55-59 50-54
65~69 65-6-L
of incontinence
‘1-79
-a---(
by age.
232 TABLE V
TABLE IV Frequency of incontinent age-groups
episodes and amount lost in three
Incontinent women (%I Age group: 35-39 Number: (125) Frequency Less than 1 x /month 1 x /month to 1 x /week 1 X/week to 1 X /day More than 1 x /day
40-64 (169)
l
65-79 (50)
27
26
25 33
22 26
15
26
25 21 23 31
54 38 8
53 45 2
41 54 5
Amount lost
Drops A little A lot
Reasons mentioned for feeling handicapped by incontinence
. . . l l
. l
the same in 70.6% of the incontinent women, had increased in 16.3%, and decreased in 13.1%. The amount of urine lost had not changed in 77.2%, increased in 12.7% and decreased in 10.1%. 158 of the incontinent women (45.9%) used protection against the loss of urine. In 125 this was restricted to sanitary towels, of which on average 2 per day were used. Thirty-three women needed larger dressings. The use of sanitary protection was higher in the women with serious incontinence (57%) than in the women with minor incontinence (42%). It was also higher in younger women than in older women. Fifty-nine women (17.1%) also used protection during the night, although only six women indicated that they actually bedwetted themselves. Forty-six (13.3%) of the incontinent women considered themselves handicapped by the symptoms. The reasons for this are given in Table V. The small numbers did not permit an analysis of this item in subgroups. None of the woman in our study had given up working because of the incontinence. In spite of the fact that most women had had their incontinence symptoms for years, only 28.2% of them had ever visited a doctor for the symptoms. This frequency was both affected by the severity of the incontinence and by age. Fortythree (44%) of the women with serious incontinence and 54 (22%) of those with minor incontinence had ever consulted a doctor. Table VI
I must always know where the nearest toilet is I had to give up sport I must always take care not to wet myself I can not go to church anymore I can not visit relatives anymore I can not do my own shopping anymore It bothers me at my work It disturbs my sexual relation
n
%
26
7.6 2.9
10 8 5 5 4 4 2”
2.3 1.5 1.5 1.2 1.2 0.6
a 230 of the 344 women (66.9%) were still sexually active,
compared with 61.5% of the continent women.
shows some data on the differences in medical consultation and treatment by age. Fewer of the older women with incontinence had visited a doctor, but the referral rate in this age-group was higher and twice as many had undergone surgery. Physiotherapy or bladder training had more often been used in the younger women. 87.6% of the women who gave a reason why they had never seeked medical help answered that their symptoms were not so serious. Other reasons mentioned were: fear for surgery 3.6% and negative ideas about treatment possibilities 2.9%. Fifty-three of the incontinent women (15.4%) indicated that they could not or did not want to talk about it. The three major reasons for this were: not wanting to talk about it (40%), not knowing to whom to talk to (34.3%) and having
TABLE VI Medical consultation for incontinence in three age-groups Age group: 35-49
50-64 (169)
65-79 (50)
25
24
64 18
68 21
86 37
32
30
23
Number: (125) Incontinent women (%I . Visited a doctor
34
Women who visited a doctor (%) . Referred to specialist . Undergone surgery l Undergone physiotherapy or bladder training
233
the idea that other people could not help them (20%).
in the analysis of the prevalence of daily incontinence. In our study 5.9% of all women suffered from daily incontinence. Both in Yarnell’s and Holst’s
studies it was 4.9% [4,9]. Jolleys mentioned that 6% of all women require daily sanitary protection for incontinence [5]. Comparing the amounts of urine lost by women in the various studies is not possible, due to totally different definitions used. Medical consultation for incontinence was low (28.2%) in the group of women that we investigated, although in the majority of women incontinence had been present for years. Even in the group of women who lost considerable amounts of urine at least once a week, less than 50% had ever seeked medical help for their symptoms. In other studies the percentage of medical consultation was even lower than in ours. Holst reported that of the women who considered that their incontinence interfered with their social life, only 35% had consulted their doctor about it [9]. In Yarnell’s study the percentage of all incontinent women who had seeked medical help was 8.8% and in Thomas’ study 10.1% of the incontinent women received any sort of skilled help [3.4]. Almost 90% of the women in our study who had not consulted a doctor gave as reason that the incontinence was not so serious. To a slightly lesser extent the same was also the case in the other studies where this question was asked (82% and 73%, respectively [9,51X This reason corresponds very well with the low percentage of incontinent women who mentioned that they felt handicapped by their symptoms: 13.3% in our data, between 3 and 14% in the other studies [4.5,9,101. Urinary incontinence in women is a disorder with a high prevalence. Our data show that 21% of Dutch women between 35 and 80 are incontinent less than once daily and that 6% at least once daily. The majority of women seem to have a high level of tolerance for urinary incontinence, even if it occurs regularly and the amount of urine lost is considerable. Consequently, the medical consultation rate for incontinence is low and the large majority of incontinent women are not known to be by their physician or gynaecologist. The possibilities to accurately diagnose the cause of incontinence and to subsequently treat it are nowadays widely available and largely successful. A more active role by physicians and gynaecologists in asking about incontinence might result in
234
improved quality of women.
