OBJECTIVE: To determine the distribution of lower urinary tract symptoms in adult women and the frequency with which the women consulted a health care provider for their symptoms. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Community Health Center of Aga Khan University Hospital from November 1st to 30th, 2002. SUBJECTS AND METHODS: A trained interviewer administered a structured questionnaire to women patients or attendants aged 18 years and older coming to the center. RESULTS: Fifty-two percent of the study subjects reported having at least one or more urinary complaints in the past. Stress incontinence was the highest reported complaint (38.4%) followed by burning (34.4%), frequency (26%), painful micturition (20.4%), urge incontinence (18.8 %), incomplete emptying of bladder (14.4%), dribbling (12.4%) and poor stream (8.4%). Forty-three percent of the women with LUTS never consulted a health care provider for their problem.CONCLUSION: Although the distribution of LUTS among females was found to be high, the patients did not consider it important enough to consult a health care provider. There is a need to create awareness among females regarding LUTS and the need to consult a health care provider for their problems

Ambreen, A

Andrades, M

Dhanani, RH

Dodani, S

Paul, R

Qidwai, Waris

English

eCommons@AKU

eCommons@AKUDepartment of Family Medicine Medical College, PakistanJanuary 2004Distribution of lower urinary tract symptoms(LUTS) in adult womenM AndradesR PaulA AmbreenS DodaniRH DhananiSee next page for additional authorsFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_fam_medPart of the Family Medicine CommonsRecommended CitationAndrades, M., Paul, R., Ambreen, A., Dodani, S., Dhanani, R., Qidwai, W. (2004). Distribution of lower urinary tract symptoms(LUTS) in adult women. Journal of College of Physicians and Surgeons Pakistan, 14(3), 132-135.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_fam_med/150AuthorsM Andrades, R Paul, A Ambreen, S Dodani, RH Dhanani, and Waris QidwaiThis article is available at eCommons@AKU: https://ecommons.aku.edu/pakistan_fhs_mc_fam_med/150ORIGINAL ARTICLE ~i-.~ DISTRIBUTION OF LO'YVER URINARY TRACT (LUTS) IN ADULT WOMEN SYMPTOMs J l'!l f t!!lt Marie Andrades, Rose Paul, Aisha Ambreen, Sun ita Dodani, Raheem H. Dhanani and Waris Oidwai (01 ',l:h fh< \\'it Jel ABsTRACT Objective: To determine the distribution of lower urinary tract symptoms in adult women and the frequency with wh· h the women consulted a health care provider tor their symptoms. 10 Design: Cross-sectional analytical study. ; \lit t in== l fl ~0 Place and Duration of Study: Community Health Center ot Aga Khan University Hospital from November 1st to 30th, 2002 Subjects and Methods: A trained interviewer administered a structured questionnaire to women patients or atten: dants aged 18 years and older coming to the center. pre mo Results: Filly-two percent of the study subjects reported having at least one or more urinary complaints in the past Stress incontinence was the highest reported complaint (38.4%) followed by burning (34.4%), frequency (26%), paintui micturition (20.4%), urge incontinence (18.8 %), incomplete emptying of bladder (14.4%), dribbling (12.4%) and poor stream (8.4%). Forty-three percent of the women with LUTS never consulted a health care provider lor their problem. Conclusion: Although the distribution of LUTS among females was found to be high, the patients did not consider it important enough to consult a health care provider. There is a need to create awareness among females regarding LUTS and the need to consult a health care provider tor their problems. A I fro1 qUI iou voi Tat KEY WORDS: Lower urinary tract symptoms. Female. Urinary incontinence. '@<1 --------------------------~----~~--------------------~------------------------------~---.. -- D£ INTRODUCTION Women of all ages report lower urinary tract symptoms (LUTS).l Older individuals are more likely to have co-existing age-related disease conditions wieich may contribute to LUTS. Community-based studies show that the worldwide preva-lence of lower urinary tract symptoms varies widely ranging from 5 to 39%.2-4 Lower urinary tract symptoms broadly include storage and voiding symptoms. Storage symptoms comprise frequency of micturition, nocturia, bladder pain and incontinence while voiding symptoms include hesitancy in micturition, poor stream, intermittency;. straining, dysuria, terminal dribbling, a feeling of incomplete