DETECTION OF URINARY INCONTINENCE AFFECTING POST-MENOPAUSAL AGE USING II Q-7 AND UDI-6 QUESTIONNAIRE AT IMMANUEL TEACHING HOSPITAL BANDUNG

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1 DETECTION OF URINARY INCONTINENCE AFFECTING POST-MENOPAUSAL AGE USING II Q-7 AND UDI-6 QUESTIONNAIRE AT IMMANUEL TEACHING HOSPITAL BANDUNG Ucke S Sastrawinata Subdivision of Social Obstetrics and Gynecology Department of Obstetrics and Gynecology Medical Faculty of Maranatha Christian University Immanuel Teaching Hospital, Bandung ABSTRACT Urination problem sometimes could be extremely bothersome, and one of the problems that occurs in urination is urinary. Adult women are more likely to complain of urination, and 30-50% of them would experience urinary. It is likely to be found in people aged years old. Women with normal postural body type and medical history of hysterectomy could possibly have the tendency to urinary and so do women with three children or more. However, the incidence of urinary in post-menopausal age hasn t evaluated yet. The objective of this study is to evaluate the incidence of urinary in post-menopausal age based upon Incontinence Impact Questionnaire (IIQ-7) and Distress Inventory (UDI-6). This study uses observational descriptive method and practically involves 75 post-menopausal women in years who suffer urinary in Obstetrics & Gynecology Department of Medical Faculty of Maranatha Christian University/Immanuel Teaching Hospital, Bandung. Data is obtained from the IIQ-7 and UDI-6 questionnaire. From all of the respondents, 90.6% complain that they suffer from urinary and it could be extremely bothersome in their daily life. The age of the patients ranged from It counts for approximately 60% in a group of people who have normal body weight. Moreover, in a group of people who get married more often are also more likely to have urinary, and that counts for 94.7%. This study shows that women who have more than three children with medical history of hysterectomy are also inclined to suffer urinary. Keywords: urinary, post menopause, Incontinence Impact Questionnaire, Distress Inventory Correspondence: Ucke S Sastrawinata, Department of Obstetrics and Gynaecology, Medical Faculty of Maranatha Christian University/Immanuel Teaching Hospital, Jl. Kopo no. 161, Bandung 40234, Phone : , uckesastrawinata@yahoo.com INTRODUCTION Urination problem sometimes could be extremely bothersome, and one of the problems that occur in urination is urinary. Adult women are more likely to complain of urination, and 30-50% of them would experience urinary. (Hervey 2001, Vassalo 2000) Buchsbaum did the research on this particular topic, and he found the fact that the highest incidence of urinary is in postmenopausal women (Buuchsbaum 2002, Yip 2003). Many factors can increase the risk of developing urinary, and that would include: vaginal birth, BMI, people who have medical history of hysterectomy. tract infection, and perineal trauma (Parazzini 2003). The aforementioned conditions may have a profound impact on their quality of life. Unfortunately, most patients with urinary are sometimes reluctant to have medical treatment, so it would be rather difficult to find out precisely the prevalence and social impact of the disease. In our department of Obstetrics and gynecology of Maranatha Christian University, Immanuel Hospital, we have not found any data on the incidence of urinary afflicting to post-menopausal women. The objective of the study is to figure out the incidence of urinary in post-menopausal age using questionnaire, and also to analyse the risk factors that may happen on urinary in post-menopausal age. However, the problem identification of this study is to learn how many women, in their post-menopausal age, develop urinary at Immanuel Teaching Hospital, Bandung. Indonesia. There is no study on urinary in post menopausal age at Immanuel Teaching Hospital, Bandung. Indonesia, using IIQ7 dan UDI-6 questionnaire. MATERIALS AND METHODS 206

