Epidemiology and Consequences of Female Urinary Incontinence in the Middle-East

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Epidemiology and Consequences of Female Urinary
Incontinence in the Middle-East
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ICS 2008, Educational Course No. 9, Cairo, Egypt,
October 21, 2008

• Ahmed Al-Badr, MBBS, FRCS(C), FACOG
• Chairman, Urogynecology Pelvic Reconstructive
  Surgery
• Deputy Medical Director, Womens Specialized
  Hospital
• King Fahad Medical City, Riyadh

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Outline

• Definitions
• Scope of the problem
• Worldwide prevalence
• Prevalence in the region
• Conclusion

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Urinary Incontinence (UI)

• Definition (ICS)
• The complaint of any involuntary leakage of
  urine
• Abrams et al. Neurourol Urodyn, 2002, 21(2)
  p167-78

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UI Definitions

• Stress Incontinence
• Is the complaint of involuntary leakage of urine
  with exertion, effort, sneezing, or coughing

Abrams et al. Neurourol Urodyn, 2002, 21(2)
p167-78
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UI Definitions

• Urge Incontinence
• Is the complaint of involuntary leakage
  accompanied by or immediately preceded by urgency

Abrams et al. Neurourol Urodyn, 2002, 21(2)
p167-78
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UI Definitions

• Mixed Urinary Incontinence
• Is the complaint of involuntary leakage
  associated with urgency and also with exertion,
  effort, sneezing, or coughing

Abrams et al. Neurourol Urodyn, 2002, 21(2)
p167-78
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UI Scope of the problem

• W.H.O. recognizes incontinence as an
  international health concern
• Clinical practice guidelines, 1996. US Department
  of Health and human Services

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UI Scope of the problem

• Impact on lifestyle ¹
• Avoidance of activities
• Depression, isolation, embarrassment
• Impact on marital/sexual relationships
• Increased dependence on caregivers
• Discomfort and skin irritation
• Interference with prayers (Salat) and purity
  (Tahara) ², 3
• Clinical practice guidelines, 1996. US Department
  of Health and human Services
• Risk et al. Int Urogynecol J 199910160-5 3.
  Saleh 2005

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Prevalence of UI worldwide
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Minassian et al 2003
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Types of UI
Minassian et al 2003
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Minassian et al 2003
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Prevalence of UI in the Middle-East
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UI Prevalence in UAE

• 400 women, PHC community
• Prevalence 20.3
• 31 sought medical advice
• Embarrassment (38)
• Low expectations from medical care (38)
• UI is normal with age (23)

Risk et al. Int Urogynecol J 199910160-5
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UI Prevalence in Qatar

• 1000 women age gt 45 years, PHC comm.
• Prevalence 20.6
• 64 inability to pray
• 47 interference with marital relationship
• 72 ashamed of themselves and have guilt
• 5 stopped all work
• 41 did not seek help (embarrassment)

Saleh et al, Maturitas. 2005
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UI Prevalence in KSA

• Prevalence 35
• Types
• SUI 57
• UUI 12
• MUI 31

Al-Amari et al. 14th SUC 2001
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UI Prevalence in KSA

• 379 women, age gt15, PHC Jeddah
• Mean age 35 (range 15 - 71)
• Prevalence 41.4
• Types
• SUI 36.4
• UUI 27.4
• MUI 22.2

Brasha et al. 2008, unpublished
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UI Prevalence in KSA

• Impact on QoL
• 34 unable to perform prayers
• 29 limitations of social activities
• 18 affected their sexual life

Brasha et al. 2008, unpublished
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UI Prevalence in KSA

• 18 sought medical advice
• 74 didnt think it is a significant problem
• 9 didnt think treatment was available
• 19 embarrassed to discuss with doctor
• 4 did not want to consult a male doctor
• 9 thought it was natural with aging

Brasha et al. 2008, unpublished
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UI Prevalence in Jordan

• 182 women, age 50 - 65 yrs, south Jordan (Karak,
  Taffileh, Aqaba)
• Prevalence 30
• Types
• Stress UI 23.1
• Urge UI 26.4
• Mixed UI 18.1

Shakhatreh, Saudi Med J, 2005
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UI Prevalence in Egypt

• 1,652 women, age gt 20
• Community (Assiut)
• Prevalence 54.8
• Urge 15
• Stress 14.8
• Mixed 25

El-Azab et al. Neurourol and Urodynam (2007)
788-26783
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UI Prevalence in Egypt

• Impact on QoL
• low self-esteem, feeling unclean (65)
• inability to pray (90)
• difficulty in performing physical activities such
  as housework (33)
• limitations of social activities (30)
• leakage during sexual intercourse (18)

El-Azab et al. Neurourol and Urodynam (2007)
788-26783
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UI Prevalence in Egypt

• 4 sought medical advice
• Embarrassment (60)
• Low expectations from medical care (44)
• Assuming UI is normal with aging (38)

El-Azab et al. Neurourol and Urodynam (2007)
788-26783
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UI Conclusion

• UI is prevalent in the Middle-East
• UI has a significant impact on QoL
• UI is underreported and undertreated
• Need to educate health-care workers and the public

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Thank you!
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