life for
substantial pro-
References 1 Anonymous. Incontinent women. Lancet 1977;i:521-522. 2 Feneley RCL, Shepherd AM, Powell PH, Blannin J. Urinary incontinence: prevalence and needs. Br J Urol 1979;51:493-496. 3 Thomas TM, Plymat KR, Blannin J, Meade TW. Prevalence of urinary incontinence. Br Med J 1980;281:12431245. 4 Yarnell JWG, Voyle GJ, Richards CJ, Stephenson TP. The prevalence and severity of urinary incontinence in women. J Epidem Comm Health 1981;35:71-74. 5 Jolleys JV. Reported prevalence of urinary incontinence in woman in a general practice. Br Med J 1988;296:13001302. 6 Vetter NJ, Jones DA, Victor CR. Urinary incontinence in the elderly at home. Lancet 1981;11:1275-1277.
7 Iosif CS, Bekassy Z. Prevalence of genito-urinary symptoms in the late menopause. Acta Obstet Gynecol Stand 1984;63:257-260. 8 Diokno AC, Brock, BM, Brown MB et al. Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol 1986;136:1022-1025. 9 Holst K, Wilson PD. The prevalence of female urinary incontinence and reasons for not seeking treatment. New Zeal Med J 1988:756-758. 10 Elving LB, Foldspang A, Lam GW et al. Descriptive epidemiology of urinary incontinence in 3100 women age 30-59. Sacn J Urol Nephrol 1989;suppl 125:37-43. 11 Molander U, Milsom I, Ekelund P et al. An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women. Maturitas 1990;12:51-60. 12 Rekers H, Drogendijk AC, Valkenburg H et al. The menopause, urinary incontinence and other symptoms of the genito-urinary tract. Maturitas 1992; in press. 13 Dixon WJ, Brown MB fEds.1. BMDP biomedical computer programs. University of California Press. Berkeley, 1979.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 43 f 1992) 229-234 0 1992 Elsevier Science Publishers B.V. All rights reserved002th2243/92/$05.00
EUROBS
01280
Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences H. Rekers
‘, A.C. Drogendijk
2, H. Valkenburg
’ and F. Riphagen
’
’ International Health Foundation, Brussels, Belgium and ’ Department of Obstetrics and Gynaecology and .’ Department of Epidemiology and Biostatistics. Unirvrsity of Rotterdam. Rotterdam. The Netherlands Accepted
for publication
9 September
1991
Summary
We investigated the prevalence and the consequences of urinary incontinence in a group of 1299 women aged 35 to 79. Incontinence was present in 344 women (26.5%), in 5.9% the incontinence occurred at least once daily. The prevalence was highest in the younger age-groups and lowest between 65 and 69 years of age, thereafter it increased again. Almost half of the incontinent women used protective sanitary towels. In contrast to this, only 13.3% considered themselves handicapped by their symptoms, and only 28.2% had ever seeked medical help, although the symptoms had been present for as long as 7.5 years on average. The major reason for not seeking medical help was that the symptoms were not considered to be so serious. Urinary
incontinence;
Ep+miology
Introduction
Urinary incontinence is a common, often underreported disorder in women [l-5]. Over the past 10 years different studies have been dedicated to the prevalence of incontinence in nonhospitalized women, especially in the U.K., North America and Scandinavia [3-111. The reported prevalence of incontinence in these studies varies between 17 and 45%. This wide variation may be partly due to the different data-sampling methods, different definitions, different age-groups
studied or real differences between the populations studied. In any case, it severely restricts extrapolation of the prevalence rates found to other populations. No data are available on the prevalence of incontinence in the female population on the European continent. Furthermore, epidemiological data on the consequences of incontinence are scarse. We have therefore studied the prevalence and the consequences of urinary incontinence in women living in the community in The Netherlands. Population
Correspondence: H. Rekers, International Health Avenue Don Bosco 8, 1150 Brussels, Belgium.
