|Year : 2020 | Volume
| Issue : 2 | Page : 47-51
The burden of urinary incontinence in late pregnancy: Antenatal clinic experience in a tertiary hospital in Northern Nigeria
Asma Irshad1, Sana Irshad1, Adebiyi Gbadebo Adesiyun1, Hajaratu Umar Sulayman1, Khaleequr Rahman2, Nana Hawwa Madugu1
1 Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Shika Zaria, Nigeria
2 Ahmadu Bello University Medical Centre, Zaria, Nigeria
|Date of Submission||11-Jul-2020|
|Date of Acceptance||03-Oct-2020|
|Date of Web Publication||20-May-2021|
Dr. Asma Irshad
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Shika
Source of Support: None, Conflict of Interest: None
Background: Urinary incontinence is an under-diagnosed and underreported problem especially among women living in developing countries. Pregnancy is one of the most consistent risk factors in the development of urinary incontinence in women with prevalence increasing with gestational age; being more marked in the late second and third trimester resulting in detrimental effects on the quality of life women live. The objective of this study was to determine the prevalence of urinary incontinence in late pregnancy and help identify women at risk who would benefit from interventions during and after pregnancy.
Patients and Method: This was a cross-sectional study that was conducted to determine the prevalence of urinary incontinence in late pregnancy using a structured interviewer administered questionnaire. Respondents were recruited from the antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. The result was analyzed using SPSS version 20.
Results: The prevalence of urinary incontinence was found to be 26.20% with the majority of the respondents having symptoms in keeping with stress urinary incontinence (57.2%) while 34.1% had urgency urinary incontinence and 8.6% had mixed urinary incontinence.
Conclusion: There is a high prevalence of urinary incontinence in pregnancy in our environment with every 1 in 5 women being affected. The antenatal period is an opportunity to identify such patients so as to ensure continuity of care and effective referral in order to improve outcome in women at risk.
Keywords: Stress urinary incontinence, urgency urinary incontinence, urinary incontinence
|How to cite this article:|
Irshad A, Irshad S, Adesiyun AG, Sulayman HU, Rahman K, Madugu NH. The burden of urinary incontinence in late pregnancy: Antenatal clinic experience in a tertiary hospital in Northern Nigeria. Arch Int Surg 2020;10:47-51
|How to cite this URL:|
Irshad A, Irshad S, Adesiyun AG, Sulayman HU, Rahman K, Madugu NH. The burden of urinary incontinence in late pregnancy: Antenatal clinic experience in a tertiary hospital in Northern Nigeria. Arch Int Surg [serial online] 2020 [cited 2021 Aug 2];10:47-51. Available from: https://www.archintsurg.org/text.asp?2020/10/2/47/316491
| Introduction|| |
Urinary incontinence (UI) has been reported to affect 15–50% of women worldwide with a high financial burden.,, During pregnancy the prevalence of UI has been observed at 23% in first trimester to 67% at the end of pregnancy, and from 6% to 29% from 6 months up to 1 year post-partum.,,, The prevalence of urinary incontinence reaches a maximum during pregnancy and decreases after childbirth.,, Pelvic floor muscle strength and tone reduction is observed due to an increase in the concentration of relaxin which is thought to cause hypertrophy and oedema of the levator Ani muscle., Observational studies have consistently shown that pregnant women with UI have significantly lower quality of life during pregnancy than those without UI, and the quality of life worsens as gestational age increases. Experiencing UI during pregnancy is a major risk factor for persistence of the problem later in life. Even though safe interventions for urinary incontinence may exist during pregnancy, utilization of available services, and the motivation to seek help is low and there is often a long delay between onset of symptoms, recognition of symptom as problematic, and the decision to seek help.
There is a lack of understanding of the magnitude of this problem on the wellbeing of women by medical practitioners in our setting. A study like this intends to help in the understanding of these issues and relating them to the peculiarities of our region. It will also be a useful guide to help bridge the gaps that result in delayed identification, prevention, and management of incontinence both in pregnancy and in the postpartum period.
| Patients and Method|| |
The study is a cross-sectional survey. It was carried out from January 2019 to April 2019 at the Antenatal clinic of the Obstetrics and Gynaecology Department at Ahmadu Bello University Teaching Hospital, Shika, Nigeria. This is a referral center for Northern Nigeria and its towns and villages. A total of 282 pregnant women who were attending the antenatal clinic were recruited for the study after calculating the sample size. A simple random sampling technique was used to administer a structured interviewer administered questionnaire which was divided into three sections. A section that defined the demographic and reproductive profile of the participants according to the relevant literature; the 3 Incontinence Questions screening tool; and a section identifying risk factors for urinary incontinence.
