Prevalence and Risk Factors for Urinary and Fecal Incontinence in Brazilian Women

Amaro, Joao L., Macharelli, Carlos A., Yamamoto, Hamilto, Kawano, Paulo R., Padovani, Carlos R., & Agostinho, Aparecido D.. (2009). Prevalence and risk factors for urinary and fecal incontinence in brazilian women. International braz j urol, 35(5), 592-598. https://doi.org/10.1590/S1677-55382009000500011

Introduction
The study of prevalence and risk factors of urinary and fecal incontinence in women is very important to establish preventive strategies. There are different epidemiological studies showing wide variability in the results, probably related to the lack of uniform methodological criteria to evaluate urinary incontinence (UI).

UI is a worldwide public health problem that affects thousands of women, and causes serious socio-economic impact. It can also influence quality of life (1,2) or lead to isolation and depression (3).

Aging, menopause, pregnancy and delivery (2) as well as obesity (5,6) are considered important risk factors to develop stress urinary incontinence (SUI).

Fecal incontinence (FI) is characterized by liquid or solid feces loss, and can originate from neuromuscular lesions of the pelvic floor muscle. A recent study showed a 19.7% incidence in women with gynecological problems (7).

The prevalence of fecal and urinary incontinence in women has been studied around the world. However, there are few reported studies regarding developed countries, with a variation between 29 and 75% in the incidence of SUI (8). To our knowledge no study showing UI prevalence in Brazilian women has to date been reported. However, Guarisi et al. observed SUI prevalence in 35% of cases in a population of exclusively climacteric women (9).

Therefore, there are few reported studies, in Brazil, with an appropriate design to detect this pathology. This study aimed to determine fecal and UI prevalence and risk factors to develop UI in women who lived in Botucatu, an averaged-size Brazilian town, whose population represents a Brazilian ethnic composition.

Materials and Methods
The study evaluated 685 women older than 20 years-old living in Botucatu. For the sample calculation, the data bank of SEADE Foundation (10) was used to obtain the number of those women who were within the age limit proposed in the study. A stratified simple random sampling of 685 women, representative and proportional to the studied age limit, was obtained out of 34,066 women.

All women, randomly selected, answered a clinical evaluation questionnaire. All participants were visited and informed about the research, and, if they agreed to participate, they signed the free informed consent approved by the Ethical Research Board of the Botucatu Medical School. This questionnaire was previously tested (11) and used for question evaluation, the verification and women’s acceptance, as well as for interviewer training.

The selected women participated in two different phases, firstly they were previously sent a sealed envelope and a clinical questionnaire by mail that had to be completed and sent back to the researchers. In the second phase, 30 days later, all selected women were interviewed in their homes by previously trained interviewers. No patient refused to answer the questionnaire, which was divided into three different parts: 1- Identification; 2- Specific evaluation of symptoms such as the relationship between strength, urinary and fecal loss, circumstances of urine loss, obstetric history, problems regarding urine storage and surgical history; 3- Psycho-social effects of disease.

Body mass index (BMI), obtained through the questionnaire, was calculated and classified according to Garrow et al. (12).

Any urine loss was considered urinary incontinence, and fecal loss was considered any loss, either solid or liquid, in the previous year. Urinary incontinence intensity was evaluated considering the circumstances of loss, that is, mild at extreme stress (cough, carrying weight), moderate at medium stress (running, going up and down stairs) and severe at minimum stress (walking, change in a lying position).

The women were divided into two groups according to the presence or absence of urine loss: group G1 (n = 500) with women without urine loss and group G2 (n = 185) with urine loss.

Considering the quantitative variables of groups (age, micturition number, pregnancies and BMI), the Student’s t-test was used for independent samples (13). As for group associations with qualitative variables (categorized), the Goodman test was used for contrasts in the multinomial population (14). The multivariable logistic regression analysis of urinary incontinence was performed as regards variables: vaginal delivery, aging, number of pregnancy and BMI (15). Differences were considered significant when the p value was < 0.05.

Results
The clinical evaluation questionnaire was answered and sent back to the researcher in 18% (121/685) of cases, which prevented the comparative analysis with the individuals interviewed at home.

UI prevalence was 27%, and 15% of the incontinent women had urine loss at minimum stress; urgency was associated with 58% of cases. Among the women with UI, 36% reported the use of 2.7 pads per day, on average. Urine loss was related to childbirth in 30% of cases (56/185), to pregnancy in 9% (16/185) and without apparent cause in 61% (113/185).

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