Chapter 1: IntroductionUrinary Incontinence is asubstantial problem throughout the world.
It significantly impacts individualsand society both socially and economically. Approximation of Prevalence ofincontinence varies as per its definition and study focused population butsignificance of the problem is internationally approved for both humansuffering and economic cost.During first International Consultation on Incontinence in 1998 theWorld Health Organization (WHO) classified urinary incontinence as universalproblem and assessed its prevalence as 200 million.People usually consider urinary incontinence as a disease impactingolder people and chain it to pregnancy as well. Conversely, studies have proventhis consideration incorrect. “It can affect people of all ages even fromdifferent social and cultural background.
1As compared to men, UI is three times more common in women.Noticeably women are suffering from UI more as compared to men which is becauseof anatomical and physiological differences which include reproductive andhormonal changes linked with pregnancy and menopause.2Urinary Incontinence considerably effect the affected people andhealth care systems even though it remains unobserved and undertreated throughthe world by physicians.3 In United States a survey conducted comprisingpopulation of different cultural backgrounds, who pursued medical care forsymptoms of incontinence, only 45% females and 22% males indicated occurrenceof urinary incontinence at least once a week.4 Symptoms of Urinary incontinence extremely harm the quality of lifeof affected along with their families, communities and medical care system butit doesn’t threat life of affected. 5 Most people avoid medical care because of embarrassment andignorance.6There arevarious types of urinary incontinence which include Stress Incontinence, UrgeIncontinence, Overflow Incontinence, Functional Incontinence, MixedIncontinence which are explained as below;Stress incontinence; Upon buildingpressure on your bladder, urine leakage occurs. This pressure can be caused byheavy exercise, lifting some heavy material, laughing, sneezing, coughing.
7Overflow incontinence; In this kindof incontinence, the bladder doesn’t empty completely which cause frequent orcontinuous seepage.Functional incontinence; In this typeof incontinence patient may not make it to the toilet in time because of aphysical or mental impairment keeps you from making it to the toilet in time.For example, in severe pain patient will not be able to unbutton pants fastenough.Urge incontinence; Unexpected orpenetrating need of urination accompanied by spontaneous loss of urine iscalled urge incontinence. Due to urge incontinence patient may need frequenturinations even during night. Urge incontinence may be caused by just infectionor severe neurologic disorder or diabetes.8Mixed incontinence; in this typepatient experience two or more types of urinary incontinence.9Total incontinence presents the constant leakage which can be caused by anatomicdefects.
True prevalence of urinary incontinence turning out to be morechallenging upon different definition and methodologies of diverse nations. Thoughall over the world is it accepted as a disturbing problem through researches.10Moreover, researchers have agreed upon the establishment ofepidemiology in their own societies11 to succeed in managing thisworrying and quiet widespread disease.
Enormous research activities have resulted into advancement ofauthenticated and locality specific tools to study symptoms and effects.12Society and Condition specific guidelines have been given for the use of tools.13Risk Factors or Assessment of the SymptomsResearch conducted in different situations and societies all overthe world a number of variables as risk factors of urinary incontinence. Riskfactors for urinary incontinence among middle-aged population were studiedwhich can be distributed into three main categories; predisposing factors,promoting factors, and obstetric or gynecological factors.14 Predisposingfactors include;Race; Studies in USA have determinedStress urinary incontinence to be found more in Caucasian people than that ofAsian origin or African-American women.Family predisposition; women withprevious family history of urinary incontinence are on high risk of symptoms.Anatomical abnormalities; women withinherited defects of the ureters or the urethra were observed on increased riskof urinary incontinence.Neurological abnormalities; inheriteddefects triggered neurological problems increase risk of developing urinary incontinence.
Promoting factors include;Age; bladder capacity, strength ofpelvic muscles are the main ageing factors towards urinary incontinence.Comorbidities; reduction inmovement and functionality of main body parts cause urinary continence. Obesity; excess weight causes straining andweakening of pelvic floor muscles resulting into Stress Urinary Incontinence.15Constipation; Shrinkage ofpelvic floor muscles resulting into constipation which cause pudendal nervedamage inventing urinary incontinence.Occupational and recreational activities; severe physically actions create abdominal pressure which isrecognized to result in prevailing urinary incontinence.
These severe physicalactivities can accelerate symptoms of urinary incontinence.Lung disease and smoking;intra-abdominal pressure due to lung diseases result into risk of urinary incontinenceto be more definite. Coughing tendency of Smokers could result into urinaryincontinence.Urinary tract infection; it is reportedto be a cause of urinary incontinence.Cognitive impairment and disability; Memory decline decreases the ability of controlling urination.
Physical disabilities prevent from getting to the toilet on time.Medications; inter-drug interfaceaffect urinary incontinence. Obstetric and gynecological factors include;Pregnancy; occurrence anddisappearance of urinary incontinence during and after delivery is quite commonbut it increases the risk for developing incontinence later on.Childbirth; C Section orCaesarean section presents less risk of urinary incontinence than that ofVaginal delivery. As compared to natural vaginal delivery, instrumental vaginaldeliveries increase risk of urinary incontinence.Parity; urinary incontinence is also linkedto number of deliveries but this phenomenon is more in younger women than in olderwomen.16 Pelvic surgery and radiation; pelvicsurgeries and radiation therapies are recognized risk factors for urinaryincontinence. Anumber of other factors can also result into Urinary incontinence or effect itsintensity.
I have included hypertension, diabetes, obesity, multiple pregnancyand ageing to be focused as major factors of urinary incontinence in middleadults. I am confident enough that this conducted study will highlight theprevalence of urinary incontinence within middle adults in the society.