| 摘要: | 背景：女性在公廁或自家以外的場所解尿可能感覺不適和恐懼，可能因而憋尿，或以腹肌用力(abdominal straining)的方式解尿。她們可能仍被強迫在不衛生的或沒有坐式便座時以蹲踞姿解尿，或蹲在馬桶座圈上而不是坐在上面，增加跌倒的風險。女性使用輔助工具，進行站立解尿，對於不論年輕健康、有膝退化性關節炎婦女長者、與孕晚期的孕婦都是一個可行的替代方式。許多婦女對站立解尿無認知或認知錯誤，但在日常生活中已採站姿小便的動作而不自知。
研究目的：主要探討女性個人基本特性與解尿行為對於女性站立解尿認知以及站立解尿嘗試意願之相關性。
方法：本橫斷面研究採問卷式調查研究，取樣採立意取樣與滾雪球抽樣，抽取20 歲以上 80 歲以下台中某區之婦女。將女性站立解尿認知與否區分為有認知及無認知組兩組，以及將站立解尿嘗試意願分成願意嘗試、考慮嘗試、不願嘗試三組進行統計分析，找出與女性站立解尿認知與嘗試意願相關之變項與預測因子，以Pearson皮爾森卡方檢定 (Pearson's chi-squared test)或連續性校正 (Fisher精確檢驗)、t檢定等統計方式進行比較，並在單變項、多變項(multivariable)、與多項式(multinomial)羅吉斯迴歸模型下進行分析，類別變項並計算勝算比 (Odds ratios)與95%信賴區間 (95% confidence intervals, 95% CI)，以雙尾檢定p值< 0.05則視為有統計學上顯著差異。
結果：多變項 (multivariable)，與多項式 (multinomial)迴歸結果顯示：在站立解尿認知的部分，認為女性能以蹲坐以外的姿勢解尿對站立解尿認知為促進因子[OR= 18.86, 95%CI (6.99-50.87)]；而 感覺淋浴解尿不順暢 OR= 0.15 (0.03-0.79)、不知站立解尿的方式OR= 0.33 (0.11-0.96) 對站立解尿認知則皆為妨害因子。此外，在站立解尿嘗試意願的部分，教育程度越高，嘗試意願的人數百分比越高且呈線性趨勢相關(P=0.001)。再者，高中職以下組認為 [願意嘗試/不願嘗試的勝算] 是專科組的0.05倍；專科組認為 [願意嘗試/不願嘗試的勝算] 是高中職以下組的14.21倍。沒有安全感組認為 [願意嘗試/不願嘗試的勝算]是有安全感組的 0.06倍；沒有安全感組認為 [考慮嘗試/不願嘗試的勝算]是有安全感組的0.09 倍。因此沒有安全感在站立解尿嘗試意願上是主要的妨害因子。
結論：認定女性解尿有蹲、坐姿以外的選擇對比只能蹲坐的傳統思維，對於女性站立解尿的認知，有將近19倍的影響力。淋浴覺得不好解尿與不知站立解尿的方式均妨害女性站立解尿的認知。我們發現教育程度越高的女性，越勇於嘗試站立解尿。然而，不安全感是降低女性站立解尿嘗試意願的最主要因素。站立解尿無論對年輕健康或蹲踞不便的女性都是一個很好的選擇。泌尿專家應該要能夠建議社區女性使用解尿輔助工具，以解決排尿相關的衛生與感覺不適的問題，建立站立解尿的正確認知。我們希望透過公共宣傳的方式能在不久的將來消除認知上的偏見。
Background: Women usually feel discomfortable when using public convenience, or fear of urinating outdoors. They might choose to hold the urine, show abdominal straining. They may still be forced to urinate while crouching and squatting positions if a sitting toilet is unsanitary or unavailable, or crouching over the toilet bowl instead of sitting on it, thus increase the risk of an accidental fall. Standing voiding using an auxiliary device is a feasible alternative for young healthy female, elderly women with knee osteoarthritis, and those in the third trimester pregnancy. Many women have never heard, or cognitive error, of standing voiding, though they have been doing so in daily life unconciously.
Purpose: The aim of present study was to investigate the correlations between individual characteristics and voiding behaviors versus standing voiding cognition and willingness to try it.
Methods: The cross-sectional study was conducted using questionnaires survey which were administered with purposive sampling and snowball sampling. Women aged 20 to 80 were selected from a region in Taichung, Taiwan.We divided the results of standing voiding cognition into 2 groups: “Yes” and “No” groups. We also divided the result of willingness to try voiding standing into 3 groups: “willing to try”, “consider to try”, and “unwilling to try”. We performed statistical analyses to determine relevant and predictive factors on standing voiding cognition and that on willingness to try it, using the t?test, Chi?square test, and the relevant factors were analyzed under univariable, multivariable, and multinomial logistic regression model. We also calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) for the categorical variables. P value <0.05 of two-tailed test is considered to be stastiscally significant.
Results: The results of multivariable and multinomial logistic regressionIn showed: in terms of standing voiding recognition, the factor considering women can urinating with other positions rather than crouching and squatting is a promoting factor [OR= 18.86, 95%CI (6.99-50.87)]; the factor considering it inconvenient on voiding while showering OR= 0.15 (0.03-0.79), and the factor not knowing the way of how to stand voiding OR= 0.33 (0.11-0.96) were 2 hazardous factors to recognition. Besides, in terms of willingness to try it, the higher educational level, the higher proportion of women willing to try standing voiding, which showed significant trend result (p= 0.001). Further, the educational level above high school group [>high school group] believed [the odds of “willing to try” compare to “unwilling to try”] was 0.05 times the junior college group believed; and the junior college group believed [willing to try / unwilling to try odds] was 14.21 times the [>high school group] believed. Feel-insecure group believed [willing to try / unwilling to try odds] and [consider to try / unwilling to try odds] 0.06 times and 0.09 times feel-secure group believed, respectively. Therefore, insecure feeling is the major hazardous factor on willingness to try standing voiding.
Conclusion: The concept that women have different options of position other than crouching and sitting while voiding compare to conventional thinking of only crouching and sitting position, the ratio of impact of promoting the standing voiding recognition is near 19 times. The factor considering it inconvenient on voiding while showering, and not knowing the way of how to stand voiding both obstruct willingness to try stand voiding. We revealed the higher educational level, the more willingness those women have to try stand voiding. However, feeling insecure is the primary factor reducing the willingness. Urinating with stading position is a good choice whether for young healthy female, or those who have difficulty to crouch, squat. Urologists should be able to advise the auxiliary device use to women in community to solve hygienic and comfort issues associated with micturition, and to build up appropriate recognition of stand voiding. We hope that by the mean of public advocacy could eliminate the bias of recognition in near future. |