emptying and postvoid dribble.3 Leak-age and frequent night time voiding (nocturia) are the most common lower urinary tract symptoms.l The International Continence Society (ICS) has recently revised the definition of urinary incontinence as "the cOmplaint of any involuntary loss of urine". Incontinence includes both the urge and the stress incontinence.2 A postal survey conducted in a community population of British women above 18 years reported the prevalence of urinary incontinence as 69%.2 The Asia Pacific Continence Advisory Board conducted an Asia-wide epidemiological survey on overactive bladder.' This questionnaire-based survey performed on 5502 females from 11 countries in Asia, including Pakistan, reported the prevalence of overactive bladder as 51%. The most common symptom was urgency (65%) followed by frequency (55%).' Department of Family Medicine, The Aga Khan University Hospital, Karachi. Corr~spondenCe:··or~·Mirfe·· .. A:OdiaC!eS:·Assistant Professor, Family Medicine Department, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi. E-mail: marie.andrades@aku.edu Received August 04, 2003 ; accepted February 27, 2004. 132 ~ lli Ag< 18·: In Pakistan, a hospital-based study on urinary incontinenc~ l ~ reported the frequency of urinary incontinence as 20.5%;how· >~ ever, there is no significant data available regarding LUTS. ~ ~ Although LUTS is common, many women are not aske<i Ma whether they wish to be investigated or treated.' Becauseol i lJrlr the paucity of data concerning local population, this stndr I Ma was done to determine the distribution of LUTS in adult ~ women and the frequency with which the women consultedo health care provider for their symptoms. N01 ~ "'' rn1 Ed nm pATIENTS AND METHODS Ert This study was conducted at the Community Health Cente ~ (CHC) of Aga Khan University Hospital, a tertiary care teach· 011 ing hospital in Karachi, Pakistan. All adult females of 18 yearl and above who consented to the shldy were included. Patien~ t who had registered for a doctor's consultation and/or !hell -accompanying female attendants were contacted. 1;: Ur . I A trained interviewer administered a struchlred questionnauel _ to the study population from November 1st to 30th, 2002,afler! Si pilot-testing it on 15 patients to check for language acceptab'1 : ity. The variables included demographic data, lower urinarl: & · ce: tract symptoms (i.e. storage symptoms of stress incontmen · · Fi frequency, nochlria~ urge incontinence and voiding sympto~. of burning, painful micturition incomplete emptying, dn " bling and poor stream). Risk factors associated with LUTS(~e: u marital status, parity, menopause~ co-morbid medical con_~ tions, surgeries, medications) and .frequency of consultatlO- In with a health care provider were also included. ' o jere A sample size of 246 was calculated using the StatCalc ca 1 p lator of Epi Info 6.0 with an expected frequency of 20%,6 bOll' ( JCPSP 2004: Vol. 14 (3): 132' ,, f 5 % and level of significance of 5%. Data was 0 a database using SPSS version 10 and was ana-frequency tables and logistic regression. information was obtained from 250 study subjects, indud<'a 147 (59%) patients and 103 (41%) attendants. ieaJ> at;c of the study subjects was 35.32 years (SD±12.28) ~j;\i iftinirntrm of 18 years and a maximum of 70 years. The ;;J;,g,.,iphlC characteristics of the study population with and LUIS are shown in Table I. Seventy-three percent were married, of which 14 were pregnant at the time Sixty-five percent (n=162) had one or more ~!zrr~~~~in~i:tlc~1te past while 47 % (n=77) of them had 5 or 130 subjects (52%) in the study population suffered The storage symptoms of stress incontinence, fre-nocturia and urge incontinence ranked first, third, and sixth respectively in order of distribution. The symptoms of burning, painful micturition incomplete 36 (14.4%) 31 (12.4%) <1yr 6 16 0 5 0 2 6 6 f\oof stream I - 21 (8.4%) >1 r <1yr >1yr 11 15 5 9 0 1 0 1 2 1 2 4 j j JCPsp 2004; Vol. 14 (3): 132-135 Table Ill: Age specific distribution of reported lower urinary tract symptoms. Stora e s m toms Total Stress Frequency Nocturia Urge incontinence ~"--19 19.7%) , . 60{24%) Age Total Bmc,icg Paiclcl Dribbliog Poor {yea") mi ;!uri i errpt1 I 25-34 S4(21.6%) 21. I I ' > 4S 60 {24%) %) 1733. 1o) 14 38.8%) 14{4S.1%) 7 Table IV: Risk factors-un:variate analysis. LUTS Variable Positive Negative OR (95% Cl)' P-value n n 86 92 1 .63(.963,2.963) 0.068 ~0 ears 44 28 Pregnancy number Zero 28 60 8.642(2. 