The questionnaire required information about socio-demographic features (age, educational status, and occupational information). It also included questions pertaining to reproductive history and risk factors (gravidity; parity; type of birth; instrumented delivery; birth weight of the heaviest infant; prior gynecologic operation; episiotomy; history of UI in previous pregnancy, smoking, consumption of alcoholic beverages or caffeinated drinks). The 3 Incontinence Questions (3IQ) questionnaire, a validated tool used to distinguish between the common types of urinary incontinence was used. The first question confirms the presence of UI. The second question reviews the various forms of UI to promote familiarity, whereas the final question establishes the diagnosis of UI subtype (stress only or stress predominant, urge only or urge predominant, other cause or other cause predominant, or Mixed UI). All data collected was analyzed using SPSS Version 20 for Windows (SPSS Inc., Chicago, Illinois, USA).
The study protocol was approved by the Ethical Committee at the ABUTH, Faculty of Medicine according to the Declaration of Helsinki, with D-U-N-S NUMBER: 954524802. Informed consent was obtained from each participant. The questionnaires were filled via face-to-face interviews with participants. Five medical students were trained in the administration of questionnaires. It took about 20–30 min to interview each participant and the data were collected over a period of three months.
| Results|| |
In this study, 282 pregnant women were approached to participate. The ages of all the respondents ranged from 18 to 42 years with a mean age of 30 years (SD: ± 6 years). Over 80% of the respondents were aged 35 years and below. The age distribution and other characteristics of the respondents are shown below in [Table 1]. About 26.2% (74 out of 282) of the respondents had leaked urine at least once in the past three months [Figure 1]. Majority had symptoms suggestive of stress urinary incontinence (57.2%) while 34.1% had symptoms in keeping with urgency urinary incontinence. Over 60% of the respondents had a BMI above 25 kg/m2 with a mean of 28.4 kg/m2 and SD ± 10.1. None of the respondents with incontinence had abdominal delivery, smoked cigarettes, or drank alcohol [Figure 2].
[Table 2] shows the characteristics of women who had urinary incontinence while [Table 3] shows the relationship between the prevalence urinary incontinence in a previous pregnancy and the prevalence in current pregnancy. When P < 0.05, it implies significant relationship and grounds for rejection of the Null hypothesis of no significance. A P value of 0.001 means that there is statistical relationship between the prevalence of urinary incontinence in present pregnancy and previous pregnancies. Crammer's value of > 0.3 signifies a strong relationship. Of the 74 women who reported urinary incontinence, 79.7% did not report this to their health care provider sighting reasons as follows: symptom is considered embarrassing (34%), client felt it was a normal part of aging (46%) and unfriendly environment (20%).
|Table 3: Relationship between Symptom of incontinence in present pregnancy and previous pregnancies|
Click here to view
| Discussion|| |
In this study, the socio-demographic characteristics of the respondents with urinary incontinence in late pregnancy revealed an age range between 18 and 42 which is similar to a study on the prevalence of urinary incontinence among postpartum pregnant women in Zaria. The mean age of the respondents was 30 years with a SD ± 6 years reflecting the peak reproductive age bracket in most developing countries. Over 70% of them were 35 years old and below. Majority of the respondents belonged to the Hausa ethnic group accounting for 35.8% followed by Yoruba ethnicity accounting for 23.0% of the sampled population. This reflected a diverse representation of the ethnic groups. About 57.8% of the respondents were Muslims and 41.4% were Christians.
Almost all (97.9%) of them were married with the majority having at least primary level of education while the minority (13.1%) had no formal education. Most of the respondents were employed while 28.4% were unemployed and 29.1% were students. A minority of the sampled population were nullipara accounting for 10.9% while majority were multipara accounting for 64.1%. The remaining 25% were grandmultipara.
This study focused on the prevalence of urinary incontinence in late pregnancy. In this context all women who were pregnant at 36 weeks gestational age or more were included using a simple random sampling technique. The prevalence of urinary incontinence in late pregnancy was 26.2% and this was based on the 3 Incontinence Questions questionnaire. This prevalence is higher than the estimated prevalence of 21.1% reported by Adaji et al. almost a decade ago. This value is much higher than the prevalence of urinary incontinence in postpartum women of 15.2% as was reported in Aminu Kano Teaching Hospital. The high prevalence may be due to an increasing trend in disclosure of information by women as well as the increasing prevalence of associated risk factors among women. Another reason for this disparity in the prevalence could be the target population as all changes resulting in incontinence tend to peak in late pregnancy and decline in the postpartum period.
