Introduction and Objectives

1. A PRELIMINARY STUDY OF URINARY INCONTINENCE IN WOMEN USING QUESTIONNAIRE URINARY INCONTINENCE DIAGNOSIS (QUID) Dhillon HK1, Gurpreet Kaur2AnuarZainiMd Zain1, Rusli Bin Nordin3 1 Jeffrey Cheah School of Medicine & Health Sciences, Monash University Sunway Campus , 46150, Bandar Sunway Malaysia. 2Institute for Public Health, Ministry of Health, JalanBangsar, 50590, Kuala Lumpur, Malaysia. 3Jeffrey Cheah School of Medicine & Health Sciences, Clinical School Johor Bahru, Monash University Sunway Campus, Johor Bharu, Malaysia OPTIONALLOGO HERE OPTIONALLOGO HERE Results Introduction and Objectives Conclusions • Introduction: Urinary incontinence (UI) is a well recognised but under-diagnosed complaint in women, which still remains poorly documented in many communities. Its prevalence values of between 14.51-2 and 40%6 have been reported in Malaysian women, however the reason for this wide range in prevalence is unclear. • A cross-sectional survey of 5,506 Asian women by The Asian Society for Female Urology (ASFU) was conducted to determine the prevalence of UI in 11 Asian countries, including Malaysia. The prevalence of overactive bladder was documented as 13.1% in Malaysian women2-3. In addition, the study was criticised forleading toward an answer favouring urge urinary incontinence 3. • Low et al.5 using the Bristol Female Lower Urinary Tract Symptoms Questionnaire reported that 19% of women in North Malaysia attending health clinics had lower urinary tract symptoms. • A study on menopausal women living in Kelantan found that up to 40%6 of women complained of having occasional stress incontinence and at least 24% of the women complained of having weak bladder control 6. • Zalinaet al.7 using an International Consultation on Incontinence Questionnaire (ICIQ)-FLUTS on a cohort of medical and nursing student population in Ipoh Perak documented the prevalence of UI at 34.9%. • Similar trends were also reported in Australian studies8. The reason/s for this wide variability in prevalence rate was not clear. But it might result from differences in the definitions used, duration of the reference period, or even the design of the questionnaire8.   • Hempelet al.4 in their attempt to document the different types of incontinence experienced by Asian and Caucasian women found that the most common type of incontinence in Asian women was mixed incontinence (63.8%), followed by stress incontinence (13.1%). Comparatively, Caucasian women experienced more of stress incontinence (50%) followed by mixed incontinence (29%)4. However, no local studies have been conducted to verify this and/or even identify the possible reasons for this. • The wide ranging prevalence of UI together with incomplete validated information on the type of urinary incontinence and the associated risk factors in Malaysian women has significant implications on the diagnosis and management of UI. There is therefore a need to ascertain the exact prevalence and types of UI and the associated risk factors in Malaysian women using a standardized diagnostic tool. • After reviewing various questionnaires used in both local and international studies for the diagnosis of UI, Questionnaire Urinary Incontinence Diagnosis (QUID)9 was considered user friendly due to its availability in English, Malay, Tamil and Mandarin language. QUID is a six item questionnaire which can be easily used as a screening tool by various health professionals within any healthcare settings and homes in Malaysia. In addition its primary version had been used in studies in other countries and its usage here will help provide data that would permit better comparison of UI between the different communities of the world. • Objective: To determine the prevalence of UI and its risk factors in Malaysian women using QUID Methods Conclusion:Of the 109 respondents, 60.6% (n=66) had reported some degree of urine leakage. Obesity, smoking, alcohol consumption, caffeine consumption, physical activities, education, ethnicity, socio economic status, menopause and age, were cross tabulated with respondents reporting urine incontinence. The result from the pilot study confirms that the prevalence of urine incontinence is higher in Malaysian women than previously reported by local studies. Also women with tertiary education were more likely to report urine incontinence than women with secondary education and less. The reason/s for this could be many fold, including a common view shared by both public and health workers that incontinence is associated with ageing, which may prevent its early recognition and therefore its early management or may even prevent many younger women with urinary incontinence from seeking medical treatment. Currently, a larger scale study using QUID is in progress in Selangor and it is expected to provide detailed information on UI in the female Malaysian population. Majority of the respondents were aged between 19 and 29 years. 33.3% were Chinese, 56.9% were single and 78.4% had received tertiary education. More thantwo-thirds were working (65.5%), more thanhalf (37.9%) were earning less thanRM 1,000 per month. The only variable significant from bivariate analysis was level of education (p=0.035) (Table 1). Logistic regression analysis revealed that women with tertiary education had 3.1 times the odds of reporting UI compared to those with lower education (OR 3.073; 95%CI1.050-8.992). References • 1 Lim, P.H.C & Lapitan, MC. Epidemiology: Asia in Textbook • of female urology and urogynecology, Linda Cardozo and David Staskin. 2nd edition. Abingdon, Oxon. Informa Healthcare 2006; 1: 52-58. • 2. Lapitan MC & Chye PL. The Asia Pacific Continence Advisory Board. The epidemiology of overactive bladder among female in Asia: a questionnaire survey. Int. Urogynecol JPelvic floor Dysfunct. 2001; 12 (4):226-231. • 3. Diokno A. Epidemiology of Urinary Incontinence in Women – Clinical Implications. Bussiness Briefing: US Kidney & Urological Disease 2005; 1- 4. • 4. Hempel C, Wienhold D, Benken N, et.al. Prevalence and natural history of female incontinence. EurUrol 1997; 3 (suppl 2): 2-12. • 5. Low BY, Liong ML, Kah HY, Chong WL, Chee C, Wing SL et al. • Study of prevalence, treatment-seeking behavior, and risk factors of women with lower urinary tract symptoms in Northern Malaysia. Urology 2006; 68: 751 -758. • Dhillon HK, Singh HJ, Shuib R, Abdul Manaf H, NikMohdZakiNikMohmood. Prevalence of menopausal symptoms among women in Kelantan. Malaysia. Maturitas2006; 54:213-21. • Zalina N, Aruku N, Azura N, Shahida N, Akmarina N & Dian F. Prevalence of lower urinary tract symptoms (LUTS) among young age medical population. International Medical Journal Malaysia 2011; 10(1):7-15. • 8. Botlero R, Urquhart D, Davis S & Bell R. Prevalence and incidence of urinary incontinence in women: Review of the literature and investigation of methodological issues. International Journal of Urology 2008;15:230-4. • Bradley CS, Rovner ES, Morgan MA, Berlin M, Novi J, Shea J, Arya LA. • A new questionnaire for urinary incontinence diagnosis in women. Development and testing. Am J ObstetGynecol 2005; 192: 66-73. • Acknowledgment • Ministry of Health Malaysia Ethics Committee Approval • Project no. NMRR-11-49-8830 • Monash University Human Research Ethics Committee • Certificate of Approval Project no. CF10/1725-2010000963 • Source of Funding: • Monash University Seed Grant of RM20,000 obtained from cardio-metabolic • research cluster to fund the pilot study. Among respondents having some type of UI, majority (42.2%) had mixed type UI, followed by an equal proportion (29%) reporting stress and urge UI. Alcohol consumption was the only significant variable associated with type of UI (Table 3). • Reference is no urinary incontinence • † 95%CI for OR Multinomial logistic regression analysis revealed that women who consumed alcohol were 4 times more likely to report stress incontinence compared to those who did not consume alcohol. There was no similar association with other types of UI (Table 4).