VOL: 100, ISSUE: 20, PAGE NO: 71
Jeanette Haslam, MPhil, GradDip(Phys), MCSP, SRP, is senior visiting fellow, University of East London
Methodology of a survey
Methodology of a survey
A telephone survey was conducted in 2003 to examine the attitudes, awareness and impact of SUI on the daily lives of women with the condition and the corresponding perceptions among females in the general population. The survey was conducted in Australia, Canada, France, Germany, Italy, Mexico, Spain, Sweden and the UK. A total of 4,558 women over the age of 18 were contacted.
It was hoped that the survey would assist in a better understanding of SUI and how it impacts on women’s lives, as well as increasing awareness of the condition.
A woman was classified as having SUI by a positive response to the question: ‘Sometimes women will experience a leak or involuntary loss of urine when coughing, sneezing, laughing, or during physical activity. Have you experienced any of these symptoms in the past year?’
The response determined whether the woman was given the SUI or ‘general public’ (for people without symptoms of SUI) questionnaire. At least 500 women were surveyed in each of the nine countries.
In the UK, 502 women were interviewed of whom 206 responded positively to the SUI question, giving a prevalence rate for SUI of 41 per cent. In the nine countries surveyed, the UK prevalence rate was the second highest - Canada was higher (42 per cent). The lowest rate was in Spain (23 per cent). The survey average over all countries was 32 per cent (Fig 1). The overall prevalence rate for 18-34-year-olds was 18 per cent; for those in the 35-54 age group it was 37 per cent; and for those over 55 it was 39 per cent.
Almost half of those without symptoms of SUI believed that symptoms start at the age of 50 years but the survey revealed that two-thirds of those with SUI had symptoms before the age of 50.
Women’s understanding It was reported that 71 per cent of the UK women with SUI did not know the correct name for the condition.
Causes of SUI When asked about the main cause of SUI there was a marked difference between the age groups. Of those women with SUI, 34 per cent of the younger women aged 18-24 years identified the main cause as drinking a lot of liquid, while 16 per cent of the 25-44 age group and 14 per cent of those over 45 believed the same.
An increase in fluid intake has only been found to have a modest positive relationship with the severity of incontinence in women over 55 with SUI (Wyman et al, 1991). There does not appear to be any research evidence to suggest that increased fluid intake is a cause of SUI.
Childbirth was believed to be the cause of SUI by 62 per cent of the middle-aged group, 26 per cent of the younger group and 39 per cent of the older group. Many authors have reported this as a cause (Persson et al, 2000; Samuelsson et al, 2000).
Ageing was another possible cause considered by the three age groups. Of the respondents over 45 years of age, 56 per cent believed that ageing was the main cause of SUI, while only 10 per cent of the younger group and 24 per cent of the middle group considered this to be the case. Although urinary incontinence is believed to increase with age, the EPINCONT study (Hannestad et al, 2000) showed that there is an increasing prevalence of SUI until the age of 49 years, which then steadily decreases.
The results of the survey suggest there is a low level of understanding of SUI. For example several other myths were exposed concerning the causes of SUI including feeling under stress or having too much sex.
Impact of SUI on daily life Women with SUI reported having to change their lifestyle in many ways (Fig 2). Those who wore absorbent pads to manage their symptoms were more likely to have lifestyle changes in other areas.
This group of women were also more likely to have spoken to someone about their problem, have consulted a doctor, be older, have had surgery, avoided sexual intercourse due to fear of leakage, used prescription drugs and be married.
The respondents without SUI believed the condition would impact on their social lives, and that they would be worried about ‘accidents’ and would be prevented from living life freely.
Awareness and treatment Swedish women knew most about exercise treatment (80 per cent), prescription drugs (32 per cent) and surgery (60 per cent).
In the UK the respective figures were 34 per cent, 8 per cent, and 26 per cent. The least knowledgeable population was in Mexico, where 58 per cent of the women surveyed were uncertain about any treatment options for SUI.
Australian women were the most likely to have used exercise therapy (53 per cent), prescription drugs (21 per cent) and surgery (18 per cent), with 35 per cent having received no treatment (Fig 3).
In the UK, 64 per cent of women had not received any treatment. In the whole population studied, of those with SUI only 40 per cent were aware of exercise as a treatment for SUI and one-third were aware of surgery.
There is a great need for public awareness campaigns to ensure that women are aware of possible treatment options and they need encouragement to consult their GP about symptoms.
Motivations and barriers Almost all of those without SUI said they would see a doctor within one year of having symptoms. However, only 38 per cent of women with SUI in the survey consulted a doctor with their symptoms.
Many women delayed this consultation, with one in five waiting up to three years and one in ten up to four years or more.
The older the woman the more likely it was that she had consulted a doctor. The factor most likely to make women consult a doctor was frequent leakage of urine.
One-third of women had not spoken to anyone about their symptoms. Married women were more likely to talk to their partners regarding their SUI, while single women tended to speak to a female family member.
Surprisingly more than 60 per cent of women with SUI had not contacted a doctor as they did not feel it was enough of a problem to bother with. Similar findings were made in the study by Hègglund et al (2003).
Sadly almost one third of the women with SUI had not sought treatment as they believed that nothing could be done to help them.
This study shows that many women worldwide experience SUI. Only by being able to assess the population of women that have treatment needs will adequate provisions be organised by each country.
Many of the women had little or no awareness of the possible treatments available to them. Education is needed to help them become more aware that SUI is a treatable condition.
Unless a woman has the basic knowledge that SUI need not be a condition to be accepted but rather one that can be treated, this situation will continue.
The study was presented by Wirthlin Worldwide on behalf of Boeringer Ingelheim and Eli Lilly and Company at the International Continence Society meeting in Florence, Italy, in October 2003