婦女尿失禁生活品質之探討

婦女尿失禁生活品質之探討 中文摘要 研究背景：婦女尿失禁一直被認為是女性老化過程中必然會出現的現象之一。 而尿失禁是一個非常敏感的問題，雖然不會致命，卻讓人失去信心甚至尊嚴，造成心理上的自卑與壓力。 就女性而言，大約有三分之一比例的人被尿失禁所困擾 ，隨著年齡愈大尿失禁的盛行率愈。 婦女在生產的時候，會造成骨盆底肌肉的傷害；或是更年期停經以後，因為缺乏荷爾蒙，也會造成尿道黏膜的萎縮老化；子宮頸癌病患接受根除性子宮切除術；或施行放射線治療，也會引起尿失禁的問題，這些都是造成婦女尿失禁現象的主要因素。 成年女性要是有尿失禁的問題時，會因為擔心漏尿而減少社交活動、減少飲水量及運動，或墊衛生棉來避免意外的漏尿。 而尿失禁的漏尿﹑頻尿﹑急尿等症狀會直接或間接影響到生活品質。 本研究主要目的是利用金氏健康問卷 (King’s health questionnaire) 探討尿失禁對婦女生活品質的影響。 再進一步分別探討不同類型的尿失禁、在不同年齡層、職業與否、嚴重度，對生活品質的影響是否有差異。 材料與方法：研究對象來自中山醫學大學附設醫院大慶院區婦產部門診病患， 年紀30-75歲，意識清楚的患者，經由尿動力學檢查且專科醫師診斷為尿失禁之患者共75名、其中真性應力性尿失禁、膀胱過動症、混合性病患各25位。本研究工具是利用金氏健康問卷來評估膀胱問題對生活所帶來的衝擊。它包括：生活品質的問題、處理尿失禁的策略和尿失禁嚴重度的主觀測量。 統計方法式以Spearman’s rank-order correlation 來檢測再測信度及嚴重度與生活品質之相關。並利用Mann-Whiteny U test的檢定方法來檢測尿失禁的類型、年齡、職業有無、是否在金氏健康問卷其總得分和各項得分上是否有明顯差異。 研究結果：本研究結果如下： （一） 本研究的金氏健康問卷中的21題再測信度為0.74-0.98，屬於高度相關； （二）真性應力性尿禁、膀胱過動症、混合型三組，在〝日常生活及家居生活的影響〞、〝外出影響〞、〝與丈夫之間的關係〞、〝性生活〞，混合型得分明顯比應力性尿失禁及膀胱過動症患者；在〝沮喪或憂鬱〞、的方面，應力性尿失禁得分明顯比膀胱過動症患者高；混合型得分明顯比膀胱過動症患者高；在〝覺得自己很糟糕、狀況很壞〞，混合型得分明顯比膀胱過動症患者高；在嚴重度測量中〝墊衛生棉墊〞、〝需要把濕的內褲換掉〞、〝擔心在一些場合被別人聞到尿的味道〞，真性應力性尿失禁得分明顯比膀胱過動症患者高；混合型得分明顯比膀胱過動症患者高；（三）在〝體能活動影響〞，大於60歲的患者得分明顯比40-60患者得分高；在〝影響和丈夫之間的關係〞、〝性生活〞、〝家庭生活影響〞，小於40歲的患者得分明顯比大於60歲患者得分高，40-60歲的患者得分明顯比大於60歲患者得分高；在嚴重度測量中的〝需要把濕的內褲換掉〞，大於60歲的患者得分明顯比小於40歲患者得分高，大於60歲的患者得分明顯比40-60歲患者得分高；（四）在〝與丈夫之間的關係影響〞、〝性生活〞、〝睡眠〞，有職業的患者得分明顯比無職業患者得分高；（五）混合型尿失禁對患者生活品質影響最大；（六）真性應力性尿失禁與混合性尿失禁患者症狀本身的嚴重度明顯較膀胱過動症患者高；（七） 症狀本身的嚴重度與生活品質的相關係數是0.633，屬於中度相關。 討論：（一）金氏健康問卷的中文版再測信度為0.74 - 0.98，其中以〝家事影響〞、〝膀胱問題覺得尷尬〞的再測信度最差分別為0.74、0.75。 第二次總得分比第一次低； （二）平均年齡為51.0 歲，以中年女性40-60 歲佔最多；（三）生活品質與尿失禁的類型有關，其中以混合型尿失禁對患者生活品質影響最大，可能是混合型尿失禁患者的比較不能預期尿失禁的發生、漏尿情形較嚴重、覺得比較無法控制膀胱症狀；（四）〝日常生活及家居生活的影響〞〝生活上的表現〞、〝外出的影響〞與尿失禁的類型有關，混合型尿失禁比應力性尿失禁及膀胱過動症對患者影響比較大，可能是混合型患者的泌尿症狀較複雜；（五）〝人際關係〞所受的影響與尿失禁型態和年齡有關，混合型尿失禁比真性應力性尿失禁及膀胱過動症對患者影響大；（六）〝情緒〞的影響與尿失禁的類型有關，混合型尿失禁比膀胱過動症對患者影響大；（七）〝睡眠〞所受的影響與他們的職業與否有關；（八）症狀本身的嚴重度與尿失禁的類型有關，真性應力性尿失禁比膀胱過動症患者嚴重，混合型尿失禁比膀胱過動症患者嚴重。 關鍵字：婦女尿失禁、生活品質、金氏健康問卷

The quality of life of urinary incontinence women Abstract Backgrounds: Urinary incontinence in women is often considered a consequence of aging. Urinary incontinence is very sensitive condition causing lost confidence and distress. Almost third female suffer from urinary incontinence and its prevalence increase with age. Childbirth, postmenopausal years, hysterectomy, and radiotherapy have been implicated as the major etiologic factors in urinary incontinence. Affected women may decrease social activities, fluid intake, and exercise. The symptoms of urine incontinence, frequency and urgency may influence and bothersome to patients. The purpose of this study used the King’s health questionnaire for assessment of urinary incontinence in women. Another aim of the study as to compare the quality of life between differ classification, age, occupation, and severity. Materials and methods: From April 2001 to September 2001, 75 women who underwent urinary urodynamic assessment and diagnosis genuine