Syed Shershah ( Department of Obstetrics and Gynaecology, Dow Medical College, Civil Hospital, Karachi. )
Razia Lateef Ansari ( Department of Obstetrics and Gynaecology, Dow Medical College, Civil Hospital, Karachi. )
Urinary incontinence, especially in females causes a great degree of social and hygienic embarassment. In one of the studies, over 50% of young, healthy, nulliparous females had incontinence; of these only 5% found it troublesome1. In old age, the frequency of troublesome incontinence rises to about 30%2, while the figures in paediatric population are about I in every 200 children3. Overall incidence of urinary incontinence in European rural areas is about 4 1%4. This high frequency of urinary incontinence in European population is probably because, (a) soiling of clothes is not considered a major problem and (b) all of them use commode type of toilet. In Pakistan soiling of clothes prohibits the person from performing daily religious activities, moreover a large population uses squatting type of toilet which empties the bladder completely, therefore, the frequency of urinary incontinence is likely to be low. The present study was done in two socially different groups who use different type of toilets, and see the frequency of incontinence in these groups and compare it with other studies.
PATIENTS, METHODS AND RESULTS
Group I (usually poor socio-economic group) comprised of’ females and their accompanying relatives attending the antenatal clinic of Civil Hospital, Karachi, while group II (higher socioeconomic group) consisted of family members and relatives of medical students. A questionnaire bearing information on the presence and frequency of urinary incontinence, its relation to cough, sneezing, laughing, duration of symptoms, and whether present before delivery or occurred later was filled by both the groups. Information on the type of toilet facilities (commode[squatting) was also noted. A total of 267 females filled the questionnaire completely, of these 130 belonged to group I who always used squatting type of toilet while 137 belonged to group II and used commode type of toilet. The frequency of urinary in continence in the two groups and its relation to various acts is shown in the accompanying table.
Females using commode type of toilet had a higher incontinence rate (28.5%) than those using squatting posture (12.3%). Pre-pregnancy incontinence was also more common in the former group. Multiparous females of both the groups had higher frequency of incontinence.
The present frequency of 20.5% urinary incontinence in Pakistani females, is much lower than that reported from the West1-4. The lower frequency of incontinence in females using squatting type of toilet is probably because of better stream, training and complete evacuation of urinary bladder during this posture, resulting in maintenance of sphincter and perineal muscletone. Due to fast urbanization in our society, there is a likelihood of an increase in the frequency of urinary incontinence of our female population.
1. Nemir, A. and Middleton, R.P. Stress incontinence in young nulliparous women; a statistical study. Am. J.Obstei. Gynaecol., 1954; 68:1166.
2. Stanton, S.L. The abdominal approach for the treatment of urinary incontinence progress in obstetrics and gynaecology. Edinburgh, Chur¬ chill Livingstone, 1981,p. 167.
3. Warrell, D.W. Prolapse and urinary incontinence in Dewhursts textbook of obstetrics and gynae-cology for postgraduates. Edited by C.R. Whit-fIeld. 4th ed. Oxford, Blackwell, 1986, p. 680.
4. Jolley, VJ. Repoited prevalence of urinary incontinence in women in a general practice. Br. Med. J., 1988; 296:1 300.