Chapter 1: Introduction
Urinary Incontinence is a
substantial problem throughout the world. It significantly impacts individuals
and society both socially and economically. Approximation of Prevalence of
incontinence varies as per its definition and study focused population but
significance of the problem is internationally approved for both human
suffering and economic cost.
During first International Consultation on Incontinence in 1998 the
World Health Organization (WHO) classified urinary incontinence as universal
problem and assessed its prevalence as 200 million.
People usually consider urinary incontinence as a disease impacting
older people and chain it to pregnancy as well. Conversely, studies have proven
this consideration incorrect. “It can affect people of all ages even from
different social and cultural background. 1
As compared to men, UI is three times more common in women.
Noticeably women are suffering from UI more as compared to men which is because
of anatomical and physiological differences which include reproductive and
hormonal changes linked with pregnancy and menopause.2
Urinary Incontinence considerably effect the affected people and
health care systems even though it remains unobserved and undertreated through
the world by physicians.3 In United States a survey conducted comprising
population of different cultural backgrounds, who pursued medical care for
symptoms of incontinence, only 45% females and 22% males indicated occurrence
of urinary incontinence at least once a week.4
Symptoms of Urinary incontinence extremely harm the quality of life
of affected along with their families, communities and medical care system but
it doesn’t threat life of affected. 5
Most people avoid medical care because of embarrassment and
various types of urinary incontinence which include Stress Incontinence, Urge
Incontinence, Overflow Incontinence, Functional Incontinence, Mixed
Incontinence which are explained as below;
Stress incontinence; Upon building
pressure on your bladder, urine leakage occurs. This pressure can be caused by
heavy exercise, lifting some heavy material, laughing, sneezing, coughing.7
Overflow incontinence; In this kind
of incontinence, the bladder doesn’t empty completely which cause frequent or
Functional incontinence; In this type
of incontinence patient may not make it to the toilet in time because of a
physical 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 fast
Urge incontinence; Unexpected or
penetrating need of urination accompanied by spontaneous loss of urine is
called urge incontinence. Due to urge incontinence patient may need frequent
urinations even during night. Urge incontinence may be caused by just infection
or severe neurologic disorder or diabetes.8
Mixed incontinence; in this type
patient experience two or more types of urinary incontinence.9
Total incontinence presents the constant leakage which can be caused by anatomic
True prevalence of urinary incontinence turning out to be more
challenging upon different definition and methodologies of diverse nations. Though
all over the world is it accepted as a disturbing problem through researches.10
Moreover, researchers have agreed upon the establishment of
epidemiology in their own societies11 to succeed in managing this
worrying and quiet widespread disease.
Enormous research activities have resulted into advancement of
authenticated and locality specific tools to study symptoms and effects.12
Society and Condition specific guidelines have been given for the use of tools.13
Risk Factors or Assessment of the Symptoms
Research conducted in different situations and societies all over
the world a number of variables as risk factors of urinary incontinence. Risk
factors for urinary incontinence among middle-aged population were studied
which can be distributed into three main categories; predisposing factors,
promoting factors, and obstetric or gynecological factors.14
Race; Studies in USA have determined
Stress urinary incontinence to be found more in Caucasian people than that of
Asian origin or African-American women.
Family predisposition; women with
previous family history of urinary incontinence are on high risk of symptoms.
Anatomical abnormalities; women with
inherited defects of the ureters or the urethra were observed on increased risk
of urinary incontinence.
Neurological abnormalities; inherited
defects triggered neurological problems increase risk of developing urinary incontinence.
Promoting factors include;
Age; bladder capacity, strength of
pelvic muscles are the main ageing factors towards urinary incontinence.
Comorbidities; reduction in
movement and functionality of main body parts cause urinary continence.
Obesity; excess weight causes straining and
weakening of pelvic floor muscles resulting into Stress Urinary Incontinence.15
Constipation; Shrinkage of
pelvic floor muscles resulting into constipation which cause pudendal nerve
damage inventing urinary incontinence.
Occupational and recreational activities; severe physically actions create abdominal pressure which is
recognized to result in prevailing urinary incontinence. These severe physical
activities can accelerate symptoms of urinary incontinence.
Lung disease and smoking;
intra-abdominal pressure due to lung diseases result into risk of urinary incontinence
to be more definite. Coughing tendency of Smokers could result into urinary
Urinary tract infection; it is reported
to 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 interface
affect urinary incontinence.
Obstetric and gynecological factors include;
Pregnancy; occurrence and
disappearance of urinary incontinence during and after delivery is quite common
but it increases the risk for developing incontinence later on.
Childbirth; C Section or
Caesarean section presents less risk of urinary incontinence than that of
Vaginal delivery. As compared to natural vaginal delivery, instrumental vaginal
deliveries increase risk of urinary incontinence.
Parity; urinary incontinence is also linked
to number of deliveries but this phenomenon is more in younger women than in older
Pelvic surgery and radiation; pelvic
surgeries and radiation therapies are recognized risk factors for urinary
number of other factors can also result into Urinary incontinence or effect its
intensity. I have included hypertension, diabetes, obesity, multiple pregnancy
and ageing to be focused as major factors of urinary incontinence in middle
adults. I am confident enough that this conducted study will highlight the
prevalence of urinary incontinence within middle adults in the society.