clinical focus often conditions present in the population over a time period. With the study that we put out – which was an electronic survey – we had over 5000 responses from nurses and midwives in NSW and we had 3000 who answered the question on urinary leakage. When we asked about urine leakage we found that one in three of the women [ responding ] had some degree of urine leakage in the past month.
Previous work, particularly in Australia, has shown that women do leak and the prevalence was dependent on how old you are. In the younger age group, under the age of 30, it’ s more around 10 per cent of women, and as we get older that prevalence increases. In a very large population survey called the Australian Longitudinal Study on Women’ s Health, the prevalence was around 35 per cent in those over 45. So we know that it is there.
Our research shows the prevalence of 32 per cent overall, so that was in the group aged 18 – 73, and in those over the age of 40 the prevalence was 40 per cent, which does appear higher than previous Australian figures.
[ Compared to international research ] of women of working age, large European studies have shown the prevalence of younger ones that are about 7 per cent, and those aged 40 – 60 around 14 per cent. [ So a ] prevalence of around 40 per cent in our study seems high, and there are lots of different reasons for that and it’ s very difficult to compare figures. That was a little higher than we expected.
Are the figures in line with what you’ d expect to see among women in the same demographic but who work in other professions? It’ s extremely hard to answer that question because there isn’ t a lot of research specific to … different jobs. With any research that has been done, which is quite limited, it is difficult to directly compare results. In my earlier work with my supervisor, as a PhD student, I examined who had researched these questions – there are a few studies that have looked at teachers and academic workers and factory workers. So they’ re quite limited. And over the past 20 or so years there was a handful of studies [ from which I was able to draw out ] 12 studies.
The majority were on nurses. There were five studies on nurses and they talked about teachers being similar to nurses because they also, due to their job requirements, may have restricted access to toilets. They might develop poor bladder habits and that may in turn expose them to urinary symptoms.
Incontinence or leaking of urine is a symptom of being able to hold on or store the urine in the bladder and there are other symptoms associated. You may have a very strong urge to pass urine but you can’ t hold off. You might go to the toilet more frequently – more than seven-eight times a day – which is what we would see as normal. Sometimes you have to get up more than once at night. Leaking is just the symptom of another problem which is being able to store the urine in the bladder.
What is interesting about our study in terms of job-specific or occupation-specific requirements was that the presence of something called“ urge incontinence” – which is where you leak before getting to the toilet – appeared higher than previously recorded in other studies.
Among the 32 per cent of nurses and midwives who say they leaked, 20 per cent leaked before they got to the toilet, so they had this urgency. We think perhaps that it’ s just because of work
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The other important issue is that it is a hidden problem, so not many people disclose that they have the problem because they are embarrassed or ashamed.
demands that they delay going to the toilet – they can’ t get to the toilet any sooner and they leak when they can’ t hold on to that urge any longer – but that’ s just speculation.
We also know that a strategy to prevent incontinence is using the bathroom frequently and emptying just in case, and that sort of habit can interrupt the nurse’ s work pattern and be a real problem if they can’ t access the toilet when they need to.
You also explored how UI might affect a nurse’ s or midwife’ s intention to leave their job. What did respondents who said they had experienced symptoms of UI reveal about their approach to their work? We couldn’ t determine what their approach to work has been. The question I asked was one in a whole barrage of questions the nurses and midwives answered, so the larger survey collected a lot of different variables into health and habits: what we eat and what we drink, what our BMI was, previous health habits in terms of health screening, things like that. I wasn’ t able to ask a question about the approach to the work, but we did … ask whether they worked part-time, full-time or shift work and what area they worked in, whether it was in acute care or aged care, etc. We did find that nurses and midwives who worked part-time hours or didn’ t do shift work – so they worked day hours – were more likely to report having incontinence. We know that there are lots of different reasons for work choices, obviously, not just incontinence. [ If we look ] back to previous research – which as I’ ve said is quite limited – researchers have said that experience of UI has influenced women’ s decisions by reducing the number of hours they work and the type of work that they do.
Why might UI be having an impact on that decision to reduce working hours? When we talk about UI, we need to talk about how severe the symptoms are, because it might just be the occasional leakage when you play sport, or you have the flu and you’ re coughing and sneezing. It might be something that doesn’ t occur very often and so doesn’ t particularly bother you.
We asked in the last survey about the severity of incontinence, and we were able to determine that by reflecting the frequency and amount of leakage and how much it bothered the nurse or midwife who had the condition. We found that the nurses and midwives who had severe incontinence were much more likely to say or indicate an intention to leave their job. Not the actual workforce but to leave their current role in the next 12 months.
In the study, we found [ that it was only ] about 40 of the nurses and midwives out of a sample of nearly 1000 who actually had severe symptoms. So that’ s around 4.4 per cent. Even though the percentage is small, what happens is there are other factors that influence the severity, and our concern is that if you can’ t manage the symptoms in your role, then that’ s probably why you would plan to leave or change your job, work fewer hours or work in another setting or in a role where you can manage your symptoms or have easier access to toilets. ■
Those seeking support or information on incontinence can contact the Continence Foundation’ s free helpline on 1800 33 00 66.
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