Foundation,
and Methods
The study was conducted in the city of Zoetermeer (80.000 inhabitants) located in the industrial and business centre of The Netherlands. The
230
population of Zoetermeer is a mixture of the rural ‘original inhabitants’ and the urban ‘immigrants’ from the neighbouring larger cities. This population mix reflects the composition of the Dutch population at large. In coordination with the Bureau for Population Registration, a stratified sample of women between 35 and 80 years of age living in the community was drawn from the city register. Two-thirds of the selected women were between 45 and 64 years old. This stratification was done to obtain a sufficient number of women around the menopausal age and shortly thereafter, in order to minimize the risk of recall bias about the menopause. This because our study partially concentrated on the relation between the menopause and the onset of incontinence [12]. Women living in residential homes for the elderly or who were receiving institutional care for other reasons were excluded from participation. A letter explaining the study and a questionnaire in optical reader format were sent to each of the selected women. It contained questions on seven topics: general background, menopause, pelvic surgery, urinary incontinence, other symptoms of the lower urinary tract, deliveries and past and present diseases and drug use. After 2 months a postal reminder was sent to the non-responders and after 4 months another reminder, this time again accompanied by the questionnaire. All completed questionnaires were computed and analysed using the BMDP statistical programs [13]. The nature of the questions on urinary incontinence (defined in the questionnaire as ‘involuntary loss of urine’) enabled an interpretation at various levels of frequency and severity. In parts of the analysis an arbitrary division was made into ‘serious’ and ‘minor’ incontinence. For this purpose serious incontinence was defined as incontinence occurring at least once a week and in larger amounts than a few drops of urine. All other incontinence was regarded as minor. A section of the questionnaire was dedicated to the consequences of incontinence and included questions about the use of protective pads, social and financial consequences and medical consultation.
Results
Of the 1920 women selected, 22 were unable to respond. 13 had moved house, and two had died in the time-interval between drawing the random sample and the sending out of the questionnaire, seven were too ill or demented. 135 women actively refused to fill out the questionnaire and 464 women did not respond. In order to establish whether a more active pursuit of the non-responders would be useful, an attempt was made to approach 139 randomly chosen non-responders by telephone. From the answers we learned that this approach might increase the response rate by 4-5% and further attempts were stopped. Completed questionnaires were returned by 1299 women (67.7%). Table I gives the response in each 5-year age-group. There were no consistent age-dependent differences in the response rate. The slightly lower response rates in the 60-64 and 75-79 year groups are unexplained. 72% of the respondents were married, 9% divorced, 14% widowed and 5% single. 1284 women (98.9%) took care of household matters themselves, 15 women (1.1%) were living in with family or relatives. A large majority of the women took care of daily shopping themselves (94.7%). These figures are in agreement with those of the Dutch female population in this age-group. As a consequence of the age stratification, 27.3% of the respondents were premenopausal
TABLE Response
I by age-group
Age
No. sent
group
out
Response
%
35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
128 128 320 320 320 320 128 128 128
93 98 219 216 221 198 90 86 78
72.6 76.6 68.4 67.5 69.1 61.9 70.3 67.2 60.9
Total
1920
1299
67.7
231 TABLE
II
Frequency
TABLE incontinence
and amount
of urine lost
n
Frequency < 1 x /month < 1 X/week
(still
having
macteric strual
(no bleeding
menopausal
a regular regular in the (last
% of all women
past
menstrual
Age group 35-39 40-44 45-49 50-54 55-59 60-63
174 148
13.4 11.4
65-69 70-74 75-79
93 98 219 216 221 19X 90 X6 78
16
1.2
Total
1299
91 242
7.5 1X.6
cycle),
but
at least
year)
and
bleeding
6.6% one
cli-
men-
66.1% post1 year
ago
(26.5%) reported involuntary loss In Table II a subdivision is made according to frequency and amount of urine lost. More than half of the incontinent women lost urine at least once a week and 22.4% (5.9% of all women> at least once every day. Only 16 women lost so much urine that it necessitated change of clothing. For further analyses the incontinence was subdivided in serious and minor incontinence. According to the used definitions, 97 women had serious incontinence (at least once a week a little or more urine was lost) and 242 minor incontinence. The prevalence of incontinence in the various age-groups is given in Table III. The highest prevalence was found in the younger age-groups (approximately 30%) and the lowest (14.4%) in the 65-69 years age-group. In the oldest agegroup the prevalence increased again to 25.6%. This age effect was not affected by the frequency or the severity of the incontinence. Both for serious and minor incontinence the prevalence was highest in the younger women in the study, lowest between 65 and 69 and higher again in the women between 75 and 79 years of age (Fig. 1). However, 344
women
incontinence
Respondents
6.9 6.1 7.5 5.9
or longer). of urine.
