Hypothesis / aims of study
A lot of health care professionals employed at hospitals are exposed to work-related factors such as busyness and understaffing, which sometimes necessitate delaying micturition. Suppressing the desire to void over time, may train the bladder to contain larger and larger amounts of urine before the desire to void appears. This condition is termed Reduced Bladder sensation and defined by ICS as awareness of bladder filling without feeling a definite desire to void (1). This may lead to the development of more severe Lower Urinary Tract Symptoms (LUTS) such as urinary incontinence (UI) or Absent Bladder sensation later in life. We aimed to investigate and clarify voiding patterns during working hours among female health care professionals, in order to identify the prevalence of normal and abnormal patterns.
Study design, materials and methods
Between 1st of February and 1st of March, 2016, a systematic literature search was performed in the databases PubMed and Cinahl, and a cross-sectional study was conducted among 31 women (13 nurses and 18 midwifes) employed at a University Hospital. The hospital has a total of 3099 nurses and 135 midwifes employed. The study included a baseline questionnaire, a validated questionnaire; ICIQ-UI-SF (the International Consultation on Incontinence Questionnaire – Urinary Incontinence – Short Form), uroflowmetry, urinary volume measurement and post-void residual measurement. All participants were asked to fill out the baseline questionnaire (providing information about age, height, weight, smoking status and parity) and the ICIQ-UI-SF at inclusion. Furthermore all participants had an uroflowmetry, a urinary volume measurement and a post-void residual measurement done during working hours when they felt the desire to void and had the opportunity to visit the toilet depending on the bustle of the department. The measurements were carried out by one of the authors and analysed by both authors in common.
An abnormal voiding pattern was defined as one or more of the following conditions; abnormal uroflowmetry (fluctuating/plateau shaped), a voided volume over 400ml or under 150ml and/or a post-void residual over 100ml.
A total of 31 women participated in the study. The average age were 36.2 years and the average BMI was 24 kg/m². Eleven women had a BMI >25 kg / m², corresponding to 34%. A total of 14 had delivered vaginally, 3 had only delivered by caesarian section and 14 were nulliparous women.
Off the 31 women included, 8 reported urinary incontinence either in the form of stress UI or urge UI. Eleven women had voided volumes > 400 ml, and six women had voiding volumes <150ml. Mean Qmax was 30.2 ml/s (range 9.5-64.4 ml/s). Two had a post-void residual amount > 100ml. Only two women had abnormal urine flow curves. Off the women with voided volumes > 400ml, three women reported UI. More women with voided volumes > 400ml (30%) reported UI compared to women with voided volumes < 400ml (24%).
Interpretation of results
According to our definition, 17 women had an abnormal voiding pattern corresponding to 55% of the participants. The most common condition was voided volume > 400ml (35%) indicating a high prevalence of Reduced Bladder sensation in the study population. This might be related to suppressing the desire to void over time which could be due to working conditions. Women employed as health care professionals at hospitals might be in higher risk of LUTS compared to other women.