Prevalence and factors associated with urinary incontinence in women farmers

Introduction: Urinary incontinence (UI) is any involuntary loss of urine, exhibiting a relationship with pelvic floor muscle weakness and overload. The physical exertion required of the woman farmer may predispose her to higher frequency of UI. Objective: To evaluate the prevalence of UI and associated factors in women farmers. Methods: Cross-sectional study, with appli-cation of an evaluation form and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) in women aged between 25 and 50 years old. Women with urinary loss responded to the King's Health Questionnaire (KHQ). Data were collected by individual interview. The data were analyzed by absolute and relative frequency, using the Mann-Whitney test for intergroups and Spearman's Correlation Coefficient to relate the variables, considering p < 0.05. Results: Two hundred farmers were interviewed, where 52 (26%) reported involuntary urine loss. The incontinent group had a higher number of annual urinary infection (3.23 ± 1.40). Most incontinent women reported escape 1x/week or less (73.08%), in small amounts (82.69%), during stress (57.69%). Quality of life was classified as very good by 59.62%. The intensity of the work was considered strong by 25% of the incontinent women. Only 30.5% of the volunteers were able to define UI and 97.7% considered it not normal. Conclusion: The prevalence of UI was equivalent to the average of the female population in general, with urinary infection as an associated factor. The loss occurs mainly to stress, and lack of knowledge can reflect in the identification treatment.


Introduction
normal and inherent to aging. 7 The greater social vulnerability of the rural population and the difficult access of professionals limit the dissemination of health information, 8 and could increase the frequency of unidentified dysfunctions. Low schooling level may also be a complicating factor in the search for and interpretation of health information. According to the 2017 agricultural sector, approximately 15% of Brazilian farmers have never attended school. 9 Although UI has a negative influence on the life of women, few seek professional help at the first signs of dysfunction. This is due primarily to embarrassment and lack of knowledge about dysfunction, associated with cultural and family influences. 10 In Brazil, the number of farms where the producer is a woman has risen from 12.7 to 18.6% in recent years. 9 This indirectly indicates their growing participation in rural activities. Agriculture is one of the most economically important activities in the country and, due to the demand for labor, women carry out both domestic and child care activities and agricultural services on the farm, 11 where the excess workload may predispose them to dysfunctions.
Thus, it is important to assess the prevalence of UI and associated factors in women farmers, assuming that the peculiarities of rural work overload PFMs and the lack of information on this dysfunction hinders their seeking treatment.

Methods
This is a cross-sectional study using quantitative analysis conducted in a rural area of the municipality of

Results
Involuntary urine loss was reported by 52 women farmers (26%). Table 1 presents the sample characteristics.
No intergroup differences were observed in age and anthropometric variables.      (Table 3).    It is important to note, however, that perceived work intensity was higher in the IG than CG, perhaps because they identified urinary loss during exertion.
Most of the IG women responsible for milking cows used a bucket in the squat position during the procedure. The number of pregnancies and deliveries, as well as the characteristics of the latter did not differ between the groups, highlighting the non-obligatory relationship between these variables and prevalence of UI. 30 Albeit not significant, the relative frequency of gynecological surgeries was greater in the IG. These procedures may affect the integrity of bladder innervation and the PFMs, as well as the integrity of the urethral sphincter, compromising voluntary urinary control. 31 In addition, the report of frequent urinary infections was higher in the IG (25%), exhibiting a direct relationship between the number of annual infections and UI severity. In a study of rural women with UI, Ganapathy 6 found that 37.59% suffered from frequent urinary tract infections.
Women are more vulnerable to urinary infections, since their urethra is narrower and due to the closer proximity between the vagina and anus when compared to men, which facilitates the presence of an infectious agent. 32 With repeated urinary infections, the bladder becomes hyperactive because of inflammation on its inner surface.
Using an absorbent pad (often adopted to avoid wetting clothes) provides a favorable environment for the proliferation of fungi and bacteria. 5,33 In addition, poor Pakistan (11.3%), 24 Israel (10%) 33 and India (30.6%), 14 the last exclusively with women living in rural areas.
Higa et al. 21 suggest that the low incidence of seeking