of urinary
90 19 9X 77
menstrual cycle,
Prevalence
III by age Incontinent
q
29 26 70 61 61 47 13 17 20
31.7 26.5 32.0 28.2 27.6 23.7 14.4 19.x 25.6
344
26.5
in the older age-groups the prevalence of serious incontinence was proportionally higher than in the younger women. This trend is further illustrated in Table IV: both for ‘daily incontinence’ and ‘larger amounts of urine lost than drops’ there is a trend towards higher prevalences in the oldest age-group. The same trend was also seen between other arbitrarily chosen age-groups. On average, the incontinence had been present for 7.5 years at the time of the survey. In younger women this period was shorter than in older women. In 24 women the incontinence had been present for more than 20 years. No duration effect could be noticed on either the frequency of incontinence or the amounts of urine lost. From the time of onset, the frequency had remained
35-39
45-49 10-14
Fig. 1. Prevalence
55-59 50-54
65~69 65-6-L
of incontinence
‘1-79
-a---(
by age.
232 TABLE V
TABLE IV Frequency of incontinent age-groups
episodes and amount lost in three
Incontinent women (%I Age group: 35-39 Number: (125) Frequency Less than 1 x /month 1 x /month to 1 x /week 1 X/week to 1 X /day More than 1 x /day
40-64 (169)
l
65-79 (50)
27
26
25 33
22 26
15
26
25 21 23 31
54 38 8
53 45 2
41 54 5
Amount lost
Drops A little A lot
Reasons mentioned for feeling handicapped by incontinence
. . . l l
. l
the same in 70.6% of the incontinent women, had increased in 16.3%, and decreased in 13.1%. The amount of urine lost had not changed in 77.2%, increased in 12.7% and decreased in 10.1%. 158 of the incontinent women (45.9%) used protection against the loss of urine. In 125 this was restricted to sanitary towels, of which on average 2 per day were used. Thirty-three women needed larger dressings. The use of sanitary protection was higher in the women with serious incontinence (57%) than in the women with minor incontinence (42%). It was also higher in younger women than in older women. Fifty-nine women (17.1%) also used protection during the night, although only six women indicated that they actually bedwetted themselves. Forty-six (13.3%) of the incontinent women considered themselves handicapped by the symptoms. The reasons for this are given in Table V. The small numbers did not permit an analysis of this item in subgroups. None of the woman in our study had given up working because of the incontinence. In spite of the fact that most women had had their incontinence symptoms for years, only 28.2% of them had ever visited a doctor for the symptoms. This frequency was both affected by the severity of the incontinence and by age. Fortythree (44%) of the women with serious incontinence and 54 (22%) of those with minor incontinence had ever consulted a doctor. Table VI
I must always know where the nearest toilet is I had to give up sport I must always take care not to wet myself I can not go to church anymore I can not visit relatives anymore I can not do my own shopping anymore It bothers me at my work It disturbs my sexual relation
n
%
26
7.6 2.9
10 8 5 5 4 4 2”
2.3 1.5 1.5 1.2 1.2 0.6
a 230 of the 344 women (66.9%) were still sexually active,
compared with 61.5% of the continent women.
