Impact of surgery for stress incontinence on the social lives of women

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 105; no. 6; pp. 605 - 612
• Main Authors: Black, N. A., Bowling, A., Griffiths, J. M., Pope, C., Abel, P. D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-06-1998
• Subjects: Activities of Daily Living; Anxiety - etiology; Bed Rest; Cost of Illness; Feasibility Studies; Female; Humans; Incontinence Pads - economics; Interpersonal Relations; Longitudinal Studies; Middle Aged; Postoperative Period; Quality of Life; Sexual Behavior; Sick Leave - statistics & numerical data; Urinary Incontinence, Stress - economics; Urinary Incontinence, Stress - psychology; Urinary Incontinence, Stress - surgery
• ISSN: 1470-0328; 0306-5456; 1471-0528
• DOI: 10.1111/j.1471-0528.1998.tb10174.x

Objective
To assess the feasibility of collecting disease‐specific and generic data on the impact of surgery on the social lives of women with stress incontinence; to describe the social impact of surgery in a representative group; and to determine the effect of timing on the assessment of outcome.
Design
Longitudinal study; questionnaires before and three, six, and twelve months after surgery.
Setting
Eighteen hospitals in North Thames region.
Participants
Four hundred and forty‐two women undergoing surgery for stress incontinence between January 1993 and June 1994.
Main outcome measures
Post‐operative recovery time, stress incontinence symptom impact index, activities of daily living, and cost of protection.
Results
Post‐operative recovery was uneventful for most women, but three months after surgery 24% of those in paid employment beforehand were still on sick or unpaid leave. Most women (75%) reported that stress incontinence had less adverse impact on their lives three months after surgery, though 18% reported no change, and 7% felt life was worse. The likelihood of improvement was similar regardless of whether pre‐operative urodynamic studies had been conducted. The extent of improvement was dependent on pre‐operative severity. Similar findings were obtained six and twelve months after surgery. After an initial slight but nonsignificant deterioration in their ability to carry out activities of daily living, women gained a slight benefit from surgery (proportion with no or only slight limitation rose from 72% to 82%; P= 0.0001). The mean cost of protection (pads and towels) fell from £8.59 a month before surgery to £2.99 a month one year after surgery, by which time 68% of women were not using protection. In contrast, 11% were still spending over £10 a month.
Conclusions
It is possible to collect standard data on the impact of surgery on social functioning and, thus, provide women with better information on likely outcomes. The benefits of pre‐operative urodynamic investigations need to be assessed. The stability of the outcome measures over the first post‐operative year suggest that outcomes need to be assessed only once and at any time from three to twelve months after the operation.