What impact does urinary and anal incontinence have on a woman’s quality of life?

Abstract

The impact of pelvic floor dysfunction is often far-reaching, and can have a devastating impact on women’s lives. In the past 50 years, the concept of quality of life (QOL) has been increasingly used, but despite acceptance that relevant data are an important metric, there is little mention of it within the available pelvic-health-related grey literature. Therefore, this literature review looks at the published evidence to evaluate the impact that urinary incontinence (UI) and anal incontinence (AI) have on a woman’s QOL. A systematic search was conducted that involved MEDLINE, CINAHL, AMED, Google Scholar, pertinent grey literature and a hand-search of reference lists in relevant papers published in the English language between 2012 and 2022. The inclusion criteria were limited to two elements of pelvic health, i.e. UI and AI, because these are common, definable symptoms, and articles tend to focus on condition-specific, health-related QOL. The literature search was also limited to “titles only” because of the high-volume return rate when “abstract and title” was employed. Among the 418 papers initially identified, five met the eligibility criteria: three were specific to UI; and two focused on AI as a result of obstetric anal sphincter injuries and its impact on QOL. The literature review identified three themes: QOL is negatively affected by UI and AI; UI and AI have a negative impact across the different domains of QoL; and finally, there are geographical variations in UI and AI. It also offered some insight into the risk factors for and the prevalence of UI and AI that was in keeping with current literature. Continence is considered to be among the most basic of needs. These findings support the perception that UI and AI are both prevalent, and have a myriad of far-reaching consequences that negatively impact QOL. The results of this literature review demonstrate that there is a clear need for QOL measures in pelvic health research. However, there is also a need for standardized outcome measures to allow for a greater depth of synthesis, and where possible, meta-analysis. Future research needs to ensure that geographical and ethnicity data are considered and accurately reported in order to gain deeper insights and address known health inequalities. In line with current thinking, health professionals and women themselves should be made aware of the prevalence of and known risk factors for UI and AI so that they can focus on prevention and early recognition to optimize lifelong pelvic health.