Urinary incontinence (UI) is defined as the involuntary leakage of urine. UI, which is
commonly observed both globally and in our country, negatively affects individuals
socially, physically, and psychologically, decreasing their quality of life. Nocturia,
which is frequently seen alongside UI, has similar adverse effects. Nocturia is defined
as the number of urinations during the main sleep period, and for these urinations to be
considered as nocturia, the intention to fall back asleep after waking must be present.
Nocturia can result from various causes, such as sleep disorders and circadian rhythm
disturbances. Sleep is one of the biological functions regulated by the 24-hour cycle of
body temperature, hormonal balance, hunger and satiety, cognitive and physical
performance. This rhythm varies from person to person and creates chronotypes. Based on
these chronotypes, the time during the day when individuals function best and when
circadian time is regulated differs. There is an undeniable relationship between sleep
and nocturia. Nocturia causes loss of deep sleep, known as slow-wave sleep, increases the
risk of metabolic diseases, decreases sleep quality and sleep efficiency, and increases
the number of awakenings after sleep onset. This decrease in sleep quality can lead to
increased sleepiness, fatigue, and reduced quality of life. It is necessary to
differentiate whether nocturia, which has a comprehensive effect, influences pelvic floor
symptoms, chronotype, sleep quality, fatigue, sleepiness, and quality of life in women
with UI. Therefore, the aim of this study is to investigate the effect of nocturia on
pelvic floor symptoms, chronotype, sleepiness, sleep quality, fatigue, and quality of
life in women with UI.
- Materials and Methods
Participants: Participants in the study will be selected from patients who visit the
Gynecology and Obstetrics Outpatient Clinic at GATA Training and Research Hospital. The
study will include patients over the age of 18 who experience incontinence. After the
patients are informed about the study, written and verbal consent will be obtained from
them. The sample size for the study was calculated using the G*Power 3.1 program with a
power of 80% and a type 1 error level of 0.05. It was calculated that a total of 102
people, with at least 51 participants in each group (with and without nocturia), would be
required. The exclusion criteria for the study include sleep disorders, neurological
diseases, chronic kidney disease, the use of sleep medication, antidepressants,
diuretics, or urinary incontinence drugs, hormone replacement therapy, pregnancy or
childbirth within the last six months, urinary tract infections in the last three months,
prolapse beyond stage 2, orthopedic trauma to the pelvic region or pelvic surgery within
the last six months, and a history of cancer.
Evaluation: A semi-structured evaluation form will be used to record the demographic data
of the participants. The participants' anthropometric features such as age (years),
height (cm), weight (kg) will be recorded. Educational level, marital status, occupation,
main complaint, and duration of complaints (months) will be queried. Their medical
history, surgeries, family history, medications, smoking, chronic cough, and constipation
status will be noted. Obstetric history and menstrual status will be collected. The type
of incontinence will be evaluated using the 3 Incontinence Questions (3IQ) survey,
urinary symptoms will be assessed with the Global Pelvic Floor Distress Inventory and
Urogenital Distress Inventory-6, chronotypes will be evaluated using the
Morningness-Eveningness Questionnaire, sleepiness will be assessed with the Epworth
Sleepiness Scale, sleep quality will be measured using the Pittsburgh Sleep Quality
Index, fatigue levels will be evaluated using the Fatigue Severity Scale, and quality of
life will be assessed with the CONTILIFE Questionnaire.
3 Incontinence Questions (3IQ): The 3 Incontinence Questions is a simple, repeatable
survey used to determine the type of urinary incontinence. It classifies the patient into
stress, urge, mixed, or other types based on the most common situation in which they
experience urinary leakage over the last three months. The 3 Incontinence Questions is an
open-access form that does not require permission for use.
Global Pelvic Floor Distress Inventory and Urogenital Distress Inventory-6: To assess
discomfort from symptoms of pelvic floor dysfunction, the Turkish validated Global Pelvic
Floor Distress Inventory and Urogenital Distress Inventory-6 will be used. Higher scores
on these scales indicate greater severity of discomfort.
Morningness-Eveningness Questionnaire: Participants' chronotype will be evaluated using
the Turkish validated Morningness-Eveningness Questionnaire. The questionnaire consists
of 19 questions, and the score ranges from 16 to 86. The score can be divided into three
ranges, each representing a different chronotype: a score of 59-86 indicates a morning
type, 42-58 indicates an intermediate type, and 16-41 indicates an evening type.
Epworth Sleepiness Scale: Participants' daytime sleepiness will be assessed using the
Turkish validated Epworth Sleepiness Scale. This scale consists of 8 items, each scored
from 0 (never doze) to 3 (high chance of dozing). The higher the score, the greater the
level of daytime sleepiness.
Pittsburgh Sleep Quality Index: The Turkish validated Pittsburgh Sleep Quality Index
(PSQI) will be used to assess sleep quality. PSQI includes seven subcategories that
evaluate aspects of sleep such as sleep latency, sleep duration, sleep efficiency, sleep
disturbances, use of sleep medications, and daytime dysfunction. The total score ranges
from 0 to 21, with scores of 5 or below indicating "good" sleep quality, and scores above
5 indicating "poor" sleep quality.
Fatigue Severity Scale: Participants' fatigue severity will be evaluated using the
Turkish validated Fatigue Severity Scale. This scale consists of 9 questions, with each
question rated on a Likert scale from 1 (strongly disagree) to 7 (strongly agree). The
total score is determined by the arithmetic mean of the responses, and a score of 4 or
above indicates the presence of fatigue.
CONTILIFE Questionnaire: The CONTILIFE Questionnaire is a quality of life scale
specifically developed for urinary incontinence and has been validated in Turkish. It
consists of six subparameters related to daily and effort activities, self-image,
emotional status, sexuality, and well-being, and contains 28 questions. Each question is
rated on a Likert scale from 1 to 5 or 0 to 5, with higher scores indicating better
quality of life.