2 Detection of Incontinence Affecting Post-Menopausal Age (Ucke S Sastrawinata) This study uses observational descriptive method where data is obtained from the II- Q-7 and UDI-6 questionnaire given to several women who have reached their post-menopausal age. The study took place at Department of Obstetrics and Gynecology of Maranatha Christian University, Immanuel Teaching Hospital Bandung. Questionnaires were randomly given to several post-menopausal women. This study, however, is primarily based on the observational method, and the study materials are taken from the IIQ-7 and UDI-6 questionnaire which had been fully answered by postmenopausal age. The collected data will be presented in tables and graphs. Post menopause is the period of time after the menopause to senium, and is formally defined as the time after which a woman has experience twelve consecutive months without menses (Baziad 2003). is regarded as involuntary leakage of urine which can cause medical trouble and social impact. Stress is an involuntary or uncontrollable loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, exercise or putting too much efforts or energy that leads to increased abdominal pressure (Melville 2002, Summit 1992, Rogers 2008). Urge is an involuntary or uncontrollable loss of urine which is accompanied with urinary urgency (Summit 1992). urgency is a sudden, compelling urge to urinate. Uterine prolapse happens when the uterus descends into the vaginal canal that results in discomfort. Medical history of childbirth is the obstetrical experience in conceiving and delivering a baby. Body posture is regarded as the classification of the body weight based on Body Mass Index (BMI),is a statistical measure which compares a person's weight and height,which is comprised of lean/underweight, normal, corpulent/overweight, obese. The current value settings are as follows: lean type/underweight individuals are those with BMI lower than 18.5 kg/m2, normal type with BMI ranged from kg/m2, corpulent/overweight with BMI ranging from kg/m2, and obese with BMI is higher than 30 kg/m2. The inclusion criteria were women in their post menopausal age (50 65 years old) who signing the informed consent as they give consent to the procedure and answering the IIQ and UDI completely. The exclusion criteria were women who have received Hormone Replacement therapy, who are not aware of or forgetting their date of birth, and those with urinary tract infection based on doctor s decision. RESULT UDI-6 and IIQ-7 scoring is a parameter to determine the severity of urinary. If UDI-6 score demonstrates more than 14, and IIQ-7 score is more than 15, a woman is inclined to develop urinary. This study reveals 75 women with the range of age of years old who are included in Post-menopausal Women (Table 1-8). Table 1. The prevalence of urinary based on the group of age Age (years old) Non Incontinence N % N % Table 2. Distribution of urinary based on body posture Not Body Posture Underweight Normal Overweight Obese Table 3. based on the medical history of hysterectomy Hysterectomy Non-urinary Symptom of urinary Table 4. Distribution based on medical history of uterine prolapse. Uterine prolapse Non- incontinene Symptom Table 5. Distribution based on medical history of stroke. Medical history of Non- stroke Symptom

3 Table 6. Distribution of urinary based on marital status. Marital Status Non-urinary Unmarried Married Table 7. Distribution of urinary based on number of labour. Number of pregnancy Non- Incontinence Nulliparaous times times > 4 times DISCUSSION In women who reach their menopausal age tend to experience various alterations in their life which is the result of diminishing production from of estrogen gradually starts to drop, and also affects the urogenital tract of women who are in this phase. The vaginal canal of the menopausal women would get shorter and narrower because of the increased production of submucous tissues. The viginal ridge would become less curvy. Maturation index will respectively shifts to the left due to the diminished estrogen with predominant parabasal and intermediate cells. Menopausal women tend to suffer from vaginal dryness. The production of epithelial glycogen and the secretion produced would decrease, and that contributes to the suppression of the Lactobacillus growth, on the other hand, it will increase the growth of other microorganism. At this point, the vulva and vagina would be prone to irritation, injury and infection. Urethra and base of the bladder will also experience the same. Urethra epithelium and the bladder trigone experience alteration, and is thought responsible to atropican cystitis, urethral carancule, and the urethra would become shorter, and stress urinary (Gass 1997) Incontinence impact questionnaire and urinary distress inventory questionnaire. Symptoms of urinary are known to negatively affect health-related quality of life in women. To assess effectiveness of treatment, it is currently recommended to include measurements of quality of life in outcome analysis. One of the questionnaires that is commonly used is the combination of the (UDI-6) and IIQ-7 (Harvey 2110, Vassalo 2002, Fitz 2001).These questionnaires contain a brief form of IIQ and UDI, where each of the questionnaires consists of 30 and 18 questions. Both of these questionnaires respectively are made in a brief form of IIQ-7, which consists of 7 questions; and UDI-6 is 6 questions (Harvey 2001). IIQ is a form of questionnaire which is frequently used to analyze the impact of urinary on the activity and emotion of a woman. These assessments contains of 4 categories; which are physical activity, social relationship, travels, and emotional health (Harvey 2001). UDI is prevalently used to find out the level of urinary where the questions covered 3 forms of urinary, stress, over activity of the bladder and obstruction (Harvey 2001, Vassalo 2002). More over these questionnaires also have various questions to analyze the existing urinary. The aforementioned questionnaires include Incontinence Impact questionnaire (IIQ), urinary distress inventory (UDI) (Harvey 2001, Vassalo 2002, Fitz 2001), quality of life (I-QOL), patient severity assessment (PISA), International consultation on questionnaire (ICIQ) (Bradley 2005, Tamanini 2004) and the last questionnaire edited is questionnaire for urinary diagnosis (QUID) (Bradley 2005). Incontinence Impact Questionnaire (IIQ), and urinary distress inventory (UDI) are the frequent-used questionnaires in various research that have the connection with the assessment of the urinary (Harvey 2001, Vassalo 2002, Fitz 2001, Melville 2002;Buchsbaum 2002) The use of brief format of Impact questionnaire (IIQ), and urinary distress inventory (UDI) have been tested on its validity (Harvey 2001). This study includes 75 post-menopausal women who have fulfilled the criteria as it is applied and have answered the IIQ-7 and UDI questionnaire completely. As result, the study found 90.6% women who suffer from urinary. is defined as involuntary leakage of urine which is frequently found in women, and is thought responsible for the afterbirth trauma, acute and chronic diseases, and also due to the diminished stimulation of estrogen that may result in pelvic muscle dysfunction (Fantl 1997). Age Distribution, among women, is one of the conditions which occasionally could be extremely bothersome. A third of women, frequently have difficulty postponing urination urges and generally must 208

