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

Epidemiology and Epidemiology and Consequences of Female Consequences of Female

Urinary Incontinence in the Urinary Incontinence in the Middle-EastMiddle-East

بسم الله الرحمن الرحيمبسم الله الرحمن الرحيم

ICS 2008ICS 2008, , Educational Course No. 9, Cairo, Egypt, Educational Course No. 9, Cairo, Egypt, October 21, 2008October 21, 2008

Ahmed Al-Badr, MBBS, FRCS(C), FACOGAhmed Al-Badr, MBBS, FRCS(C), FACOG

Chairman, Urogynecology & Pelvic Reconstructive Surgery Chairman, Urogynecology & Pelvic Reconstructive Surgery

Deputy Medical Director, Women’s Specialized HospitalDeputy Medical Director, Women’s Specialized Hospital

King Fahad Medical City, RiyadhKing Fahad Medical City, Riyadh

Outline:Outline:

DefinitionsDefinitions

Scope of the problemScope of the problem

Worldwide prevalenceWorldwide prevalence

Prevalence in the regionPrevalence in the region

ConclusionConclusion

Urinary Incontinence (UI):Urinary Incontinence (UI):

Definition (ICS):Definition (ICS):

The complaint of any The complaint of any involuntary leakage of urineinvoluntary leakage of urine

Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-7878

UI: DefinitionsUI: Definitions

Stress Incontinence: Stress Incontinence:

Is the complaint ofIs the complaint of involuntary involuntary leakage of urine with exertion, leakage of urine with exertion, effort, sneezing, or coughingeffort, sneezing, or coughing

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


Urge Incontinence: Urge Incontinence:

Is the complaint Is the complaint of involuntary of involuntary leakage accompanied by or leakage accompanied by or immediately preceded by urgencyimmediately preceded by urgency



Mixed Urinary Incontinence: Mixed Urinary Incontinence:

Is the complaint ofIs the complaint of involuntary involuntary leakage associated with urgency leakage associated with urgency and also with exertion, effort, and also with exertion, effort, sneezing, or coughingsneezing, or coughing


UI: Scope of the problemUI: Scope of the problem

W.H.O. recognizes incontinence W.H.O. recognizes incontinence

as an international health as an international health

concernconcern

Clinical practice guidelines, 1996. US Department of Health and human Services

UI: Scope of the problemUI: Scope of the problem

Impact on lifestyle ¹¹ 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) ²², 3, 3

1. Clinical practice guidelines, 1996. US Department of Health and human Services

2. Risk et al. Int Urogynecol J 1999;10:160-5 3. Saleh 2005

Prevalence of UI Prevalence of UI worldwideworldwide

Minassian et al 2003

Types of UITypes of UI


Prevalence of UI in the Prevalence of UI in the Middle-EastMiddle-East

UI: Prevalence in UI: Prevalence in UAEUAE

400 women, PHC & community400 women, PHC & community PrevalencePrevalence:: 20.3% 20.3%

31% sought medical advice:31% sought medical advice: EmbarrassmentEmbarrassment (38%) (38%) LowLow expectations from medical care expectations from medical care

(38%)(38%) UI is normal with age (23%)UI is normal with age (23%)

Risk et al. Int Urogynecol J 1999;10:160-5

UI: Prevalence in QatarUI: Prevalence in Qatar

1000 women age > 45 years, PHC & comm. 1000 women age > 45 years, PHC & comm.

Prevalence: 20.6% Prevalence: 20.6% 64%: 64%: inability to prayinability to pray 47%: 47%: interference with marital relationshipinterference with marital relationship 72%:72%:ashamed of themselves and have guilt ashamed of themselves and have guilt 5%:5%: stopped all workstopped all work 41%: 41%: did not seek help (embarrassment)did not seek help (embarrassment)

Saleh et al, Maturitas. 2005

UI: Prevalence in KSAUI: Prevalence in KSA

PrevalencePrevalence: : 35%35%

Types:Types:• SUI: SUI: 57%57%• UUI: UUI: 12%12%• MUI: MUI: 31%31%

Al-Amari et al. 14th SUC 2001Al-Amari et al. 14th SUC 2001

UI: Prevalence in KSAUI: Prevalence in KSA 379 women, age >15, PHC Jeddah379 women, age >15, PHC Jeddah Mean age 35 (range: 15 - 71)Mean age 35 (range: 15 - 71) PrevalencePrevalence: : 41.4%41.4% Types:Types:

• SUI: SUI: 36.4%36.4%

• UUI: UUI: 27.4%27.4%

• MUI: MUI: 22.2%22.2%

Brasha et al. 2008, unpublishedBrasha et al. 2008, unpublished


Impact on QoL:Impact on QoL:

34% unable to perform prayers34% unable to perform prayers 29% limitations of social activities29% limitations of social activities 18% affected their sexual life18% affected their sexual life



18% sought medical advice:18% sought medical advice:

74 % didn’t think it is a significant problem74 % didn’t think it is a significant problem 9 % didn’t think treatment was available9 % didn’t think treatment was available 19 % embarrassed to discuss with doctor19 % embarrassed to discuss with doctor 4 % did not want to consult a male doctor4 % did not want to consult a male doctor 9 % thought it was natural with aging9 % thought it was natural with aging


UI: Prevalence in JordanUI: Prevalence in Jordan

182 women, age: 50 - 65 yrs, south 182 women, age: 50 - 65 yrs, south Jordan (Karak, Taffileh, Aqaba) Jordan (Karak, Taffileh, Aqaba)

Prevalence: Prevalence: 30%30%

Types:Types:•Stress UI: Stress UI: 23.1% 23.1% •Urge UI: Urge UI: 26.4% 26.4%

•Mixed UI:Mixed UI: 18.1%18.1%

Shakhatreh, Saudi Med J, 2005

UI: Prevalence in UI: Prevalence in EgyptEgypt

1,652 women, age: > 201,652 women, age: > 20 Community (Assiut)Community (Assiut) PrevalencePrevalence:: 54.8%54.8%

• Urge Urge 15%15%

• Stress Stress 14.8%14.8%

• MixedMixed 25%25%

El-Azab et al. Neurourol and Urodynam (2007) 788-26:783


Impact on QoL: Impact on QoL: low self-esteem, feeling unclean low self-esteem, feeling unclean

(65%)(65%) inability to pray (90%)inability to pray (90%) difficulty in performing physical difficulty in performing physical

activities such as housework (33%)activities such as housework (33%) limitations of social activities (30%)limitations of social activities (30%) leakage during sexual intercourse leakage during sexual intercourse

(18%)(18%)El-Azab et al. Neurourol and Urodynam (2007) 788-26:783


4% sought medical advice:4% sought medical advice:

Embarrassment (60%)Embarrassment (60%)

Low expectations from medical care Low expectations from medical care

(44%) (44%)

Assuming UI is normal with aging Assuming UI is normal with aging

(38%)(38%)El-Azab et al. Neurourol and Urodynam (2007) 788-26:783

UI: ConclusionUI: Conclusion

UI is prevalent in the Middle-EastUI is prevalent in the Middle-East

UI has a UI has a significantsignificant impact on QoL impact on QoL

UI is underreported and undertreatedUI is underreported and undertreated

Need to educate health-care workers Need to educate health-care workers and the publicand the public

Thank you!Thank you!

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

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