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孕期尿失禁的可能预测因素有哪些?

What are the probable predictors of urinary incontinence during pregnancy?

作者信息

Demircan Nejat, Özmen Ülkü, Köktürk Fürüzan, Küçük Hamdi, Ata Şevket, Harma Müge, Arıkan İnan İlker

机构信息

Faculty of Medicine, Department of Family Medicine, Bülent Ecevit University , Zonguldak , Turkey.

Faculty of Medicine, Department of Obstetrics and Gynecology, Bülent Ecevit University , Zonguldak , Turkey.

出版信息

PeerJ. 2016 Jul 27;4:e2283. doi: 10.7717/peerj.2283. eCollection 2016.

Abstract

Objectives. The frequency, predisposing factors and impact of urinary incontinence (UI) on quality of life (QoL) during pregnancy were investigated. Materials and Method. A preliminary cross-sectional survey was studied among pregnant women between January and July of 2014. A total of 132 pregnant women were recruited using a questionnaire form for sociodemographic features, the Turkish version of the International Consultation on Incontinence-Short Form (ICIQ-SF), for the characteristics of UI and Wagner's Quality of Life scale to assess impact on QoL. p < 0.05 was set significant. Results.Urinary incontinence was present in 56 out of 132 pregnant women (42.4%, UI-present group): mean age, 26.7 ± 5.4y(p = 0.780); median height, 160 cm (min-max: 153-176, p = 0.037); median BMI, 28.7 kg/m(2)(min-max: 22.4-50.0, p = 0.881); urine leakage occurred per week once (n = 18, 32.1%), twice or thrice (n = 8, 14.3%); per day few times (n = 14, 25%), once (n = 5, 8.9%) and always (n = 8, 14.3%) with mainly a small amount of urine leakage (n = 33, 58.9%) or a moderate (n = 4, 7.1%). There were statistically significant relationships between QoL scores and frequency of UI (p = 0.002) or amount of leakage (p = 0.002). Impact on QoL scores ranged from mild (n = 33, 58.9%), moderate (n = 4, 7.1%) to severe (n = 4, 7.1%) levels in daily life. UI impacted the daily life activities of women by making them less likely to undertake activities outside their homes (23.2%), by affecting their working performance and friendships (8.9%), their daily home activities (7.1%), their general health status (12.5%), their sexual relations (12.5%), by making them more nervous or anxious (10.7%) and by the need to wear pads or protectors (25%). ANOVA, Tukey, and Tamhane tests as the minimal important difference model yielded significant relevance between statistical analyses and clinical outcomes by using standard deviations (p = 0.001, 0.001 and 0.005 respectively). The following features favored the occurence of UI: Age (OR = 0.845, 95% CI [0.268-2.669]), being a housewife (OR = 1.800, 95% CI [0.850-3.810]), anemia (OR = 0.939, 95% CI [0.464-1.901]), parity (OR = 0.519, 95% CI [0.325-0.829]), miscarriage (OR = 1.219, 95% CI [0.588-2.825]) and living in rural areas (OR = 1.800, 95% CI [0.887-3.653]). Height (p = 0, 037), educational status (0.016), miscarriage (0.002), parity (0.006) and place of living (0.020) were significant factors. Conclusions.Many pregnant women are suffering from UI, which warrants a significant public health consideration in the region. Age, height, being a housewife or graduation level higher than primary school, living in rural, parity, miscarriage, and anemia were the factors in favor of the onset of UI. The authors plan a health promotion program in the region according to the results in order to provide information to health caregivers, especially family physicians, and to educate women about the predictors of UI and pelvic floor exercises for primary prevention and secondary relief of UI during and after pregnancy and provide some hygienic supplies to the poor in this aspect.

摘要

目的。调查孕期尿失禁(UI)的发生率、诱发因素及其对生活质量(QoL)的影响。材料与方法。2014年1月至7月间,对孕妇进行了一项初步横断面调查。通过问卷调查收集了132名孕妇的社会人口学特征,采用国际尿失禁咨询委员会简表(ICIQ-SF)土耳其语版评估尿失禁特征,并使用瓦格纳生活质量量表评估对生活质量的影响。设定p < 0.05为有统计学意义。结果。132名孕妇中有56名存在尿失禁(42.4%,尿失禁组):平均年龄26.7±5.4岁(p = 0.780);中位身高160 cm(最小值 - 最大值:153 - 176,p = 0.037);中位体重指数28.7 kg/m²(最小值 - 最大值:22.4 - 50.0,p = 0.881);每周漏尿一次(n = 18,32.1%),两次或三次(n = 8,14.3%);每天漏尿几次(n = 14,25%),一次(n = 5,8.9%)及总是漏尿(n = 8,14.3%),主要为少量漏尿(n = 33,58.9%)或中度漏尿(n = 4,7.)。生活质量评分与尿失禁频率(p = 0.002)或漏尿量(p = 0.002)之间存在统计学显著关系。对生活质量评分的影响在日常生活中从轻度(n = 33,58.9%)、中度(n = 4,7.1%)到重度(n = 4,7.1%)不等。尿失禁影响了女性的日常生活活动,使其减少外出活动(23.2%),影响工作表现和友谊(8.9%)、日常家庭活动(7.1%)、总体健康状况(12.5%)、性关系(12.5%),使其更加紧张或焦虑(10.7%)以及需要使用护垫或保护装置(25%)。方差分析、Tukey检验和Tamhane检验作为最小重要差异模型,通过标准差得出统计分析与临床结果之间具有显著相关性(分别为p = 0.001、0.001和0.005)。以下特征有利于尿失禁的发生:年龄(OR = 0.845,95%可信区间[0.268 - 2.669])、家庭主妇(OR = 1.800,95%可信区间[0.850 - 3.810])、贫血(OR = 0.939,95%可信区间[0.464 - 1.901])、产次(OR = 0.519,95%可信区间[0.325 - 0.829])、流产(OR = 1.219,95%可信区间[0.588 - 2.825])及居住在农村地区(OR = 1.800,95%可信区间[0.887 - 3.653])。身高(p = 0.037)、教育程度(0.016)、流产(0.002)、产次(0.006)及居住地点(0.020)是显著因素。结论。许多孕妇患有尿失禁,这在该地区值得公共卫生部门高度关注。年龄、身高、家庭主妇身份或小学以上学历、居住在农村、产次、流产及贫血是有利于尿失禁发生的因素。作者计划根据研究结果在该地区开展一项健康促进项目,以便向医护人员,尤其是家庭医生提供信息,并教育女性了解尿失禁的预测因素及盆底肌锻炼,用于孕期及产后尿失禁的一级预防和二级缓解,并在这方面为贫困女性提供一些卫生用品。

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