Chronic cough is common and affects both patients and physicians. Prolonged coughing is linked to a lower quality of life, which includes discomfort in the body, sadness, and social isolation (1). It is often recognized that women's coughs are frequently linked to urine incontinence (UI); however, little is known regarding the true frequency of this condition among women who have chronic coughs, particularly in the Arab world, such as Egypt (10). There are some previous studies that link urinary incontinence to the occupational status (8).
A total of 80 female patients with chronic cough were investigated, out of which 55% were found to have stress urinary incontinence. The prevalence rate of UI was shown to vary widely in earlier studies, ranging from 16.1–68.8% (11, 12).
Our results are in accordance with the study of Yang’s et al., 2022 which investigated the different risk factors for urinary incontinence in female adult patients with chronic cough and found that the frequency of urinary incontinence in female patients with chronic cough was 50.1% (13) and this is not far from an European study by Hunskaar et al. in 2004, where in 35% of women reported experiencing any type of involuntary urine loss (UI). Spain had the lowest incidence at 23%, but the UK, France, and Germany had higher rates at 44%, 41%, and 42%, respectively (3).
The most prevalent causes of chronic cough, according to the literature, are upper airway cough syndrome, asthma and GERD (12). This somewhat agrees with our results where GERD was the most common cause of chronic cough which was found in 48.8% of patients followed by bronchial asthma, which was found in 22.5% of patients.
In the current study, the majority of patients (90.9%) reported that urinary leakage interfered with their quality of life and 43.1% of UI patients reported that their sexual life was affected, this was in line with Corrado team study in 2020, which found that UI affects a variety of facets of patients' lives, including relationships at work, with family, and during sexual activity. As a result, UI can lower patients' quality of life (14). According to Bradaia et al. (2009), who looked into the effects of UI among female patients who had interstitial lung diseases-related chronic cough, the median impact of UI was 3 (minimum = 1, maximal = 5) on a 5-point quality of life scale, while the median impact of chronic cough was 3.5 (15).
According to the current results, 43.1% of UI patients reported that their sexual life was affected and this was not far from what reported by Corrado and his coworkers in 2020 who indicated that UI is often difficult to accept, because it negatively affects their privacy and sexuality (14).
All female patients with UI didn’t declare about incontinence without direct questioning (100%), which is due to the delicate nature of the subject, individuals often underreport their illness. The same reason explains the low medical request rates in the European countries for this issue, for example; about a quarter of those in Spain and the UK had ever visited a physician for their condition (3) and In 2009, a different European team under the direction of Bradaia found that most patients (64%) thought that incontinence was a normal aging symptom, that all patients felt embarrassed about this symptom, and that 79% of patients were unable to bring it up with the physicians (15).
The present study showed that occupations requiring physical activity (heavy lifting) had significantly higher frequency of UI than non-physical work, which aligns with what was reported in a cross-sectional study by Wang and his colleagues in China, that indicated that manual labor was a risk factor for incontinence in women compared to mental work (16). Liao et al. (2008) also showed that lifting heavy objects at work was a risk factor for incontinence among Taipei school teachers. (17).
The current study showed that other environmental work conditions as unclean, uncomfortable, accidents, time pressure, awkward positions had no significant relationship with UI and this was in line with Kaya et al.'s study, which examined the relations between various work-related factors and UI in 218 nurses and 63 secretaries and found no significant relationships (18). However, Kim et al.'s 2017 study produced a different conclusion, stating that urinary incontinence was significantly linked to various work environments, including an unhygienic and uncomfortable workplace, accidents, time constraints, and awkward positions (8). This diversity may result from varying occupational workplaces and environments.
Our study found that older age was an indicator of risk for UI, which is in keeping with other research that found that age was a significant risk factor for UI. This may be explained by the fact that urethral sphincter tension decreases with age (19, 20). The same in a European study which conducted by Hunskaar et al., in 2004, revealed that prevalence increased with age, which adds to our results (3).
We found that more severe cough either by cough severity index or cough visual analogue scale and long duration of cough were significant risk factors for UI, which concurs with Yang’s et al., 2022 who reported that patients with UI had considerably greater median cough duration and cough visual analogue scores than those without UI (13).
Contrary to our results that deny the significance of BMI as a risk factor for UI, previous studies have shown that high BMI was a significant indicator of the existence of UI in female patients (19, 20, 21). Noblett et al. examined the link between BMI and intra-abdominal and intra-vesical pressure, suggesting that being overweight or obese may result in a persistent condition of elevated pressure in the pelvic floor, increasing the risk of UI (22). This disparity could result from varying demographics and small sample size in current study.
One of the most important environmental factors related to UI is thought to be pregnancy and childbirth. In our research, the mean number of parities, and vaginal delivery were significantly higher in UI patients. Menopause patients had 2.9 times higher risk of developing UI. These results partially match those of Schreiber Pedersen et al., 2017 where age, parity & vaginal deliveries were strongly associated with UI (21).
In contrast to Guin et al.’s study, we didn’t find any association between nutritional status and UI. Guin et al., 2018 reported that stress urine incontinence was found to be more common in those with poor nutritional status; causing weak pelvic support (23). This discrepancy may be due to the different age groups and nutritional categorizations between studies.
Hysterectomy may alter the support of the bladder and urethral neck and impair the complex mechanism of the urethral sphincter by damaging the inferior hypogastric plexus and distal branches of pudendal nerves. However, we found no association between hysterectomy & UI. The results of different studies are controversial, as Singh et al., 2013 reported a significant relation between hysterectomy and different types of incontinence (24). On the other hand, Burgio et al., 1991 and Samuelsson et al., 1997 reported that urinary incontinence was not significantly associated with hysterectomy (25, 26). This controversial may be attributed to the variant hand skills of surgeons.
By using logistic regression analysis, our results showed that age, occupational status according to physical activity and cough severity index were independently statistically significant risk factors for UI in female patients with chronic cough which are somehow consistent with Yang et al., 2022 who reported that Patients with UI had significantly higher scores for daytime cough symptoms, night time cough symptoms, and cough visual analogue scores than did patients without UI. However, it was discovered that only the cough VAS score may be an independent risk factor for UI when the three values mentioned above were included in a multivariate logistic regression analysis. Muscle strain from regular exercise, particularly moderate-to-high intensity activity, can raise the pressure inside the abdomen. Furthermore, exercise-induced cough could consistently raise abdominal pressure which increases the risk of UI (13), which may explain why occupations requiring physical activity had significantly higher frequency of UI than those without.