“Stain in life”: The meaning of urinary incontinence in the context of Muslim postmenopausal women through hermeneutic phenomenology

Highlights

• UI was an obstacle to go to Hajj in Mecca for Iranian Muslim postmenopausal women.

• “Loosing desire to live with UI” was a unique meaning for the Persian culture.

• Advising to seek treatment will prevent UI's detrimental effects in life.

Abstract

Introduction

UI is a worldwide chronic condition among postmenopausal women. Little is known about the meaning of lived experiences of urinary incontinence of these women's viewpoints in their context.

Objective

The aim of this study was to illuminate the experience of Muslim community-dwelling postmenopausal women who were living with urinary incontinence (UI).

Methods

Seventeen women with UI (range: 52–68 years) who had experienced it for more than ten years were interviewed. A phenomenological hermeneutic method was used to analyze and interpret the interview texts.

Results

The women's experiences of living with urinary incontinence have been presented in terms of three main themes: disruption of normal functioning, self-imposed restriction, and feelings of despair. Disruption of normal functioning meant emotional, spiritual, physical, and daily life disruption. Self-imposed restriction meant suppression of delights and needs and avoidance of social interactions. Feelings of despair referred to predictions of a bad and dark future of living with urinary incontinence, ambiguity, and hopelessness. The meaning of living with UI has been considered a ‘stain in life’. Health care providers should be familiar with the different manifestations of urinary incontinence for early diagnosis and prevention of the negative effects of this condition to improve quality of life. In addition, symbolic interactionism theory can help health care providers to understand the meaning of urinary incontinence for women.

Introduction

Urinary incontinence (UI) is highly prevalent cross-culturally. UI is a chronic condition that affects individuals of all ages and genders. However, the probability of developing UI is significantly higher among females (Botleroa, Davis, Shortreedb, & Bell, 2009) and more specifically, among postmenopausal women (Hsieh et al., 2008).

Although UI has physical psychological, sociological, and economic consequences and can impair the quality of life of women (Subak et al., 2006, Yip and Cardozo, 2007, Bartoli et al., 2010, Botlero et al., 2010), little is known about life experiences from the standpoints of women (MacDonald & Butler, 2007). The life experiences of sufferers can help to understand the meaning of the disease; understanding the meaning of UI can provide insight into early diagnosis and intervention (Polit & Beck, 2008b). A few studies that have examined the life experiences of UI among women were mostly conducted in the West (Zeznock, Gilje, & Bradway, 2009) or ethnic emigrant groups living in Western countries (Wilkinson, 2001, Muijsenbergh and Lagro-Janssen, 2006, Andersson et al., 2009) and none had focused on Muslim women living in their own countries. Deep understanding of life experiences depends on sensitivity to the emotional, cultural, and social aspects of UI (Bradway, 2005), and inclusion of participants from different countries may lead to different meanings (Oh et al., 2008). Also, life experiences could greatly vary among the different age groups from young, middle age, and elderly women; the present study focused on the experiences of postmenopausal women, among whom the prevalence of UI is higher (Nojomi, Amin, & Bashiri Rad, 2008). The elderly age group has a different set of experiences and the meaning of UI in everyday life would differ for this group when compared to the young and middle age groups (Higa, Lopes, & Turato, 2008).

The present study has been one of the few studies, which have explored the experiences of community-dwelling postmenopausal Muslim women living with UI, in the context of their births and upbringings and not in another country through the lens of symbolic interactionism. Symbolic interactionism (SI) is a theoretical perspective that highlights how people explicate, act toward, and accordingly give meaning to the events, objects, and situations around them. This position highlights how human actions and meanings arise out of the social processes of communication and interpretation role taking (Sandstrom, Martin, & Fine, 2006). Thus, SI can adjust with the research question: “What does urinary incontinence mean to post-menopausal women?”

UI is not a life-threatening condition but it can lead to remarkable psychosocial distress and influence health-related quality of life. UI is regarded as a social and individual disgrace in which discrimination and loss of the status can be experienced by patients as well as stigmatization. Hence, issues related to UI do require that researchers and professionals examine the situation from the patients’ viewpoint and context (Lazzeri & Novara, 2008). The meanings and life experiences of females living with UI have been explored by several researchers. Some research (Bradway, 2005) presented UI through varying themes, such as “memories of UI” and “responses to UI”; while others (Komorowski & Chen, 2006) elicited ‘knowledge about UI’ and ‘shattering the silence of UI’ and ‘encountering the institutional culture of UI’ were highlighted by MacDonald and Butler (2007); and ‘women's fears in coping with UI’ Youngmi and Neva (2008) cited in Rosenberg ‘A disease is no absolute physical entity but a complex intellectual construct, an amalgam of biological state and social definition’ (Komorowski & Chen, 2006, p. 107). UI is one of the conditions highly affected by intellectual construct and shaped by the socio-cultural situation. The participants’ characteristics and their socio-cultural situations can be some of the important factors influencing the life experiences of UI sufferers. The present study was conducted in Iran with its specific socio-cultural context that differs from other countries in Asia.