Barriers in entering treatment among women with urinary incontinence
Bariery w podejmowaniu leczenia przez kobiety z nietrzymaniem moczu
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1 Specialized Medical Clinics „ Good Doctor”, Cracow, Poland
2 Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian Univeristy, Medical College, Cracow, Poland
3 Department Gynecology and Oncology, Jagiellonian Univeristy, Medical College, Cracow, Poland
4 Department of Gynecology and Oncology, Jagiellonian Univeristy, Medical College, Cracow, Poland
5 Jagiellonian University, Medical College. Faculty of Health Science ( PhD studies), Cracow, Poland.
Abstract
Objective: The aim of the study was to identify barriers in help seeking behaviors among women with urinary incontinence UI .
Materials and methods: The study was performed using the method of diagnostic enquiry by means of question- naire and interview among two groups of patients. The first group of women aged 47-79 years consisted of 80 members of the Association of People with Urinary Incontinence „Uroconti”. The second group included 61 females aged 26-81 years admitted to the Urodynamic Laboratory of Gynecology and Oncology Clinic at the University Hospital in Krakow.
Results: Patients with stress urinary incontinence (SUI) reported to the doctor on average after 4 years, patients with urgency urinary incontinence (UUI), after 3 years, patients with a mixed form of urinary incontinence (MUI), after 6 years, and with overflow incontinence, after 10 years from the appearance of first symptoms. Anxiety, shame, the conviction that symptoms of UI are a normal age related state, as well as the conviction that the symptoms are temporary, significantly affected the delay in seeking medical consultation. Most of the surveyed women made the decision to undertake treatment themselves, and their main motive was the escalation of symptoms. The majority (89.4%) of women surveyed alleviated the symptoms of urinary incontinence without the help of a doctor, someti- mes using methods detrimental to their health.
Conclusion: The identification of help seeking barriers and reaching out to risk groups is essential for early diagno- se and effective treatment of women with urinary incontinence.
Key words: urinary incontinence / help seeking barriers / education /
Otrzymano: 30.12.2013
Zaakceptowano do druku: 20.02.2014 Adres do korespondencji:
Urszula Wójtowicz,
Specialized Medical Clinics „ Good Doctor”, 3 Plac Szczepański str., 31-011 Cracow, Poland Telefon: 517-389-670
e-mail:urszula.wojtowicz@uj.edu.pl
Introduction
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Materials and methods
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Streszczenie
Cel: Celem pracy była identyfikacja barier w szukaniu pomocy przez kobiety z nietrzymaniem moczu (NM).
Materiał i metody: Badania przeprowadzono metodą sondażu diagnostycznego, techniką ankiety i wywiadu wśród dwóch grup pacjentek. Pierwszą (gr. I) stanowiło 80 kobiet w wieku 47-79 lat, należących do Stowarzyszenia Osób z Nietrzymaniem Moczu “Uroconti”. Druga grupa (gr. II) obejmowała 61 pacjentek w wieku 26-81 lat, które zgłosiły się do Pracowni Urodynamicznej Kliniki Ginekologii i Onkologii Szpitala Uniwersyteckiego w Krakowie.
Wyniki: Pacjentki z wysiłkowym nietrzymaniem moczu (WNM) zgłaszały się do lekarza średnio po 4 latach, z na- glącym nietrzymaniem moczu (NNM) po 3 latach, z mieszaną postacią nietrzymania moczu (MNM) po 6 latach, a z nietrzymaniem moczu z przepełnienia po 10 latach od wystąpienia pierwszych objawów. Lęk, wstyd, przekonanie, że objawy NM są stanem normalnym związanym z wiekiem, a także uznanie go za sytuację przejściową miały znaczący wpływ na długość czasu, jaki upłynął od wystąpienia objawów do zgłoszenia się do lekarza. Najczęściej badane kobiety podejmowały decyzję o leczeniu samodzielnie, a głównym motywem było nasilenie objawów. Więk- szość (89,4%) ankietowanych kobiet łagodziła objawy nietrzymania moczu bez pomocy lekarza, niekiedy stosując metody niekorzystne dla zdrowia.
Wnioski: Pacjentki z NM zgłaszały się późno do lekarza z powodu braku wiedzy i błędnych przekonań na temat choroby. Konieczne jest opracowanie metod wczesnego dotarcia do grup ryzyka i systemu pomocy dla kobiet z tym problemem.
