1. Epidemiology and Consequences of Female Urinary Incontinence in the Middle-East بسم الله الرحمن الرحيم ICS 2008, Educational Course No. 9, Cairo, Egypt, October 21, 2008 Ahmed Al-Badr, MBBS, FRCS(C), FACOG Chairman, Urogynecology & Pelvic Reconstructive Surgery Deputy Medical Director, Women’s Specialized Hospital King Fahad Medical City, Riyadh

2. Outline:  Definitions  Scope of the problem  Worldwide prevalence  Prevalence in the region  Conclusion

3. Urinary Incontinence (UI): Definition (ICS): The complaint of any involuntary leakage of urine The complaint of any involuntary leakage of urine Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

4. UI: Definitions Stress Incontinence:  Is the complaint of involuntary leakage of urine with exertion, effort, sneezing, or coughing Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

6. UI: Definitions Urge Incontinence:  Is the complaint of involuntary leakage accompanied by or immediately preceded by urgency Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

7. UI: Definitions Mixed Urinary Incontinence:  Is the complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

8. UI: Scope of the problem W.H.O. recognizes incontinence as an international health concern Clinical practice guidelines, 1996. US Department of Health and human Services

9. UI: Scope of the problem ¹ Impact on lifestyle ¹   Avoidance of activities   Depression, isolation, embarrassment…   Impact on marital/sexual relationships   Increased dependence on caregivers   Discomfort and skin irritation  ², 3  Interference with prayers (Salat) and purity (Tahara) ², 3 1. 1.Clinical practice guidelines, 1996. US Department of Health and human Services 2. 2.Risk et al. Int Urogynecol J 1999;10:160-53. Saleh 2005

10. Prevalence of UI worldwide

12. Minassian et al 2003

13. Types of UI Minassian et al 2003

15. Prevalence of UI in the Middle-East

16. UI: Prevalence in UAE  400 women, PHC & community  Prevalence: 20.3%  31% sought medical advice: Embarrassment (38%) Embarrassment (38%) Low expectations from medical care (38%) Low expectations from medical care (38%) UI is normal with age (23%) UI is normal with age (23%) Risk et al. Int Urogynecol J 1999;10:160-5

17. UI: Prevalence in Qatar  1000 women age > 45 years, PHC & comm.  Prevalence: 20.6% 64%: inability to pray 64%: inability to pray 47%: interference with marital relationship 47%: interference with marital relationship 72%:ashamed of themselves and have guilt 72%:ashamed of themselves and have guilt 5%:stopped all work 5%:stopped all work 41%: did not seek help (embarrassment) 41%: did not seek help (embarrassment) Saleh et al, Maturitas. 2005

18. UI: Prevalence in KSA  Prevalence : 35%  Types: SUI: 57%SUI: 57% UUI: 12%UUI: 12% MUI: 31%MUI: 31% Al-Amari et al. 14th SUC 2001

19. UI: Prevalence in KSA  379 women, age >15, PHC Jeddah  Mean age 35 (range: 15 - 71)  Prevalence : 41.4%  Types: SUI: 36.4%SUI: 36.4% UUI: 27.4%UUI: 27.4% MUI: 22.2%MUI: 22.2% Brasha et al. 2008, unpublished

20. UI: Prevalence in KSA  Impact on QoL: 34% unable to perform prayers 34% unable to perform prayers 29% limitations of social activities 29% limitations of social activities 18% affected their sexual life 18% affected their sexual life Brasha et al. 2008, unpublished

21. UI: Prevalence in KSA 18% sought medical advice:  74 % didn’t think it is a significant problem  9 % didn’t think treatment was available  19 % embarrassed to discuss with doctor  4 % did not want to consult a male doctor  9 % thought it was natural with aging Brasha et al. 2008, unpublished

22. UI: Prevalence in Jordan  182 women, age: 50 - 65 yrs, south Jordan (Karak, Taffileh, Aqaba)  Prevalence: 30%  Types: Stress UI: 23.1%Stress UI: 23.1% Urge UI: 26.4%Urge UI: 26.4% Mixed UI: 18.1%Mixed UI: 18.1% Shakhatreh, Saudi Med J, 2005

23. UI: Prevalence in Egypt  1,652 women, age: > 20  Community (Assiut)  Prevalence:54.8% Urge 15%Urge 15% Stress 14.8%Stress 14.8% Mixed25%Mixed25% El-Azab et al. Neurourol and Urodynam (2007) 788-26:783

24. UI: Prevalence in Egypt Impact on QoL:  low self-esteem, feeling unclean (65%)  inability to pray (90%)  difficulty in performing physical activities such as housework (33%)  limitations of social activities (30%)  leakage during sexual intercourse (18%) El-Azab et al. Neurourol and Urodynam (2007) 788-26:783

25. UI: Prevalence in Egypt 4% sought medical advice:  Embarrassment (60%)  Low expectations from medical care (44%)  Assuming UI is normal with aging (38%) El-Azab et al. Neurourol and Urodynam (2007) 788-26:783

26. UI: Conclusion  UI is prevalent in the Middle-East  UI has a significant impact on QoL  UI is underreported and undertreated  Need to educate health-care workers and the public

27. Thank you! Q & A