102,6.315) <0.000 1 or more 102 60 Marital status Married 112 71 4.294(2.318,7.956) <0.000 Unmarried 18 49 Co-morbid Yes 84 46 ?.93(1.75,.914) <0.000. No 46 74 Surgeries 66 39 2.14(1.28,3.581) <0.000 No 64 81 Meno ause Yes 37 24 0.62(.349, 1.13) 0.1?1 No 93 96 10dds ratio with 95% confidence interval. Table V: Risk factors-multivariate analy$iS. LUTS Variable Positive Negative OR (95% Ci)' P-va!ue Pregnane~ No n n 0 28 60 1 or more 10? 60 • .724(.656,4.528) 0.269 Marital status Married 112 71 Unmarried 18 49 '.967(.695,5.566) 0.023 Co-morbid Yes 84 46 No 46 74 2.157(1.242,3.745) 0.006 Sur eries Yes 66 39 No 64 81 01.156(.633,2.110) 0.637 t0dds ratio with 95% confidence interval. emptying, dribbling and poor stream ranked second, fifth, seventh, eightl1 and ninth respectively (Table II). The age spe· cific distribution of LUTS is shown in Table III. Out of the 130 subjects with LUIS, 43% (n=56) never con?ult-ed a health care provider. The reasons r.tated included not con-sidering LUTS as a problem, being vcorried about other co-morbid conditions, feeling it to be a <tormal ageing process, monetary reasons1 not getting time for consultation, feeling ashamed and self treatment. Of those who did consult, 96 % (n=71) visited doctors as compared to homeopathic doctors, Hakims and Dais. A univariate analysis was performed on six major risk factors associated with.!Jl12.fTh.bk IV). Four out of these six, which is parity, being ever married, Coex~ting co-morbid conditions and a previous history of a pelvic or a,bdominal surgery were \ 133 statistically significant. Multivariate analysis was done to exclude the effect of confounders and showed statistical sig-nificance for being ever married and having a coexisting co-morbid condition (Table V). DISCUSSION LUIS is common worldwide. There is a paucity of data on the prevalence of LUIS in Pakistan. This study showed a high dis-tribution of LUIS (52%). A similar high prevalence of over active bladder (51%) was also found in the Asia-wide epi-demiological survey conducted on 5502 females from 11 Asian countries.' This suggests that compared to the West, LUIS might be more common in Asia. Further studies are needed to verify a significant difference in prevalence of LUIS among Asians and Western population. In this study, stress incontinence (38%) was reported most fre-quently, followed by burning and frequency. The majority (76%) of women were less than 45 years of age which may be the reason that stress incontinence was reported more than urge incontinence (38% and 19% respectively); as stress incon-tinence is present in all age groups whereas urge incontinence tends to be more prevalent in the older age group.' There is also considerable evidence to support the theory. that the prevalence of urinary incontinence increases with increasing age as seen in IJLis study as well. It remains uncertain whether the increase in the prevalence of urinary incontinence is due to the decrease in circulating estrogens at menopause or just part of the aging process.JO Almost 70% of the women reporting burning were less than 45 years of age. Similarly, in a study in Bristol, among women aged 19 years and above, pain symptoms (bladder pain and dysuria) were reported to be more prevalent in the youngest age group (19 to 39 years).!! Fifty-six women (22%) reported having nocturnal voiding of two or more times per night. The prevalence of nocturia in a survey of urinary. dysfunction in a Chinese population in Hong Kong was reported by 166 of 819 women (20%).12 Parous women were three times more likely to report LUIS as compared to nulliparous women. Thomas et al. reported that parous women had incontinence more commonly than nulli-parous women at all ages.13 This incontinence was similar for those with one child and those with two or three children, ,however, women who had four or more babies were most likely to report regular incontinence, therefore, the relation-ship between childbearing and incontinence has to be further clarified.l4 As in other retrospective studies, we also found a positive association between abdominal or pelvic surgery. and lower urinary. tract symptoms. There have been studies supporting an association between hysterectomy and lower urinary tract symptoms.s . Almost half of the women in our study with symptoms had never consulted a health care provider for their complaints. The reasons stated included not considering LUIS as a prob-lem, feeling it to be a normal ageing process, being worried about other co-morbid conditions, not getting time for consul-tation, monetary problems, feeling ashamed and being afraid of doctors. Incontinence is often dismissed by patients as minor.lS They avoid seeking help because they are embar-134 ~··.