POLSKI
INTRODUCTION
Urinary incontinence is a common medical and psychosocial problem among women. The International Continence Society defines urinary incontinence as a condition in which involuntary urination, observed objectively, constitutes a serious hygiene problem and makes social contacts difficult. The highest percentage of incidence occurs in the perimenopausal period, and then, with age, an even increase in the incidence of characteristic ailments is observed among both sexes [2,3]. The incident of leakage of urine at least once a year occurs in 5-69% of women and 1-39% of men [4]. As a chronic disease, it affects 17-60% of the population, and is twice as common in women. According to data in Poland, 2-3 million females suffer from it. In reality, however, it may be much more common because many women hide their ailments, treating them as embarrassing or inevitably related to the aging process. Patients’ self-esteem clearly decreases, their interest in particular forms of activity decreases, and it has also been proven to have a negative impact on relationships with family and friends, which depreciates the woman in her professional, social and social life [5,6]. This causes the symptoms to worsen, making effective treatment more difficult. In the future, it may be the reason for late diagnosis, as the diagnosis of this disease is based primarily on a detailed interview confirmed by a physical and urodynamic examination.
The development of the disease is facilitated by various factors, which can be divided into predisposing factors, i.e. genetic, anatomical, racial and neurological, and causative factors, e.g. pregnancy, childbirth or pelvic surgery. Promoting factors include obesity, constipation and chronic obstructive pulmonary disease [5, 7].
The aim of the study was to self-assess knowledge and knowledge of factors influencing the development of stress urinary incontinence (SUI).
MATERIAL AND METHODS
164 women took part in the study, mainly from the Minsk District. The research was conducted between September and December 2022. Knowledge was tested using an original survey questionnaire in electronic form, such as CAWI. The respondents’ age, education, place of residence, professional activity and profession were analyzed. The surveyed women were in the age group of 25 to 76 years (Table 1).
Table 1
Characteristics of the study group
It was found that 29% of the respondents lived in the city, while as many as 71% of the surveyed women lived in the countryside. 81% of the respondents were professionally active, 3% were students, and 6% were unemployed. In the studied group of women, the largest number were women with higher education, and the fewest had primary and vocational education (Table 1).
The level of knowledge of the subjects was determined based on the number of correctly identified risk factors, with „sufficient” being defined as providing correct answers to more than half of the questions, and „good” being assuming correct answers to more than 75% of the questions. The relationship between the level of knowledge and selected variables was assessed using the chi-square test. The significance level of p<0.05 was assumed.
The analysis showed that the majority of respondents had a sufficient/good level of knowledge regarding the concept of stress urinary incontinence (Table 1). It was shown that respondents with secondary education had a significantly lower level of knowledge than people with primary/vocational and higher education. The place of residence and age of the respondents were not statistically significantly related to their knowledge of the concept of stress urinary incontinence. Urban residents and people over 40 years of age were more likely to have an insufficient level of knowledge (Table 2). The concept of stress urinary incontinence was known to the majority of study participants - 87%, while 13% of respondents claimed that they had never encountered it.
Table 2
Knowledge of the concept of stress urinary incontinence
The study participants most often gained knowledge about stress urinary incontinence from the Internet - 45% and from health care system employees - 43%, less often from close relatives and family - 24%, based on their own experiences - 21%, but also from leaflets - 19%, brochures - 17%, and from other, unspecified sources - 2% (Table 3).
Table 3
Sources of information about SUI
| Answers | N | % |
|---|---|---|
| Brochures | 28 | 17 |
| Leaflets | 31 | 19 |
| Media | 59 | 36 |
| Healthcare (doctor, midwife) | 71 | 43 |
| Internet | 74 | 45 |
| Subjective symptoms | 35 | 21 |
| Friends / Family | 39 | 24 |
| Other | 3 | 2 |
| Total | 164 | 100 |
The respondents’ knowledge about the causes of stress urinary incontinence was verified. The respondents most often believed that stress urinary incontinence was caused by a large number of deliveries - 65%, its course, including irregularities - 55%, as well as age - 54%, work and excessive physical effort - 52%.
Less than half of the respondents believed that the causes of stress urinary incontinence include the child’s birth weight - 35%, previous gynecological surgery - 35%, overweight - 25%, genetic factors - 11%, hormonal deficiencies - 9%, diabetes - 7%, smoking cigarettes-7%, a diet low in fiber-7%, asthma-5% and sedentary work-5% (Table 4).
Table 4
Causes of SUI*
Some respondents believed that the natural aging process was among the causes of stress urinary incontinence - 15%. About 1/3 of the respondents associated the occurrence of stress urinary incontinence with the use of a diet low in fiber - 3% and a high-fat diet - 32%, fewer respondents with the use of a low-protein diet - 23% and carbohydrate diet - 12%. More than ¼ of respondents were convinced that smoking tobacco products may be associated with the occurrence of stress urinary incontinence. A similar part of the respondents - 26% - indicated that smoking is not associated with the occurrence of stress urinary incontinence, while almost half expressed their opinion ambiguously, declaring that they had no opinion on the assessed issue. Defecation disorders have a direct impact on muscle tone, and thus affect the severity of the symptoms of stress urinary incontinence. Almost ¾ of the surveyed women agreed with this statement, but 22% did not express their opinion clearly.
