This was a cross-sectional study conducted on 87 MS women who were in their reproductive age. Single women and those with severe physical disabilities were excluded from the study. Diagnosis of MS was done according to the revised McDonald criteria in 2017 [16]. The design of the study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ref ID: IR.AJUMS.REC.1395.518). All eligible women provided written informed consent prior to data collection. Data collection started in March 2020 and completed in September 2020.
Setting:
The women were initially screened regarding inclusion/exclusion criteria in an MS clinic (located in the Rehabilitation Faculty of Ahvaz Jundishapur University of Medical Sciences) in Ahvaz, Khuzestan province, southwest of Iran. All MS patients in Khuzestan province are registered in this center. In total, of all 2300 individuals suffering from MS are registered in the MS society of Khuzestan, 400 were residents of Ahvaz and in their reproductive age. However, half of them did not provide consent, because they were involved in other research projects. Finally, out of the 200 remaining women, only 87 women provided consent to participate in this study.
Measurements
A demographic questionnaire, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and Quality of Life Questionnaire (QOL-SF-36) were used to collect data. The demographic questionnaire consisted of questions about age, length of marriage, number of pregnancies, body mass index, length of disease, marital status, mode of delivery, educational attainment, occupation, and disease relapse.
ICIQ-SF questionnaire was used to assess urinary incontinence during the past four weeks. In this questionnaire, questions 1 and 2 are about demographic characteristics (age and sex), question 3 is about frequency of urinary incontinence, question 4 is about urinary leakage, question 5 is about the effect of urinary incontinence on quality of life, and question 6 is about the time of urinary leakage. The total score of this questionnaire is between zero and 21, with higher scores indicating severe urinary incontinence [17]. This questionnaire was validated by HajEbrahimi et al. in Iran [18].
The QOL-SF-36 was used to measure the quality of life of the participants. This questionnaire includes 36 questions and 8 subscales. Its subscales are: physical function (10 questions), role limitations due to physical problems (4 questions), vitality, energy/fatigue (3 questions), social functioning (2 questions), role limitations due to emotional problems (3 questions), bodily pain (2 questions), general mental health (6 questions), and general health perception (6 questions). This questionnaire has two major domains including the physical component summary (PCS) and the mental component summary (MCS). Each subscale is scored from zero to 100, with higher scores indicating better quality of life [19]. This questionnaire was validated by Montazeri et al. in Iran [20]. Because both ICIQ-SF and QOL-SF-36 questionnaires have been validated in Iran, the permission for using these two questionnaires in Iran was obtained by authors who conducted the validation study.
Procedures
Eligible women were requested to complete the demographic questionnaire, as well as ICIQ-SF and QOL-SF-36. One of the researchers (ST) was available in case that women had any question. To measure the strength of perineal muscle, the women were placed in the lithotomy position. A perineometer covered by a plastic cover (condom) was placed in the vagina. The women were requested to contract their vagina and the perineum as much as possible. The specified number on the device was observed, and this procedure was repeated two more times to record the average of three measurements as the strength of perineal muscle. All measurements were done by a trained midwife (ST).
The participants’ weight was measured using a digital scale (Seca, Germany made) with light cloths and barefooted. The height of the participants was measured using a stadiometer while they were standing barefooted. Body mass index (BMI) was calculated using weight (kg)/height (m2).
Statistics
All data were entered into SPSS version 25. Frequency, percentages, mean, and SD of the data were measured. Multiple linear regression was used to assess the relationship between perineal muscle strength, stress incontinence, and quality of life when adjusted for confounding variables. P<0.05 was considered statistically significant.