Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: A questionnaire survey
Introduction
Lower urinary tract symptoms (LUTS) include three main symptom groups – storage, voiding, and postmicturition. Storage symptoms occur during the filling and storage phase of the bladder and include increased daytime urinary frequency, nocturia, urinary urgency, and urinary incontinence (UI). Voiding symptoms such as slow stream, splitting or spraying, intermittent stream, hesitancy, straining, and terminal dribble occur during the voiding phase. Postmicturition symptoms –feeling of incomplete emptying and postmicturition dribble – occur immediately after micturition (Abrams et al., 2002). Overactive bladder (OAB) is another focus of many ongoing studies and is defined as a symptom complex that includes urinary urgency with or without urgency UI, usually with increased daytime frequency and nocturia (Abrams et al., 2006).
Previous study results showed that the overall prevalence rates of female LUTS ranged from 28% to 69% (Swithinbank et al., 1999, Moller et al., 2000, Irwin et al., 2006a, Irwin et al., 2006b, Herschorn et al., 2008). The prevalence of OAB has not been well studied because it is a recently defined syndrome (Ouslander, 2004). Most studies have been focused on the effects resulting from UI or OAB (Donovan et al., 2005). Very little research has addressed the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL). An increasing proportion of women in the global labor force is a striking phenomenon of recent times; thus, more attention will need to be given to the effects of paid employment on women's health.
Taiwan's Executive Yuan statistics showed that about half of adult women are employed and about 70% of women 20–45 years of age are working (Executive Yuan, 2006). Employed women are exposed not only to the general risk factors of LUTS, but also to the risk factors such as inadequacy of bathroom breaks or toilet facilities in their work environments (Fultz et al., 2005). Preliminary study results showed that women employed in occupations that place constraints on urinary elimination have an increased risk of developing UI. Employed women with restrictive bathroom breaks were more likely to develop LUTS than women who were not employed. Examples include women working on production lines, as nurses, as teachers, and in the military (Sampselle et al., 2004).
Women with UI or OAB reported negative impact not only on HRQL (Araki et al., 2005, Chiaffarino et al., 2003, Hägglund et al., 2001) but also on some aspects of work (Fultz et al., 2005, Margalith et al., 2004). Study results showed that women without UI or OAB reported better physical and mental health than women with these symptoms (Chiaffarino et al., 2003, Hägglund et al., 2001, Margalith et al., 2004), that UI had a greater impact on working women's physical health than mental health (Araki et al., 2005), and that severity of UI was associated negatively with HRQL (Chiaffarino et al., 2003, Yu et al., 2003). With respect to work life, women with OAB were shown in one study to be more likely to be unemployed, and those who were employed reported decreased work productivity (Irwin et al., 2006b).
Although LUTS have widespread human and psychosocial implications that negatively affect women's HRQL (Moller et al., 2000, Swithinbank et al., 1999), only one fourth to one third of women with LUTS seek professional help (Irwin et al., 2008, Roberts et al., 1998). Many women with LUTS manage symptoms with self-care strategies, and some of these strategies could have adverse effects. Restricting fluids may lead to dehydration, and frequent voiding combined with a low urine output may result in a reduction of the bladder's functional capacity, urinary tract infections (UTI), and pathogenesis (Anders, 2000, Dowd et al., 1996).
There are few international studies about female LUTS, particularly studies on the prevalence and impact of LUTS for women in Asia. Information is also limited on employed women's experiences of LUTS and the impact of LUTS. Common work environment factors associated with nurses’ role stress were high job demand and work overload (Chang et al., 2005), and Bendtsen et al. (1991) reported that 69% of nurses and nursing assistants avoided urinary elimination during their work shifts. In response to the lack of information about LUTS among the Taiwanese population and Taiwan's nurses, the major objectives of this study were to estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS.
Section snippets
Sample
The majority of nurses in Taipei (73%) were employed at medical centers or regional hospitals (Taipei City Nurse Association, 2004). Therefore, the target population of this study was defined as all female nurses who were employed at the medical centers or regional hospitals in Taipei. In Taipei, there were over 9000 nurses in seven medical centers and 4000 nurses in 11 regional hospitals (Taipei City Nurse Association, 2004).
A formula (n0 = 4pq/d2) was used to calculate the required
Results
All the Directors of the Department of Nursing from the selected medical centers and regional hospitals gave approval to participate in this study. A total of 1065 (180 × 3 + 105 × 5 = 1065) surveys were distributed to the three medical centers and five regional hospitals. Of the 1065 selected female nurses, 92 declined participation, so 92 additional nurses were selected randomly as substitutes. Among the 1065 nurses initially selected, 927 completed the survey, resulting in a response rate of 87.0%.
Discussion
The results are interpreted in light of the limitations and the literature on LUTS and OAB. This study is limited by the cross-sectional study design and self-report on many important variables. Because this study was conducted with employed female nurses in Taipei, the results should be generalized with caution and do not infer to a causal relationship. Another limitation of this study is that information about the age distribution of female nurses and their working experiences in Taipei was
Conclusions
This study contributes to knowledge about LUTS among employed women in Asia and increases the awareness of this health concern. Although most of the nurses in this study were young and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to a concern that the working environment and nurses’ poor bladder habits and poor personal habits may affect LUTS.
Nurses’ working conditions are associated with the quality and safety of patient care. Study results showed that
Acknowledgements
The authors wish to acknowledge the assistance of all the nurses who participated in this study.
Conflicts of interest: All authors confirmed that there is no any actual or potential conflict of interest.
Funding: Taipei Medical University.
Ethical approval: This study has obtained the ethical approvals from the selected hospitals and Taipei Medical University.
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