Słowa kluczowe: nietrzymanie moczu / bariery w szukaniu pomocy / edukacja /
Results
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Women’s knowledge about incontinence
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Motives behind the decision to seek treatment
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Self-treatment methods for symptoms of urinary incontinence
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Discussion
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Ta b l e I . Types of urinary incontinence—data from the Gaudenz questionnaire.
Types of UI Group I Group II Total
n n n
Stress UI 35 16 26.2 51 36.2
Urgent UI 10 2. 11 18 21 14.9
Mixed UI 34 42. 29 4. 63 44.7
2YerÀoZ UI 1 1.2 5 8.2 6 4.2
Ta b l e I I . Patients’ reasons to initiate treatment.
:Ko or ZKat inÀuenFed tKe deFision to initiate treatment?
Group I Group II Total
n n n
Independent decision 64 80 46 74 110 78,1
Exacerbation of symptoms 49 61,2 48 78,7 97 68,8
Refundable medication 0 0 14 23 14 9,9
Family/Friends 6 7, 6 9,8 12 8,
Gynecologist 1 1,2 8 13,1 9 6,4
“Uroconti” Association 6 7,4 0 0 6 4,2
Nurse 0 0 2 3,3 2 1,4
Urologist 0 0 1 1,6 1 0,7
Media: press, television, internet 0 0 1 1,6 1 0,7
* % does not total 100 because patients were allowed multiple responses Ta b l e I I I . Barriers in seeking treatment by patients.
Barriers in seeking treatment Group I Group II Total
n n n
Fear 13 16,25 28 45,9 41 29,1
Shame 32 40 43 70,5 75 53,2
Considering UI a transient condition, which “will
pass on its own”. 44 55 42 68,85 86 61
Conviction that UI is not treated as it is a normal
part of aging 37 46,25 43 70,5 80 56,7
Anxiety of surgical procedure 1 1,25 1 1,6 2 1,4
Lack of burdensome symptoms 5 6,25 3 4,9 8 5,6
Unwillingness to see a doctor 1 1,25 1 1,6 2 1,4
*% does not total 100 because patients were allowed multiple responses Ta b l e I V. Patients’ methods of self-treatment.
Methods of alleviating symptoms of UI Gr.I Gr.II Razem
n n n
Inserts 67 83,7 53 87 120 8,1
Reduction of Àuid intake 51 63,7 30 49,2 81 7,4
Mapping out toilets 28 3 27 44,3 55 39
Wearing dark clothing 12 1 23 37,7 35 24,8
Limiting physical activity 11 13,7 11 18 22 1,6
Exercises 11 13,7 6 9,83 17 12
Medications: Urospet, Furagin 0 0 12 19,7 12 8,
Herbs, sitz baths 1 1,2 10 16,4 11 7,8
Setting breaks in work for voiding 7 8,7 12 19,7 19 16,7
*% does not total 100 because patients were allowed multiple responses
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Figure 1. Presence of risk factors and the occurrence of urinary incontinence.
Figure 2. Number of childbirths and the occurrence of UI.
Figure 3. Physician to whom the women reported urinary incontinence.
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Oświadczenie autorów
1. Urszula Wójtowicz – autor koncepcji, założeń pracy i metodologii badań, ze- branie materiału badawczego, analiza i interpretacja wyników, opracowanie wyników badań, interpretacja dokonanej analizy statystycznej, przegląd i ana- liza przedmiotu, przygotowanie roboczej wersji manuskryptu, przygotowanie manuskryptu i piśmiennictwa, przygotowanie, korekta i akceptacja ostateczne- go kształtu manuskryptu –autor zgłaszający i odpowiedzialny za manuskrypt.
2. Lucyna Płaszewska-Żywko – pomoc w opracowaniu koncepcji pracy, nadzór nad przygotowaniem artykułu, weryfikacja manuskryptu i korekta, analiza kry- tyczna roboczej wersji artykułu, nadzór nad przebiegiem i przygotowaniem artykułu.
3. Klaudia Stangel-Wójcikiewicz – korekta, aktualizacja literatury.
4. Antoni Basta – ostateczna weryfikacja i akceptacja manuskryptu.
Źródło finansowania: Praca nie była finansowana przez żadną instytucję nauko- wo-badawczą, stowarzyszenie ani inny podmiot, autorzy nie otrzymali żadnego grantu..
Konflikt interesów: Autorzy nie zgłaszają konfliktu interesów oraz nie otrzymali żadnego wynagrodzenia związanego z powstawaniem pracy.
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