The current state of continence in Canada: a population representative epidemiological survey.

Shaw C1, Wagg A2, Cahill J J3

Research Type

Clinical

Abstract Category

Prevention and Public Health

Abstract 621
Epidemiology and Prevention
Scientific Podium Short Oral Session 30
Friday 31st August 2018
14:00 - 14:07
Hall C
Incontinence Questionnaire Overactive Bladder Stress Urinary Incontinence Quality of Life (QoL)
1. University of Alberta, Edmonton, Alberta, Canada, 2. University of Alberta, Edmonton, and the Canadian Continence Foundation, 3. The Canadian Continence Foundation
Presenter
C

Christina Shaw

Links

Abstract

Hypothesis / aims of study
Epidemiological data on the prevalence of lower urinary tract symptoms and urinary incontinence in Canada are dated [1].  Demographic change suggests that the prevalence of these conditions will rise over time as a greater proportion of the Canadian population survives into later life.  Urinary incontinence is associated with significant effects on quality of life, employment and social well-being notwithstanding the impact on healthcare resource use.
Awareness of and access to healthcare services for these conditions varies across the country and, anecdotally, many sufferers report significant barriers to healthcare.  This study aimed to describe, in a nationally representative sample, the prevalence of lower urinary tract symptoms and urinary incontinence and to assess the current state of knowledge of these conditions, the treatment for them and the treatment experience of symptomatic persons.
Study design, materials and methods
A nationally representative adult (18 years and above) sample (age, region, sex) of 1000 people were surveyed by random digit dialling during May 2017.  A 20 minute questionnaire based upon the previous EPIC [2] survey with additional questions on awareness, access, barriers to care, stigma and healthcare experience was administered.  Resulting data were coded, entered into a database and analysed using SPSS v25 (IBM,Cary, Ind.).  Descriptive statistics were used to illustrate the data, comparisons were made using parametric or non-parametric statistics according to the underlying distribution of the data. The margin of error associated with a probability based sample of 1,000 is  +/-3.1%, 19 times out of 20.
Results
Of the 1000 people contacted, 52% were female, 64% married or living with a partner and 17 % single, divorced or widow(er)ed.  78% of all respondents were either aware or vaguely aware of the term “incontinence” (84% women 72% men); 48% understood this as an “inability to hold one’s bladder” and 27% as involuntary urine leakage. Respondents felt incontinence to be a common problem affecting 30% of Canadians, this estimate increased with age of the respondent and was higher when estimated by women. 44% of respondents felt that incontinence was a serious problem that could easily ruin quality of life, 37% felt that incontinence was a problem that could be medically managed; only 11% felt that incontinence was an inconvenience.  When asked, 94% of respondents felt that people with incontinence should seek medical advice, but only 41% knew what help was available or what could be done for symptoms.  There was a marked sex difference, with only 27% of men aware compared to 54% of women. When asked about incontinence as a taboo subject, respondents indicated that they would find incontinence easier to talk about than either body odour (37%v37%), reduced libido (49%v25%) or a sexually transmitted disease (51%v23%). People under the age of 45 would be less likely to discuss incontinence than depression (31v43%).
Of the total sample, 12.7% had a diagnosis of coexistent diabetes mellitus, 14.9% depression, chronic cough 10.6%, chronic constipation 7.6%, asthma 12.0%, 21.1% hypertension 2.9% associated neurological conditions and 3.1% of the men had a diagnosis of benign prostatic enlargement and prostate cancer.  21.0% of the sample had urinary incontinence.  The distribution of incontinence subtypes and bothersome LUTS and treatments used is shown in table 1. Of the respondents with incontinence, 126 (41.0%) experienced leakage a few times a week or more frequently. 24% of sufferers had had their incontinence for more than 11 years.  4.0% of respondents reported accidental bowel leakage over the previous four weeks. Figure 1 shows the impact of incontinence on quality of life domains. 49% of people with UI had initiated a discussion with their healthcare provider about their urinary symptoms, 51% within the last year.  Of those who had discussed their problem, 61% had discussed their problems with a doctor. Of the 41 respondents taking prescription medications for their bladder problem, only 10 felt that they were working well; 29 were taking their medication for over a year.
Interpretation of results
These data give an impression of the current prevalence and effects of urinary incontinence in the general Canadian population. The current distribution of UI and subtypes is similar to that found in 2006. There remains a lack of awareness of the available treatments for the condition despite an acknowledgement that UI is an important medical condition. Few people with UI have actively engaged with treatments. Men remain less aware and less likely to seek healthcare advice than women. Incontinence did not seem to be such a great taboo as is often thought; this opens up opportunities to further the social discussion of the problem in Canada.  These data will form the backbone of a Canadian Continence Foundation national awareness campaign.
Concluding message
UI in Canada remains a common and troublesome condition for which there continues to be only limited awareness of treatments.  A planned awareness campaign will address this problem
Figure 1
Figure 2