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بسم الله الرحمن الرحيم. Epidemiology and Consequences of Female Urinary Incontinence in the Middle-East. ICS 2008 , Educational Course No . 9, Cairo, Egypt, October 21, 2008. Ahmed Al-Badr, MBBS, FRCS(C), FACOG Chairman, Urogynecology & Pelvic Reconstructive Surgery

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epidemiology and consequences of female urinary incontinence in the middle east

بسم الله الرحمن الرحيم

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

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, Women’s Specialized Hospital

King Fahad Medical City, Riyadh

outline
Outline:
  • Definitions
  • Scope of the problem
  • Worldwide prevalence
  • Prevalence in the region
  • Conclusion
urinary incontinence ui
Urinary Incontinence (UI):

Definition (ICS):

The complaint of any involuntary leakage of urine

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

ui definitions
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
ui definitions6
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
ui definitions7
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
ui scope of the problem
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

ui scope of the problem9
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 1999;10:160-5 3. Saleh 2005
types of ui
Types of UI

Minassian et al 2003

ui prevalence in uae
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 1999;10:160-5

ui prevalence in qatar
UI: Prevalence in Qatar
  • 1000 women age > 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

ui prevalence in ksa
UI: Prevalence in KSA
  • Prevalence: 35%
  • Types:
          • SUI: 57%
          • UUI: 12%
          • MUI: 31%

Al-Amari et al. 14th SUC 2001

ui prevalence in ksa19
UI: Prevalence in KSA
  • 379 women, age >15, 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

ui prevalence in ksa20
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

ui prevalence in ksa21
UI: Prevalence in KSA

18% sought medical advice:

  • 74 % didn’t think it is a significant problem
  • 9 % didn’t 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

ui prevalence in jordan
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

ui prevalence in egypt
UI: Prevalence in Egypt
  • 1,652 women, age: > 20
  • Community (Assiut)
  • Prevalence: 54.8%
      • Urge 15%
      • Stress 14.8%
      • Mixed 25%

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

ui prevalence in egypt24
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) 788-26:783

ui prevalence in egypt25
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) 788-26:783

ui conclusion
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