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A PRELIMINARY STUDY OF URINARY INCONTINENCE IN WOMEN USING QUESTIONNAIRE URINARY INCONTINENCE DIAGNOSIS (QUID)

Dhillon HK1, Gurpreet Kaur2 Anuar Zaini Md 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, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia. 3Jeffrey Cheah School of Medicine & Health Sciences, Clinical School Johor Bahru, Monash University Sunway Campus, Johor Bharu, Malaysia

Introduction and Objectives

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 for leading 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.

Zalina et 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.  

Hempel et 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

Results Conclusions

References

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.

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Table 1: Association between Urinary Incontinence and Socio-demographic Characteristics

VariablesUrinary

incontinence No Urinary

incontinenceP value

n % n %Level of education (n=109) 0.035

Tertiary 47 55.3 38 44.7

Secondary and below 19 79.2 5 20.8

Age (years) (n=106) 0.696

<50 45 59.2 31 40.8

50 19 63.3 11 36.7

In menopause (n=109) 0.984

Yes 17 60.7 11 39.3No 49 60.5 32 39.5

Ethnicity (n=109) 0.875

Malay 19 59.4 13 40.6

Chinese 22 59.5 15 40.5

Indian 22 64.7 12 35.3

Income level (RM) (n= 87) 0.208

<1000 17 51.5 16 48.5

1000-<3000 22 71.0 9 29.0

3000 16 69.6 7 30.4

Work status (n= 110) 0.277

Working 46 64.8 25 35.2

Not working 20 54.1 17 45.9

Coffee consumption (n=109) 0.886

Yes27 61.4 17 38.6

No39 60.0 26 40.0

Alcohol consumption (n= 111) 0.239

Yes 24 68.6 11 31.4

No 42 56.8 32 43.2

Physical Activity (n= 109) 0.635

Yes 56 61.5 35 38.5

No 10 55.6 8 44.4

Smoking (n= 111) 0.150

Yes 66.0 61.7 41 38.3

No 0 0.0 2 100.0

BMI (n=106) 0.682

Normal BMI (18.5 – 25kg/m2) 39 62 24 38.1

Abnormal BMI (≥ 25kg/m2) 25 58 18 42

Marital status (n= 109)

Married 28 60.9 18 39.1 0.982

Single 37 60.7 24 39.3

Table 3 : Alcohol consumption and types of urinary incontinence

Variables

Types of UI

No UrineIncontinence

Stress Incontinence

Urge Incontinence

Mixed Incontinence

P value

n % n % n % n %

Overall 43 39.4 19 17.4 19 17.4 28 25.7

Alcohol consumption (n=111) 0.028

Yes 11 31.4 11 31.4 3 8.6 10 28.6

No 32 43.2 8 10.8 16 21.6 18 24.3

Note: The only variable significant with types of UI was alcohol consumption.

Methodology

Study Design: Cross-sectional Pilot study

Study Period: September 2011 - February 2012

Sample size & Study Population : 111 Malaysian women living inSelangor

The English version of Questionnaire for Urinary Incontinence Diagnosis was administered to women who fulfilled the eligibility

Inclusion criteria:

Healthy women age 18 years and above with well controlled non-

communicable diseases such as diabetes and hypertensionExclusion criteria:

Pregnant women and women who had delivered within the last two years

Women who have had an abortion within the year

Women who had undergone recent operation on their reproductive tract or had undergone cancer treatment in the last six months

Statistical Methods: Descriptive and inferential statistical analyses were used

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

than two-thirds were working (65.5%), more than half (37.9%) were earning

less than RM 1,000 per month. The only variable significant from bivariate

analysis was level of education (p=0.035) (Table 1).

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).

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

Table 2: Association between Level of education and Urinary incontinence

Variables B S.E. Wald OR CI 95%

P value

Level of Education

Lower Upper

Tertiary 1.122 0.548 4.196 3.072 1.050 8.992 0.041

Constant -1.335 0.503 7.055 0.263 - - 0.008

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%CI 1.050-8.992).