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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
UI: DefinitionsUI: Definitions
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
Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78
UI: DefinitionsUI: Definitions
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
Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78
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
Minassian et al 2003
Minassian et al 2003
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
UI: Prevalence in KSAUI: Prevalence in KSA
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
Brasha et al. 2008, unpublishedBrasha et al. 2008, unpublished
UI: Prevalence in KSAUI: Prevalence in KSA
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
Brasha et al. 2008, unpublishedBrasha et al. 2008, unpublished
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
UI: Prevalence in UI: Prevalence in EgyptEgypt
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
UI: Prevalence in UI: Prevalence in EgyptEgypt
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!
Q & AQ & A