Urinary incontinence in hospital patients: prevalence and associated factors 1

ABSTRACT Objectives: to analyze the prevalence of urinary incontinence and its associated factors in hospital patients. Method: this is a cross-sectional epidemiological study whose data were collected using the instruments Sociodemographic and Clinical Data, Characteristics of Urinary Leakage and International Consultation on Incontinence Questionnaire - Short Form. Prevalence was surveyed on a single day for four consecutive months. Data were analyzed using Chi-square test, Fisher’s exact test, Student t-test, Mann-Whitney test and logistic regression (forward stepwise). Results: the final sample consisted of 319 hospital adults (57.1% female), mean age of 47.9 years (SD=21.1). The prevalence of urinary incontinence was 22.9% (28% in women and 16.1% in men) and the associated factors were: female sex (OR=3.89), age (OR=1.03), asthma (OR=3.66), use of laxatives (OR=3.26), use of diaper during the evaluation (OR=2.75), use of diaper at home (OR=10.29), and use of diaper at some point during the hospital stay (OR=6.74). Conclusion: the findings of this study differ from those found in the scarce existing literature on the subject in hospital patients. There is a need for previous studies such as this before proposing the implementation of preventive and therapeutic actions during the hospital stay.


Method
This is an epidemiological, observational, crosssectional, analytical and descriptive study.
This study was carried out at the University Hospital Outpatient Clinic during the data collection period. The average rate of bed occupancy during the data collection period was 86.13%, totaling 410 hospital patients.
In order to achieve the calculated sample size, data were collected four times (point prevalence), on a single day, always on the same day of the month (day 18th), Sixty-four (15.6%) patients were excluded from the Junqueira JB, Santos VLCG. Interval was set at 95%.

Results
According to    For the application of the logistic regression model to evaluate the association between variables and UI in women, age and asthma were repeated, together with the number of deliveries and DM, as shown in Table 4. Despite the popular belief and the large number of studies carried out with elderly patients, UI is not an inherent alteration in the aging process. In fact, its incidence increases proportionately with age and can be considered as a geriatric syndrome (8,7,(17)(18) . Aging leads to cognitive changes related to body coordination and mobility, as well as the emergence of associated diseases such as neurodegenerative diseases, and these factors contribute to the incidence of UI.
Unlike the age factor, the association between UI and the use of laxatives is still poorly studied and no other study was found in the national and international literature to corroborate this association. The use of laxatives probably emerged as a factor associated with UI due to the concomitant incidence of UI and constipation in the same individual. Another hypothesis is that due to diarrhea, the individual has a greater difficulty in containing the leakage of urine during evacuation.
The association between asthma and leakage of urine has been frequently demonstrated by other epidemiological studies (7,14) . Respiratory problems lead to chronic coughing or frequent sneezing, which cause repeated increase in intra-abdominal pressure and a consequent pelvic floor overload. A study conducted in 2015 showed that individuals who reported having bronchitis or asthma were 38% more likely to have UI than those who did not have these diseases (7) .
The use of diaper among the factors associated with UI leads to the formulation of some hypotheses about the relationship between these variables. The previous use of diaper at home clearly shows the existence of collinearity between the variables. Therefore, it is naturally expected that those who have long-standing incontinence will wear diapers and vice versa. However, the use of diapers during the evaluation or at some point during the hospital stay raises doubts about the induction of the loss of control of urinary continence due to the use of diapers in previously continent patients.
It is known that the use of diapers during the hospital stay may facilitate the care of elderly patients, avoiding efforts to remove them from the bed and take them to the bathroom. In addition, diapers are commonly used during the hospital stay, especially at night, to avoid the risk of falls in elderly patients. An international study showed that the excessive use of diapers in continents patients during the hospital stay was the second most frequent cause of iatrogenesis, that is, it induced UI (19) .
Women are generally the population most affected by UI, and aging is an aggravating factor for the incidence of UI. The incidence of UI in men and women happens in a systematically different way, occurring predominantly in females (4,(6)(7)(8) . This association may be due to estrogen deficiency and parity, among other factors (20)(21) .
Estrogen plays an important role in the pelvic support mechanism, controlling the synthesis and degradation of collagen (20) . In addition, the tissues of the lower urinary tract are sensitive to estrogen, which influences the increase in urethral resistance, the frequency and amplitude of the contractions of the detrusor muscle, and consequently, the sensory threshold of the bladder (21) .
For these reasons, the reduction of this hormone after menopause is a possible etiologic factor for pelvic floor disorders, including urinary incontinence (14) .
In this study, there were statistically significant Discussions about the association between the type of delivery and the occurrence of UI are still contradictory, however, the most recent publications suggest that cesarean delivery is a protective factor for UI (22)(23) . In a study carried out with women who have recently given birth, the frequency of postpartum SUI was significantly higher in vaginal delivery when compared to cesarean delivery after one month (p<0.001), six months (p<0.001) and 12 months (p<0.001) (22) . In a systematic review (23)  UUI is common in elderly and is associated with an increased risk of falls and consequent fractures (25) . This risk is even greater at night, usually when the caregiver is sleeping.
In addition, only 16.7% of patients reported having sought professional help to deal with this problem. This can be explained by the belief that urinary incontinence is an expected phenomenon during aging, which may imply some resilience from those affected with regard to the problem and the development of adaptive actions (18) .