High prevalence of urinary incontinence and poor knowledge of pelvic floor exercises among women in Ladysmith
South African Journal of Obstetrics and Gynaecology, Feb, 2010 by J.P. Madombwe, S. Knight
Urinary incontinence (UI) is a common but under-reported problem among women globally, (1,2) with a reported prevalence between 27% and 42%. (3-7) It is an increasing public health issue in ageing populations. (8) Information on the prevalence and health burden of UI in South Africa is very limited, and there is a need for better understanding of the health burden imposed by this treatable condition and why so few women seek help. In 1998 the South African Demographic and Health Survey (SADHS) measured the prevalence of stress urinary incontinence (SUI) in South Africa for the first time, but only among women who had had children. (2)
In 1998, the World Health Organization’s first International Consultation on Incontinence classified UI as a disease, made recommendations on its assessment and treatment, and advocated raising awareness about its symptoms and prevention. (8,9) There are three types of UI: SUI, urge urinary incontinence (UUI) and mixed urinary incontinence (MUI).
Pelvic floor muscle (PFM) exercises both with and without biofeedback have been shown to be a safe and effective way of significantly improving symptoms of UI. (10) Randomised controlled trials and a Cochrane systematic review have shown that PFM exercises are an effective and safe first-line alternative treatment for all three types of incontinence. (1,8) Despite availability of this safe and effective therapy, Australian women’s knowledge, practices and intentions regarding PFM exercises in 2000 was found to be poor and they needed to be taught how to do the exercises correctly. (11)
UI is a social taboo and often considered a normal consequence of childbirth and ageing, so sufferers remain silent due to embarrassment and the misconception that the condition cannot be treated. (12) In 1998 it was found that only 25% of incontinent Japanese women had consulted a doctor. (7) The situation was similar in Sweden, where 3 out of 4 incontinent women had never sought help because they felt that their incontinence was not a serious illness that needed professional care. (13)
This study aimed to investigate the prevalence of UI in Ladysmith, KwaZulu-Natal, the health-seeking behaviour of affected women, and women’s knowledge of pelvic floor exercises.
Methodology
This was an observational descriptive cross-sectional study of 100 Ladysmith women, randomly selected using dwelling units as a proxy sampling frame. Any adult female over the age of 21 years was included in the study. Exclusion criteria were mental retardation or degenerative brain disease, spinal cord injuries, chronic urinary tract infection, current treatment with diuretics, antipsychotics or opiates, and age over 80.
Data were collected using a custom-designed questionnaire and administered by four trained interviewers, in the language of the respondent’s preference. The wording and the questions were validated by translators and pilot testing to identify any possible problems. The questionnaire was then piloted again among eight women in a gynaecologist’s waiting room to identify any further problems.
To identify UI, the question ‘Do you have any difficulty at all controlling urination?’ was asked. There was a follow-up question on any past problems with controlling urination, and all those who indicated a problem in the past 12 months were taken as having UI. The questionnaire included questions to determine type of incontinence (whether stress, urge or mixed), based on the definitions of the International Continence Society, (14) a section on knowledge of PFM exercises, and a section reporting behaviour.
Using four interviewers threatened the reliability of the questionnaire. In order to overcome this, the interviewers underwent intensive training on how to administer the questionnaire; the importance of asking the questions exactly as they were presented on the questionnaire was explained. Standard prompts were given when necessary.
Simple random sampling of dwelling units reduced selection bias. If there were more than one woman in a home, all were interviewed. Using interviewer-administered questionnaires overcame the problems of low response rate and low literacy, while interviewing respondents in their language of preference reduced language bias. In most cases it was possible to match interviewers and respondents by race, minimising any possible cultural biases.
The Ladysmith community is a very small, urbanised community, and most of the women use similar health facilities. This may mean that the results of this study cannot be generalised to larger cities where there are a variety of health care options available
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