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Research Article | DOI: https://doi.org/10.31579/2642-9756/193
1 Obstetrics Gynecological Nursing, Faculty of Nursing Benha University.
2 Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.
*Corresponding Author: Hanan Elzeblawy Hassan, Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.
Citation: Amel A. Hassan Omran., Elham A. Ramadan., Abdelazim Mohamed SS., Hanan E. Hassan, (2024), Women's Psychological Condition and Urinary Incontinence., J. Women Health Care and Issues, 7(2); DOI:10.31579/2642-9756/193
Copyright: © 2024, Hanan Elzeblawy Hassan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 12 January 2024 | Accepted: 09 February 2024 | Published: 15 February 2024
Keywords: urinary incontinence; psychological condition; polychlorinated dibenzofurans
Background: The significant association of symptoms of urinary incontinence with anxiety, fear, and depression alters the QOL and general functioning of the women. A population-based study reported that majority of women with urinary incontinence presented with depression and panic disorders. Aim of the study: examine the effect of stress urinary incontinence on elderly women's psychological condition. Design: A descriptive study design was utilized in this study. Sample: A Purposive sample was used from the above-mentioned setting. Total sample was 100 women who attended to gynecological and urological outpatient clinics at Beni-Suef University Hospital. Tools: Data was collected using: (1) a structure interviewing questionnaire schedule. (2) The International Consultation on Incontinence Modular Questionnaire ICIQ-SF. Results: It indicates that 20% of the studied women reported urine leakage once a week or less often; while 30% leak twice or three times a week, and 45% of the studied women reported urine leakage several times a day, Moreover, 7% of them reported that they leak a large amount in addition, all of them (100%) leak during cough or sneeze. There was a highly statistically significant deference in psychological condition of the women with urinary incontinence (p≤0.01).
Conclusion: It concluded that psychological condition regarding sexual relationship, and negative feelings as (loss of self-confidence, nervousness or anxiety, embarrassed, fear and frustration) were affected by urinary incontinence. Recommendations: Replication of the present study under different circumstances (sampling, setting, measurement, duration of management) is recommended to validate its results.
In general, women report that urinary incontinence (UI) has a greater impact on psychological condition, and self-perception. Nevertheless, comorbidity associated with urinary incontinence such as fungal infections, perineal dermatitis, skin irritation, sores, and rashes by wet skin involves several negative consequences in QOL of women. Frequency, nocturia, urgency, and urge incontinence have also been shown to increase the risk of falls, which may lead to fractures and other morbidities [1-9]. Furthermore, the significant association of symptoms of urinary incontinence with anxiety, fear, and depression alters the QOL and general functioning of the women. A population-based study reported that majority (80%) of women with urinary incontinence presented with depression and panic disorders [1]. Although incontinence is not a life-threatening disease, the loss of bladder control can affect social, psychological, familial, occupational, physical and sexual aspects on patients’ lives. Urinary incontinence leads to reduce quality of life, to cause social isolation and to restriction life styles. Therefore, this disease, as a social problem, personal health prevents employment and education leads to shame and causes rejection from society, ultimately it resulted in moving older peoples from family home to nursing home [10-17].
Research questions
Subject and methods
Study Setting and Sampling:
A Purposive sample was used from the above mentioned setting. Total sample was 100 women who attended to gynecological and urological outpatient clinics at Beni-Suef University Hospital.
Tools of data collection:
Tools that were used for data collection:
Tool I: A structured interviewing questionnaire sheet was developed by the researcher in the Arabic language based on a review of recent literatures, under guidance of supervisors. It was consist of three parts:
The first part: included personal characteristics data of the study women.
Second part: Obstetrics history.
Tool II: The International Consultation on Incontinence Modular Questionnaire ICIQ-SF: (The ICIQ is a self-reported survey and screening tool for evaluating the frequency, severity of urinary incontinence. It consisted of 4 main items of 6 total ask for rating of symptoms in the past 4 weeks. Take sum score of items 3, 4, 5 (items 1 and 2 are demographic) for the actual score. The final item is a self-diagnostic item that is un-scored. The ICIQ-UI Short form provides a score ranging from 0-21; with a higher score indicating greater severity of symptoms; this assessment done before and after intervention.
Scoring system of The ICIQ-UI:
Statistical Design:
The collected data was revised, coded, tabulated and introduced to a computer using statistical package for social sciences (IBM SPSS .25.0). Data was presented and suitable analysis was done according to the type of data obtained for each parameter.
Table (1): Shows that 49% of the studied sample were aged 50-55 years old, 38% aged 55-60 years old and 13% aged more than 60 years old. The mean age of them was 54.23±2.87. Moreover, 71% were from rural areas while 29% of them from urban areas. Also, 52% of them were working and 48% of them are housewives.
Table (2): Illustrates the distribution of studied sample according to obstetrics history. It demonstrates complications during labor revealed that 46% of the studied sample delivered without any complications while 36% experienced prolonged labor, and 14% reported obstructed labor. Regarding, complications during postpartum period, the same table shows that 32%, 18%, and 14% of them complained from chronic constipation and post-partum hemorrhage and Puerperal sepsis respectively.
Figure (1): portrays the distribution of studied sample according to the International Consultation on Incontinence Modular Questionnaire (ICIQ-SF). It indicates that 20% of the studied women reported urine leakage once a week or less often; while 30% leak twice or three times a week, and 45% of the studied women reported urine leakage several times a day, Moreover, 7% of them reported that they leak a large amount (under wear or pad is very wet), while 32% leak moderate amount (under wear or pad is wet), and 61% of them reported that they leak small amount (under wear or pad is damp) of urine. In addition, 2% of them leak during sleeping, while 24% leak before getting to the toilet, and all of them (100%) leak during cough or sneeze.