stress incontinence, overactive bladder, and mixed type incontinence were recruited to this study. Our study used the King/s health questionnaire to measure the quality of life of women with urinary incontinence. It included not only quality of life questions, but also strateqies for coping with urinary incontinence and subjective measures of severity of urinary symptoms. The Spearman’s rank-order correlation and Mann-Whiteny U test were used for statistical analysis of the data. Results: The results showed as follows: The test-retest reliability was 0.74-0.98. Women with mixed type incontinence had significantly higher scores in 〝How much do you think your bladder problem affects your life ?〞〝Does your bladder problem affect your daily activities outside the home?〞〝Does your bladder problem affect your relationship with your partner?〞〝Does your bladder problem affect your sexual life?〞 than overactive bladder and genuine stress incontinence. Women with genuine stress incontinence had significantly higher scores in 〝Does your bladder problem make you feel depressed?〞 than overactive bladder. Women with mixed type incontinence had significantly higher scores in 〝Wear pads to keep dry?〞〝Change your underclothes when they get wet〞〝Worry in case you smell?〞 than overactive bladder. Women older than 60 years old had significantly higher scores in〝Does your bladder problem affect your physical activities?〞than 40-60 years old. Women younger than 40 years old had significantly higher scores in 〝Does your bladder problem affect your relationship with your partner?〞〝Does your bladder problem affect your sexual life?〞 than Women older than 60 years old. Women older than 60 years old had significantly higher scores in 〝Change your underclothes when they get wet〞than the others. Women with occupation had significantly higher scores in〝Does your bladder problem affect your relationship with your partner?〞〝Does your bladder problem affect your sexual life?〞〝Does your bladder problem affect your sleep〞. Women with mixed type incontinence had greatest quality of life impairment than women with other diagnoses. Women with genuine stress incontinence and mixed type incontinence had more severe than overactive bladder. There was a moderate correlation between the symptom severity and quality of life. Discussion: The test-retest reliability was 0.74-0.98 for the King’s health questionnaire, and was found to be easy to complete. The average age was 51 years, and the majority of women were between 40-60 years old. The quality of life had correlation with urinary incontinence classification. Women with mixed type incontinence achieved higher scores. It is possible that the unpredictable nature of the urinary symptoms, more severe incontinence, and unable control urinary symptoms. Keywords: urinary incontinence in women, quality of life, King’s health questionnaire.