Adult women's experiences of urinary incontinence: a systematic review of qualitative evidence

EXECUTIVE SUMMARY Background Women are affected dramatically by urinary incontinence (UI). This disease is currently considered as epidemic. Objective The objective of this review is to identify, through the best available evidence, how women experience UI worldwide. Inclusion criteria Types of participants The current review included studies of adult women who had experienced UI. Phenomena of interest Women with UI from various social and cultural settings were included in this review. Types of studies Qualitative data including, but not limited to, study designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included in this review. Outcomes All aspects related to the experience of UI endured by women were considered. Search strategy An initial search of MEDLINE (PubMed) and CINAHL was done, followed by the exploration of all the databases and all identified studies, published in English, Spanish, French and Portuguese. The databases searched were CINAHL, PubMed, PsycINFO, Lilacs, Scielo, BVS, BVS-Psi, Scopus, Embase, Sociological Abstracts, Dissertation Abstracts International and the University of São Paulo Dissertations and Thesis bank and gray literature. Methodological quality Each primary study was assessed by two independent reviewers for methodological quality. The Joanna Briggs Institute Qualitative Appraisal and Review Instrument (JBI-QARI) data extraction form for interpretive and critical research was used to appraise the methodological quality of all papers. Data extraction Qualitative data were extracted using the JBI-QARI. Data synthesis Qualitative research findings were synthesized using the JBI-QARI. Results From the 28 studies were included, 189 findings were extracted and they were grouped into 25 categories and eight synthesized findings: (i) cultural and religious backgrounds and personal reluctance contribute to delays in seeking UI treatment; (ii) the inevitable and regrettable problem of UI endured silently and alone affects women's daily activities and their social roles; (iii) poor knowledge and the vague nature of the symptoms mask the fact that UI is a disease; (iv) the experiences provoked by UI and the sense of shame regarding the condition have contributed to impair women's lives; (v) UI has provoked negative effects on women′s intimacy and sexual satisfaction and provoked changes in the ways they experience their sexuality and sexual function; (vi) UI is considered a consequence of pregnancy and childbirth, inherent to aging or a religious punishment; (vii) the women affected by UI adopt several strategies to improve their health status; and (viii) women have personal preferences toward care providers and treatments; they confront difficulties through UI treatment and some care needs are not met. Conclusion Personal and tailored health care should be provided, and preferences and expectations should be taken into consideration in the provision of health care to the people affected by UI.