~ rassed or ashamed. Sometimes they view inca tin >+ normal consequence of bearing children or grow: enc~ as f because they do not understand that it is treatabf olcter',v si who do not seek treatment because of mild or eas;~· IV,">; able symptoms could benefit from knowing the ~ rnana~' symptoms especially if the symptoms progress 1~15 a~! :: severe form. Though the bothersome aspects wer a rn~ ( e not ·! tioned in our study, they should be looked at in future qu~l 1, they can help identify the reasons for low consultati '"« \ . 1 . ld onrate·J our population. In our cu ture 1t wou also be im 's<r inquire about the impact of LUIS on performance opf 0 ' 11ilrlll\ re tgi 1 duties. It has been suggested that the ICS definition1 f" OU;j tinence be expanded to include quality of life issueso 8 !nco,. i social and hygienic problems as perceived by patients~ch~l givers. Social problems would include the statement thatrcare 1 • vidual leisure or work activity is compromised by the'" md,. 1 • '-'LCOnij ' nence. Hygiene problems would rnclude the need to we · \ tective aids or to change under, outer or bed clothes bec::tiJ. i· incontinence.lO eof CoNCLUSION LUIS was common among women, yet 43% of the study sub. Jects never consulted a health care provider. There is a needt create awareness among females regarding LUIS. 0 REFERENCES I 1. Lose G, Alling-Moller L, Jennum P. Nocturia in women. Am]O!i~tl Gyneco/2001; 185:514-21. ,, 2. Swithinbank LV, Donovan JL, du Heaume JC, Rogers CA, James 11 MC, Yang 0, eta/. Urinary symptoms and incontinence in women: relationships between occurrence, age and perceived impact, Br]GenPract 1999; 49:897-900. i 3. Moiler LA, Lose G, Jorgensen T. The prevalence and bathe~· , sameness of lower urinary tract symptoms in women 40 ---60years i of age. Acta Obstet Gynecol Scand 2000; 79: 298-305. 4. Pinnock C, Marshall VR. Troublesome lower urinary tract symp· toms in the community: a prevalence study. Med] Aust 1997; 21: 167: 72-5. 5. Abrams P, Cardozo L, Fall M, Griffiths D, Rasier P, Utmsten U. et a/. The standardisation of terminology of lower urinary trad function: report from the standardisation Sub-committee of the International Contine nee Society. Am] Obstet Gynecol 2002; 187: 116-26. 6. Lapitan MC, Chye PL. Asia Pacific Continence Advisory Board. ·-The epidemiology of overactive bladder among females in Asia: a , .. questionnaire survey.Jnt Urogynecol] 2001: 12; 226-31. 7. Shershah S, Anasri RL. Frequency of urinary incontinence in Pak· istani women.] Pak MedAssoc 1989; 39: 16-7. 8. Abrams P. Lower urinary symptoms in women: who to investigate and how. Br j Uro/1997; 80: 43-8. 9. McDowell JB, Engberg SJ, Rodriguez E, Engberg R, Sereika 5 Characteristics of urinary incontinence in~homebound older adults.] Am Geriatr Soc 1996; 44: 963-8. 10. Milsom I, Eke lund P, Molander U, Arvidsson L, Areskoug B. Th: influence of age, parity, oral contraception, hysterecto(I1Y ar. menopause on the prevalence of urinary incontinence in women ] Uro/1993; 149: 1459-62. 11. Swithinbank LV, Abrams P. Lower urinary tract symptoms in coil',·, munity dwelling women: defining diurnal and nocturnal frequenc) ' JCPSP 2004; Vol. 14 (3): 132· p ..... , t'1nence case, B]U!nt 2001; 88 (suppl2): 18-22, incon Yip sK, Hin LY, Chung TK. The prevalence of urinary in. Hong Kong Chinese women. Obstet Gyneco/1996; 88: · TM, Plymat KR, Blannin J, Meade TW. Prevalence of uri· r!continenc:e, BMJ 1980; 281: 1243-5, KL, Matthews KA, Engel BT. Prevalence, incidence and correlates of urinary incontinence in healthy, middle aged women. ]Uro/1991; 146: 1255·9, 15. Brein JO, Austin M, Sethi P, Boyle PO. Urinary incontinence: prevalence, need for treatment, and effectiveness of intervention by nurse, BM] 1991; 303: 1308-12. 16. Holst K, Wilson PD. Tr,e prevalence of female urinary incontinence and reasons lor not seeking treatment. N z Med] 1988; 101: 756·8. ·····*····· 'P'~----------------------------------------------------------' SP2004; Vo1.14 (3): 132-135 135 

Distribution of lower urinary tract symptoms (LUTS) in adult women

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Distribution of lower urinary tract symptoms (LUTS) in adult women

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