4 Detection of Incontinence Affecting Post-Menopausal Age (Ucke S Sastrawinata) promptly empty their bladder on cue and without delay. 10% of them who experience urinary at least once in a week, and the other 5 % complain its symptom. It has been said that urinary is a dynamic condition that can lessen spontaneously (Samuelsson 2000). can be found 23.6% in women aged 20 until 59 years old (Samuelsson 2000). Other study reveals the prevalence of urinary in post-menopausal age (Vassalo 2002, Buchsbaum 2002). is the most frequently emerging problem and approximately 50% of them, who are in their age of 65, who considerably often complain from this symptom. 81.5% from all of the women in their post-menopausal age suffer from this symptom4. From 75% who had filled in the questionnaire, we could find 90.6% of them complaining about the symptom. Moreover, we also found that most women who experience the urinary, are the age of 50-54, amounting to 39.1%. Body Weight Index Distribution. The study indicates 60% of people who suffer from urinary demonstrate normal Body Mass Index, and 22.7% of them are in obese state. Body Mass Index does not significantly show the difference between people suffering urinary and who do not. The result demonstrates the same with the one obtained from the study done by Bai which also shows no difference on age, parity, the age when menopause begins, and Body Mass Index (BMI) Distribution of Medical History of Particular Illness or Operation Former medical history of particular illness, such as stroke, uterine prolapse could relate with the symptom of urinary. Besides, medical history of hysterectomy could possibly contribute to the symptom, for instance; from 7 people with post hysterectomy, there were 5 of them complained of having urinary. This indicates that the counseling should be performed before the operation in order to give more information to the patient about the risk involved. Autonomic nervous system controls the input and the output of urine. The impairment of autonomic nervous system may cause urinary. We could also find the urinary in 9.3% patient who suffers a stroke (Lee 2004, Green 2003). This study shows 7 patients out of ten who suffer from urinary and had a stroke. Studies have inconsistently shown that hysterectomy and uterine prolapse are the risk factor for developing urinary (Parazzini 2003, Buchsbaum 2002, Hart 2006). These medical histories would lead to pelvic floor dysfunction that contributes to involuntary urine leakage (Zaccardi 2010). There are 9 persons who suffer from uterine prolapse and 8 persons with the medical history of hysterectomy. However, almost all the patients mentioned above suffer from urinary. Distribution of The Number of Pregnancies and Vaginal Delivery is more likely to be found in multiparous women (Summit 1992). It is believed that the interval of a woman giving birth does increase the risk of developing urinary, and it approximately counts for 30% (Viktrup 2001). The more frequent a woman giving birth, the higher risk the mother may have. Degenerative change in autonomic nervous system of the lower urinary tract or mechanical pressure due to the pregnancy itself would raise the risk of developing urinary. Partial denervation of pelvic floor is considered the result from the impairment of pudendal nerve that plays a role during labour or the tightly stretched abdominal muscles is also thought to serve this abnormality. The impairment of connective tissue in the process of labour may also cause urinary that result from the weakening of paraurethral connective tissue,thus it can also possible becomes rigid. Many studies reveal a higher prevalence of urinary in parous women compared with nulliparous women. CONCLUSION This study reveals approximately 90.6% of postmenopausal women develop urinary. This symptom can be found mostly in people aged years. 39.1% of them who suffer from urinary tend to have normal body weight. This symptom could be found in primarily multiparous women who already had at least 3 children. Considering many risk factors that might affect urinary, child limitation would be the way out to reduce the prevalence of urinary. Every woman is advised not to either conceive or even give birth more than 3 times. Moreover, every procedure of hysterectomy must be informed precisely to the patient about the risk that might happen later. REFERENCES 1. Bai SW, Lee JW, Shin JS, Park JH, Kim SK, Park KH (2004). The Predictive values of various parameters in the diagnosis of stress urinary. Yonsei Med J 45,

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