The majority of respondents (61%) were convinced that there is a cause-and-effect relationship between the occurrence of stress urinary incontinence and the occurrence of this condition among family members. 13% of respondents were convinced of the lack of genetic links influencing the development of stress urinary incontinence, while 26% of respondents gave an ambiguous answer.
DISCUSSION
The study showed that over 80% of the surveyed women had heard about the problem of urinary incontinence, while 64% of the respondents claimed that their knowledge was at a sufficient level, 7% at a good level and almost 30% of the surveyed women had heard about the problem but were unable to comment. to this disease. Research conducted by Stadnicka et al. showed that among the surveyed women, more than half (57%) had not encountered the concept of stress urinary incontinence [6].
The surveyed women indicated the Internet as a source of information about stress urinary incontinence - 45%, followed by health care - 43% of women, the media - 36% of respondents and friends/family - 24%. Stadnicka showed similar results et al. that over 43% of women received information about the disease in question from health care workers [3]. This means that the most reliable source of health information for patients is still their doctor or a nurse or midwife [6].
In terms of the level of knowledge about the causes of stress urinary incontinence, a slight change can be observed. According to research by Stadnicka et al., only 40.7% of respondents were able to name some of the risk factors, while 54.3% were unable to determine the causes of stress urinary incontinence, and some women associated them with the natural aging process of the body [6]. Our own research showed a sufficient and good level of knowledge of women about stress urinary incontinence, while studies by Kopańska et al., Fiodorenko-Dumas et al. and Vaughan et al. indicated a low level of knowledge about stress urinary incontinence and too late initiation of treatment worsens symptoms and leads to complications [16, 17, 18].
The surveyed women stated that the factors increasing the likelihood of SUI to the greatest extent are advanced age - 92%, heavy physical work - 56%, perinatal perineal damage - 50% and repeated urinary tract infections - 50%. Similar results were obtained by Wójtowicz et al., who studied a group of 60 women working in educational institutions and supermarkets in the city of Alwernia. The surveyed women most often indicated menopause - 75%, obesity - 63% and giving birth to a newborn with a body weight >4000g - 54% of respondents as factors increasing the likelihood of SUI [8]. The study by Kubia et al. similarly shows that the risk factors predisposing to stress urinary incontinence include: aging, obesity, pregnancy, hormone deficiency and genetic factors [19].
According to the presented research, a slight change can be observed in the level of knowledge about the causes of stress urinary incontinence. The respondents stated that the factors increasing the probability of SUI are the number of deliveries - 65% of the surveyed women answered this way and the course of deliveries - 56%. More than half of the respondents noticed the influence of age on the occurrence of this disease. Jóźwik also emphasizes that today there is much evidence of a negative impact of vaginal delivery on the function of the pelvic floor and urethra [9]. Least of all respondents associated smoking and a poor diet with stress urinary incontinence in fiber. These were the reasons indicated by only 7% of respondents, similarly to in the research of Stadnicka et al.
The factors contributing to stress urinary incontinence are very difficult for women to define. The harmful effects of smoking, poor diet, obesity and certain types of activity remain unnoticeable for a large part of women. There is little knowledge about the impact of diet on stress urinary incontinence. Only 11% of respondents indicated it as a factor determining the occurrence of stress urinary incontinence. The respondents’ selection of the type of diet was slightly better. A comparable number of respondents indicated a diet low in fiber - 34% and a high-fat diet - 32%, associating it with the occurrence of overweight. Baranowski and Piechota emphasize that stress urinary incontinence occurs in obese women four times more often than in the general population [10].
Similarly, cigarette smoking was one of the least frequently chosen factors contributing to the occurrence of stress urinary incontinence - 7%. Similarly in the study by Stadnicka et al. Only 5% of surveyed women mentioned cigarette smoking as a predisposing factor to the occurrence of stress urinary incontinence. Analysis of a detailed question about the impact of smoking on this disease showed that 29% of women are aware of the risk, and 45% of women have no idea about it.
The issue of births experienced by patients was the first most recognizable cause of stress urinary incontinence. However, only 35% of respondents notice a direct relationship between the child’s birth weight and the mother’s tendency to develop symptoms of the disease, which indicates low general knowledge about the disease under study. In the research conducted by Stadnicka et al., it was the most frequently mentioned factor by 40% of women [21]. However, Moossdorff-Steinhauser et al. in a study conducted between January 1998 and October 2018 regarding the prevalence and/or incidence of urinary incontinence during pregnancy, which included 88,305 pregnant women, gave results indicating that stress urinary incontinence ( 63%) was the most common type of urinary incontinence. 26% of women reported daily urinary incontinence, while 40% reported urinary incontinence at least once a month. At the same time, the examined patients reported embarrassment for this reason, which was perceived as mild or moderate [13] . In another observational study conducted by Moossdorff-Steinhauser et al., on a group of 35,064 women, which took place between January 1998 and March 2020, the weighted average of urinary incontinence in the study group was 31%. This concerned women from 6 weeks to 1 year after giving birth. The most common type was stress urinary incontinence (54%). The incidence of SUI was the same among primiparous and multiparous women and was described by the study group as mild or moderate [14].
