| Objective: Urinary incontinence (UI) is the complaint of any involuntary leakage of urine and belongs to pelvic floor dysfunction diseases (PFD). It is not fatal, but has serious impact on women's physical and mental health. The quality of life of women with UI is significantly worse than women without it. UI has now become an international and social issue. Epidemiological study of clinical disease is macroscopic study, including incidence and prevalence rates, etiology, regularity of distribution, severity of disease, risk factors, impact on individual and society, cognition and prognosis of disease and so on. To master epidemiological characteristics of disease is good for the prevention and treatment. The aims of our study were to evaluate the prevalence and status of Chinese women with UI in Hebei Province. And it was the first project in P.R. China to identify the related factors for different types of UI. So our study would provide information for preventing and curing this disorder. Secondly, during the investigation, providing UI-related knowledge to women could make them pay attention to this disease. So they would prevent or go to see a doctor early. At the same time, inferior hospitals should provide UI-related clinic service as soon as possible , in order to promote the development of health care of our province. Finally, to provide important statistical data for our ongoing multi-center epidemiological survey in China.Methods: Our survy was cross-sectional study and use stratified and cluster sampling methods. Three regions in Hebei Province, Shijiazhuang, Baoding and Xingtai, were chosen for the study. At last, eight counties were randomly selected from the three regions and each county included urban as well as rural areas in order to make the results more reasonable. 2500 individuals with different ages and different occupations were invited to participate in our research. The sample size was big enough. The International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Module (ICIQ-FLUTS) and the adult questionnaire made by Asia-Pacific Continence Society were used in our research. Some parts of the content were adjusted according to the characteristics of women in Hebei Province and the purpose of our research. Experts who were good at epidemiology or obstetrics and gynecology gave us precious advice . A small group of women were investiged before the fomal research in order to make the questionnaire more practical. The questionnaire was divided into two sections. Demographic information and related factors were contained in section 1, and all questions about the status of UI were contained in section 2. 20 female students from Hebei Medical University were chosen as interviewers and were trained together. We taught them something about the content of the questionnaire, interview-related skills and especially the attitude they should have, for example, carefully, patiently and factually. Only those who were qualified could be employed. The women enrolled were interviewed face-to-face in their homes by interviewers. All of them should answer questions in section 1 of the questionnaire. If the answer was'yes'to the last question:'have you had any involuntary loss of urine during the last 6 months?', she was asked to answer questions in section 2. People suffering from mental disease were eliminated. Researchers themselves as the quality control personnel strictly supervised the whole procedure. 50 answered questionnaires were sampled randomly and 10 questions in them were asked again by telephone. The conformity rate was 96%. SPSS13.0 and SAS8.1 statistical software were used to input and analyze the data. Normality test, nonparametric test, Chi-square test, partitions ofχ~2 method, Cochran-Artimage test for trend and logistic regression analyses were all used in our study.Results:1 The questionnaires were distributed to 2500 women, and all of them were collected. The invalid ones which were incomplete or had obviously logistic errors were removed from our study and 2448 questionnaires were valid. Among women interviewed, the youngest one was 20 years old, and the oldest one was 87 years old. The mean (standard deviation, S.D.) age and median age were 43.47 (S.D.12.26) years and 43 years, respectively. 1485 women came from city and 963 from countryside, including 874 workers, 723 peasants, 246 cadres, 159 teachers, 66 students, 51 doctors and 329 other occupations.2 The overall prevalence of UI was 35.2% (862/2448) in Hebei Province. Among those women, 26.4% (647/2448) reported stress only, 1.9% (47/2448) reported urge only and 6.9% (168/2448) reported a mixed pattern. It were 31.9%, 26.0%, 1.5%, 4.4% in city and 40.3%, 27.1%, 2.6%, 10.6% in countryside.3 Regarding to the composition of UI, stress, urge and mixed type accounted for 75.1% (647/862), 5.4% (47/862) and 19.5% (168/862), respectively. It were 81.4%, 4.7%, 13.9% in city and 67.3%, 6.4%, 26.3% in countryside.4 Among 862 women with UI, 737 (85.5%) had slight urinary leakage, 97 (11.3%) reported moderate and 28 (3.2%) severe. The percentages of incontinent women who complaint pain or slow stream in urination were 15.5% and 25.3%, respectively. 2.7% had involuntary leakage of urine during sleep and 17.7% had a clear family history of urine leakage. 24.1% of the incontinent women thought they were much bothered by their symptoms. Sexual life of 10.3% of the women was affected. As a result, less drinking water, more going to the toilet and using pads instead of seeking for medical treatment were used to against their leakage of urine.5 Although the prevalence rate of UI in Hebei Province has been identified so high, only a few women (about 6.6%) went to see a doctor, 8.6% in city and 4.0% in countryside. 80.2% of women believed that UI is an inevitable part of aging and need no treatment. 13.3% did not know where to go for treatment. 3.8% thought that UI is an embarrassing and silent issue. 2.7% could not accept the relative high price of surgery. A very small number of severe patients consulted a doctor for help and only 3 patients received surgery.6 For stress only UI, in the multivariate analyses, age, body mass index (BMI), abortion times, dysmenorrhea, fetal weight, dystocia, vaginitis and cervicitis, constipation, pelvic organ prolapse and cesarean section were all found to be statistically significant at the 0.05 level. Among those factors, cesarean section was a protective one.7 For urge only UI, with the same method, only age of menarche and dystocia were found to be statistically significant.8 For mixed UI, there were 11 statistically significant related factors that were age, living in city or countryside, abortion times, diseases of respiratory system, heart disease, urinary infection, history of pelvic operation, constipation, pelvic organ prolapse, alcohol consumption and cesarean section. Cesarean section was also a protective factor.Conclusion:1 UI was a common disease among women in Hebei Province of P.R. China, and stress UI was the commonest type, accounting for more than a half.2 It was seriously backward in diagnosis and treatment of UI in Hebei Province. The work of health care of UI in hospital of each levels was not good enough. So the majority of patients had not adequate knowledge of this disease. The quality of life was impacted seriously.3 There were so many factors related with the incidence of UI. Apart from leakage of urine, UI was always combined with other complex symptoms. Stress, urge and mixed UI not only have some same related factors but also have some different ones. Clinicians should pay attention to it and make correct decisions in diagnosis and treatment.
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