Table (3): Reveals the distribution of studied sample according to their psychological condition. It illustrates that 60% of them their psychological condition regarding sexual relationship were moderately affected and 50% of them their feeling negative feelings as (loss of self-confidence, nervousness or anxiety, embarrassed, fear and frustration) also moderately affected. It shows that there was highly statistical significant deference in psychological condition of the studied sample (p≤0.01).
Table 1: Distribution of studied sample according to personal characteristics (n=100).
| Personal Characteristics | No | % |
| Age (in years) | ||
| 50-55 years | 49 | 49.0 |
| > 55-60 years | 38 | 38.0 |
| >60 years | 13 | 13.0 |
| Mean ±SD 54.23±2.87 | ||
| Residence | ||
| Rural | 71 | 71. 0 |
| Urban | 29 | 29.0 |
| Occupation | ||
| House wife | 48 | 48.0 |
| Working | 52 | 52.0 |
Table 2: Distribution of studied sample according to obstetrics history (n=100).
| Obstetrics history | No | % |
| *Complication during labor | ||
| No complications | 46 | 46.0 |
| Antenatal hemorrhage | 9 | 9.0 |
| Prolonged Labor | 36 | 36.0 |
| Obstructed labor | 14 | 14.0 |
| *Complication during postpartum | ||
| No complications | 51 | 51.0 |
| Postpartum hemorrhage | 18 | 18.0 |
| Chronic constipation | 32 | 32.0 |
| Puerperal sepsis | 14 | 14.0 |
*results not mutually exclusive
Figure 1: Distribution of studied sample according to their ICIQ-SF scale (n=100)
*results not mutually exclusive
Table 3: Distribution of studied sample according to their psychological condition (n=100)
| psychological condition | A lot | moderately | slightly | Not at all | X2 | P value | ||||
| No | % | No | % | No | % | No | % | |||
| Participating in social activities outside the home | 40 | 40.0 | 42 | 42.0 | 18 | 18.0 | 0 | 0.0 | 54.250 | 0.000** |
| Feeling negative feelings as (loss of self-confidence, nervousness or anxiety, embarrassed, fear and frustration) | 44 | 44.0 | 50 | 50.0 | 6 | 6.0 | 0 | 0.0 | 97.000 | 0.000** |
| Practicing worship (prayers) in the desire manner | 39 | 39.0 | 38 | 38.0 | 20 | 20.0 | 3 | 3.0 | 91.000 | 0.000** |
| Sexual relationship | 21 | 21.0 | 56 | 56.0 | 13 | 13.0 | 10 | 10.0 | 48.725 | 0.000** |
*significant at p≤ 0.05 **highly significant at p≤0.01 Chi test
Despite urinary incontinence isn’t being a life-threatening condition; it has a major impact on psychological and social health and wellbeing, including sleep problems, low self-esteem, depression, and psychological distress. In addition to restrictions in physical activity, relationships, feelings of helplessness, increased risk of urinary tract infections (UTIs), pressure ulcers, falls, and fractures, all of which may lead to functional impairment and decline in overall health status. The restricted activities not only interfere with interpersonal relationships, but also it can damage self-esteem as a result of the shame and embarrassment some older adults feel, and those afflicted women health and quality of life [18]. So this study was conducted to examine the effect of stress urinary incontinence on elderly women's psychological condition. The results of the present study presented distribution of studied sample according to the International Consultation on Incontinence Modular Questionnaire (ICIQ-SF). It indicates that 45% of the studied women reported urine leakage several times a day, 32% leak moderate amount (under wear or pad is wet), and 61% of them reported that they leak small amount (under wear or pad is damp) of urine. In addition, and all of them (100%) leak during cough or sneeze. This is attribute that around half of them 50-55 years and urinary sphincter affected by aging. El-Badway (2019) reported that elderly women have many problems that affect their health, special problems with incontinence because of many changes may occur in the lower urinary tract due to aging, physical limitation and the environments in which they live [19]. Results revealed that psychological condition of 60% of the studied women regarding sexual relationship were moderately affected and 50% of them their feeling negative feelings as (loss of self-confidence, nervousness or anxiety, embarrassed, fear and frustration) also moderately affected. This is expected as urinary incontinence surly will interrupt women's life style; restrict their activity which leads to change psychological conditions as well as “performing daily activities without stress, feeling of confidence and satisfied from sexual relation”. In light of the high prevalence and the psychological and, social consequences of UI in menopausal women, it is necessary to determine an effective treatment for this problem. The International Continence Society recommends conservative treatment as the first line of treatment for incontinent women with a focus on increasing strength and correcting activating patterns of the pelvic floor muscles [20]. In addition, UI patients often experience low self-esteem, low physical attractiveness, body negativity, inadequacy, stigmatization and a reduction of sexual desire, which can lead to loneliness, self-isolation and depression. In the most severe cases, even activities of daily life are compromised since patients must continually interrupt what they are doing to use the bathroom. In addition to all the negative medical and psychosocial aspects, the high economic burden of UI is a factor to be considered: the money spent for pads is an important cost item [21].
It concluded that psychological condition regarding sexual relationship, and negative feelings as (loss of self-confidence, nervousness or anxiety, embarrassed, fear and frustration) were affected by urinary incontinence.
Replication of the present study under different circumstances (sampling, setting, measurement, duration of management) is recommended to validate its results.
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