The author’s research has shown that vaginal and abdominal surgery predispose to the symptoms of stress urinary incontinence. Respondents were more likely to notice a connection between vaginal surgery and the occurrence of this disease (68%) than abdominal surgery (35%). The fact is that 23% of the participants were women the study found that the type of surgery did not differentiate the severity of symptoms of stress urinary incontinence at all. Jędrzejczyk et al. wrote about the impact of selected gynecological surgeries on the occurrence and type of urinary incontinence. They report in their research that among patients referred for diagnostic tests due to urinary incontinence, as many as 40% were women after gynecological surgery [11]. The reasons for such a frequent occurrence of urinary incontinence in women after gynecological surgery should be attributed to the anatomical proximity of the reproductive organs and the urinary bladder within the myofascial structures of the pelvis, as well as the type of surgical technique. This is not only the result of damage to the urinary tract or disruption of myofascial structures leading to disturbances in the statics of the reproductive organ, but primarily it is the result of damage or disruption of the autonomic innervation of the urinary bladder at the L4, L5 and S1-4 levels [20,21,22 ] Thanks to modern surgical techniques in the pelvic area, complications related to postoperative urinary incontinence have been minimized for patients with persistent (irremovable) risk factors for stress urinary incontinence, such as obesity, heavy physical work and chronic cough, as mentioned by Baranowski et al. [24 ]
The impact of the type of diet on the symptoms of the disease was relatively little known, but this did not translate into the level of awareness of the effects of excretion disorders. More than 74% of respondents closely associate urinary incontinence with previous, long-term defecation disorders. In a study conducted by Stadnicka et al., only 5% of respondents mentioned constipation as a factor predisposing to the occurrence of this ailment [6].
Research has proven that the presence of certain diseases increases the symptoms of stress urinary incontinence. However, the knowledge of the surveyed women about these relationships is low, 45% correctly selected the disease entity contributing to the development of this condition. The remaining respondents most often chose rheumatoid arthritis and osteoporosis as diseases that are directly related to stress urinary incontinence.
Physical exercise is one of the factors predisposing to the occurrence of stress urinary incontinence in women. Respondents in the author’s study were asked about the impact of particular forms of activity on SUI. The correct answer was given by 82% of the examined patients. In the study by Stadnicka et al., it was the most frequently mentioned risk factor by over 2/5 of the respondents [6].
The article by Wójcik et al. analyzed 33 articles published between 2004 and 2021 regarding the role of individual physiotherapeutic methods in the treatment of urinary incontinence. The collection of these publications confirmed the research results in relation to our own research. He also drew attention to the assessment of the effectiveness of individual rehabilitation methods in the treatment of urinary incontinence, which was not the subject of his own research [23].
Particularly interesting, the essence of the SUI problem was presented in thirteen studies (6 comparative and 7 non-comparative) by Dominguez-Antuña E. et al., in which the quality assessment of the included studies was carried out using the Oxford Center of Evidence-Based Medicine scale and the Newcastle-Ottawa scale ( NOS) adapted for cross-sectional studies. A total of 4,823 women aged 18 to 71 years participated in the mentioned study, 91.0% participated in CrossFit training and 1,637 had SUI, indicating a prevalence of 44.5%. Also, 55.3% and 40.7% presented with mild or moderate rates of urinary incontinence, respectively. The most common type reported by respondents was stress urinary incontinence (81.2%). Respondents in the above-mentioned study indicated age, body mass index (BMI) and number of parities as the main risk factors that predispose to an increased likelihood of developing SUI. Jumping exercises have been commonly associated with urinary incontinence [15]. Our study also indicated risk factors such as: number of deliveries, age, and only then body mass index as a decisive parameter when assessing the causes of SUI.
CONCLUSIONS AND RECOMMENDATIONS
Stress urinary incontinence is a serious problem, not only medical but also psychosocial. It occurs so often that it should require the attention of not only a gynecologist, but also a general practitioner. The specificity of the disease is that it can occur at any time in a woman’s life, although research shows that its frequency increases with age. The main cause is considered to be dysfunction of the internal urethral sphincter or excessive mobility of the bladder neck and the proximal section of the urethra. Despite enormous progress in medicine and constantly increasing access to professional literature, women still have relatively low knowledge about the causes of stress urinary incontinence, which means that their preventive measures are very limited.
Stress urinary incontinence is still a hidden and very troublesome disease. It should also be emphasized that women very rarely report this problem on their own initiative, which is mainly due to the specificity of the disease as well as the lack of basic knowledge and information on the possibilities of its treatment and prevention. Even when visiting a gynecologist or family doctor, patients are ashamed to admit their problems, and sometimes they do not know that the use of appropriate therapy can lead to a significant reduction in the severity of symptoms and a significant improvement in the quality of their life [12].