shows some data on the differences in medical consultation and treatment by age. Fewer of the older women with incontinence had visited a doctor, but the referral rate in this age-group was higher and twice as many had undergone surgery. Physiotherapy or bladder training had more often been used in the younger women. 87.6% of the women who gave a reason why they had never seeked medical help answered that their symptoms were not so serious. Other reasons mentioned were: fear for surgery 3.6% and negative ideas about treatment possibilities 2.9%. Fifty-three of the incontinent women (15.4%) indicated that they could not or did not want to talk about it. The three major reasons for this were: not wanting to talk about it (40%), not knowing to whom to talk to (34.3%) and having
TABLE VI Medical consultation for incontinence in three age-groups Age group: 35-49
50-64 (169)
65-79 (50)
25
24
64 18
68 21
86 37
32
30
23
Number: (125) Incontinent women (%I . Visited a doctor
34
Women who visited a doctor (%) . Referred to specialist . Undergone surgery l Undergone physiotherapy or bladder training
233
the idea that other people could not help them (20%).
in the analysis of the prevalence of daily incontinence. In our study 5.9% of all women suffered from daily incontinence. Both in Yarnell’s and Holst’s
studies it was 4.9% [4,9]. Jolleys mentioned that 6% of all women require daily sanitary protection for incontinence [5]. Comparing the amounts of urine lost by women in the various studies is not possible, due to totally different definitions used. Medical consultation for incontinence was low (28.2%) in the group of women that we investigated, although in the majority of women incontinence had been present for years. Even in the group of women who lost considerable amounts of urine at least once a week, less than 50% had ever seeked medical help for their symptoms. In other studies the percentage of medical consultation was even lower than in ours. Holst reported that of the women who considered that their incontinence interfered with their social life, only 35% had consulted their doctor about it [9]. In Yarnell’s study the percentage of all incontinent women who had seeked medical help was 8.8% and in Thomas’ study 10.1% of the incontinent women received any sort of skilled help [3.4]. Almost 90% of the women in our study who had not consulted a doctor gave as reason that the incontinence was not so serious. To a slightly lesser extent the same was also the case in the other studies where this question was asked (82% and 73%, respectively [9,51X This reason corresponds very well with the low percentage of incontinent women who mentioned that they felt handicapped by their symptoms: 13.3% in our data, between 3 and 14% in the other studies [4.5,9,101. Urinary incontinence in women is a disorder with a high prevalence. Our data show that 21% of Dutch women between 35 and 80 are incontinent less than once daily and that 6% at least once daily. The majority of women seem to have a high level of tolerance for urinary incontinence, even if it occurs regularly and the amount of urine lost is considerable. Consequently, the medical consultation rate for incontinence is low and the large majority of incontinent women are not known to be by their physician or gynaecologist. The possibilities to accurately diagnose the cause of incontinence and to subsequently treat it are nowadays widely available and largely successful. A more active role by physicians and gynaecologists in asking about incontinence might result in
234
improved quality of women.
life for
substantial pro-
References 1 Anonymous. Incontinent women. Lancet 1977;i:521-522. 2 Feneley RCL, Shepherd AM, Powell PH, Blannin J. Urinary incontinence: prevalence and needs. Br J Urol 1979;51:493-496. 3 Thomas TM, Plymat KR, Blannin J, Meade TW. Prevalence of urinary incontinence. Br Med J 1980;281:12431245. 4 Yarnell JWG, Voyle GJ, Richards CJ, Stephenson TP. The prevalence and severity of urinary incontinence in women. J Epidem Comm Health 1981;35:71-74. 5 Jolleys JV. Reported prevalence of urinary incontinence in woman in a general practice. Br Med J 1988;296:13001302. 6 Vetter NJ, Jones DA, Victor CR. Urinary incontinence in the elderly at home. Lancet 1981;11:1275-1277.
7 Iosif CS, Bekassy Z. Prevalence of genito-urinary symptoms in the late menopause. Acta Obstet Gynecol Stand 1984;63:257-260. 8 Diokno AC, Brock, BM, Brown MB et al. Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol 1986;136:1022-1025. 9 Holst K, Wilson PD. The prevalence of female urinary incontinence and reasons for not seeking treatment. New Zeal Med J 1988:756-758. 10 Elving LB, Foldspang A, Lam GW et al. Descriptive epidemiology of urinary incontinence in 3100 women age 30-59. Sacn J Urol Nephrol 1989;suppl 125:37-43. 11 Molander U, Milsom I, Ekelund P et al. An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women. Maturitas 1990;12:51-60. 12 Rekers H, Drogendijk AC, Valkenburg H et al. The menopause, urinary incontinence and other symptoms of the genito-urinary tract. Maturitas 1992; in press. 13 Dixon WJ, Brown MB fEds.1. BMDP biomedical computer programs. University of California Press. Berkeley, 1979.