Hypothesis / aims of study
Urinary Incontinence (UI) is a problem that affects women's and men´s physical, mental and social health. Although this some conditions are still not prioritized as it seems to be the case of UI prevention and treatment in Brazil, despite being a major economic and social problem.
Few studies in Brazil have investigated and reported the organization of public health services to carry out information, prevention and treatment measures for UI. Organizing adequate care in this field involves issues related to the demand of the population for treatment, information for the population and health professionals to deal with demands, the services available and the access of the population to services. Despite the high levels of scientific evidence in the treatment of UI through conservative treatments such as pelvic floor muscle training, medications and surgical treatments, it is uncertain how much the population has access to these treatments.
This research aimed to identify the demand of patients with UI in public health services in a medium-sized city in Brazil and their access to any treatment registered in the official municipal and federal health information system.
Study design, materials and methods
This is a descriptive research that carried out an investigation of the demands for urinary incontinence treatment in a medium size city with a resident population of 698,642 people [2022] in Brazil. The health department of the city was contacted and a search request form was filled out and authorized by the Research Project Assessment Committee . The search was done from january 2018 to january 2022. Data was collected from municipal health information system (HYGIA) and by crossing data with the DATASUS system of the Ministry of Health, accessing the international classification of diseases CID (10 edition in Brazil). In the records of urinary incontinence cases presenting ICD-10: N393, N394 and R32 diagnosis, the following variables were raised: sex, age and BMI (Body Mass Index), number of pregnancies, smoking and referral for conservative treatment (physiotherapy) and urological/urogynecological surgery. The data were organized in Office Excel 2016 spreadsheets, and the results were analyzed using percentage, mean, standard deviation (SD) and confidence interval (CI) with p≤0.05; and presented in graphs and tables.
Results
Regarding the demand for UI in the public health network, 1317 cases of patients diagnosed with UI were identified in the municipality. Women representated 88% of the cases, and men 12%. Most of women 62.53% were caucasian with a high mean Body Mass Index (BMI= 31.12); indicating grade I obesity for women; and overweight for men (BMI= 27.11). Regarding the International Classification of Diseases (ICD-10), the results identified the highest rates of Urinary Incontinence diagnoses by ICD-10: R32, demonstrating that 66.93% of women and 89.44% of men presented this classification, followed by ICD-10: N394, where 31.72% of women and 10.56% of men, and ICD-10:N393 occurred only in 1.35% of women (table 1). The data also showed that of the 1317 patients identified, only 1.75% were referred and treated by a Physician and only 0.76% were treated by a Physiotherapist.
Interpretation of results
The UI has emerged as an increasingly relevant problem in several countries, especially where population aging has become prominent. As observed in this study, it affects men and women of different ethnic groups and ages, and it is influenced by modifiable risk factors such as obesity. However, despite the high prevalence of UI, data showed that only few patients had access to tretament and were referred to a Physician or to a Physiotherapist. Both women and men presented a high BMI suggesting one prevalent modifible risk factor demanding appropriate intervention.