In keeping with previous studies,,, Stress urinary incontinence was the prevailing kind of incontinence accounting for 57.2% while 34.1% experienced urgency urinary incontinence. The remaining had symptoms of both stress and urgency urinary incontinence. However, 79.7% of those with symptoms did not report to their health care providers unlike the study from Ilorin which revealed that none of the respondents who reported symptoms of urinary incontinence complained to their attending doctor. This may be attributable to the educational level of the sample population., The reasons cited for not reporting the symptom included: fear of embarrassment (34%), a natural part of aging (46%) and unfriendly environment to divulge such information (20%). Similar findings have been reported in other studies.,
For those who reported incontinence in current pregnancy, 66.2% also reported incontinence in past pregnancies. A Chi square and Crammers V test was done on these variables which revealed a strong positive relationship with women having an eight times higher risk of incontinence if they experienced this symptom in their previous pregnancies. Other positive relationships to urinary incontinence asserted in this study included history of incontinence in women outside pregnancy, incontinence, BMI >25 kg/m2 and constipation. No statistical significant relationship was found to be existent between incontinence and episiotomy.
| Conclusion|| |
There is a high prevalence of urinary incontinence in pregnancy in this environment and the antenatal period is an opportunity to identify such patient so as to ensure continuity of care and effective referral in order to improve outcome.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Haylen BT, De Ridder D, Freeman RM, Swift Se, Berghman B, Lee J, et al
. An International Urogynaecological Association (IUGA)/International Continence Society (ISC) joint report on the terminology of female pelvic floor dysfunction. Int Urogynaecol J 2010;21:5-26.
Sarah Haag PT. In: Urinary Incontinence. Barbara LH, John OS, Karen DB, Lisa MH, Joseph IS, Marlene MC, Williams Gynecology. 3rd
ed. United States: McGraw-Hill Education; 2016. p. 514-37.
Danso KA, Ankoebi-Kokroe F, Ofori AA. Urinary Incontinence. In: Kwawukume, EY, Ekele BA, Danso KA, Emuveyan EE, editors. Comprehensive Obstetrics in the Tropics. 2nd
ed. Ghana: Assemblies of God Literature centre Ltd; 2015. p. 197-206.
Vasavada SP, Rackley RR. Urinary Incontinence. Available from: http://medscape.com
[Last accessed on 2019 Feb 18].
Samuel CS, Lekgabe ED, Mookerjee I. The effects of relaxin on extracellular matrix remodeling in health and fibrotic disease. In: Agoulnik A, editor. Relaxin and Related Peptides. New York: Springer; 2007. p. 88-103.
Ijaiya M, Raji H, Aboyeji A, AdesinaK. Non-fistulous urinary incontinence among women attending family planning clinic. Int J Women's Health 2011;3:409-13.
Rosenman EA. Pelvic floor disorders pelvic organ prolapse, urinary incontinence, and pelvic floor pain syndromes. In: Hacker FN, Gambone CG, Hobel JC, editors. Hacker & Moore's Essentials of Obstetrics & Gynecology. 6th
ed. Philadelphia: Elsevier; 2016. p. 296-303.
Smith A, Bevan D, Douglas HR, James D. Management of urinary incontinence in women: Summary of updated NICE guidance. BMJ 2013;347:5170.
Kaplan A, Cham B, Njie LA, Seixa A, Blanco S, Utzet M. Female genital mutilation/cutting: The secret world of women as seen by men. Obstet Gynecol Int 2013;2013:643780.
Azra J, Riffiat S, Sarah F, Quratulain. The prevalence of urinary incontinence in pregnancy. Pak J Surg 2013;29:66-69.
Huebner M, Antolic A, Tunn R. The impact of pregnancy and vaginal delivery on urinary incontinence. Int J Gynaecol Obstet 2010;11:249-51.
Fritel X, Ringa V, Qubioeuf E, Fauconnier A. Female urinary incontinence, from pregnancy to menopause: A review of epidemiological and pathophysiological findings. Acta Obstet Gynecol Scand 2012;91:901-910.
Adaji ES, Oladapo SS, Bature SB, Nasir S, Olatunji O. Suffering in silience: Pregnant womens experience of urinary incontinence in Zaria, Nigeria. Eur J Obstet Gynaecol Reprod Biol 2010;150:19-23.
Rabi A, Abbakar IS, Garbu J. Prevalence of postpartum urinary incontinence among women attending postnatal clinic at Aminu Kano Teaching Hospital. Trop J Obstet Gynaecol 2015;32:137-44.
Ojukwu C, Chisolu UA, Anorue OJ, Anekwu E. Urinary incontinence: Prevalence, correlates and utilization of physiotherapy among parous women in Enugu, south-eastern Nigeria. Int J Sci Res 2016;7:14508-13.
Martins G, Soler ZA, Cordeiro JA, Amaro JL, Moore KN. Prevalence and risk factors for urinary incontinence in healthy pregnant Brazilian women. Int Urogynecol J 2010;21:1271-7.
Jundt K, Scheer I, Schiessl B, Karl K, Friese K, Peschers UM. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res 2010;15:246-52.
Mallah F TP, Navali N, Azadi A. Urinary incontinence during pregnancy and postpartum incidence, severity and risk factors in Alzahra and Taleqani hospitals in Tabriz, Iran 2011-2012. Int J Women's Health Reprod Sci 2014;2:178-85.
Sangsawang B, Sangsawang N. Stress urinary Incontinence in Pregnancy: A review of prevalence, pathophysiology and treatment. Int J Urogynaecol 2013;24:901-12.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]