title: The meanings of silence in Brazilian women with urinary incontinence.
abstract: OBJECTIVE
  We explored the meanings of silence for Brazilian women with urinary incontinence (UI).
  
  
  METHODS
  The sample consisted of 8 women, aged 30 to 45 years. Respondents worked as housekeepers or cleaning staff and were from lower social, economic, and educational strata. Their years of formal education varied from 0 to 8 years and they earned up to 4.5 times the Brazilian minimum wage, which is equivalent to US$900.
  
  
  METHODS
  A qualitative method using semistructured interviews was employed to gather data. Individual semistructured interviews were recorded and subsequently transcribed, including researchers' observations of subjects' nonverbal behaviors. The interviews began with the question: "Can you tell me about your experience with urinary incontinence?" Data were analyzed using a content analysis technique.
  
  
  RESULTS
  Respondents avoided discussing UI and initially resisted labeling themselves as incontinent, but their nonverbal behaviors provided clues to the psychosocial distress caused by urinary leakage. Results suggest that respondents' underprivileged social, economic, and cultural situation may aggravate their limitations when expressing their feelings. We found that the women employed silence as a means to contain the psychosocial distress created by their UI, and that the silence itself should be interpreted as an expression of distress associated with UI.
  
  
  CONCLUSIONS
  The silence of Brazilian women with UI is an essential element of communication about incontinence. We believe that the silence used by these women expresses the pain and anxiety they experienced, and it acts as an adaptive psychosocial mechanism.
authors.affiliation: Nursing Department, Women's Hospital Prof Dr José Aristodemo Pinotti, CAISM, Brazil. rosangelahiga@bol.com.br
authors.forename: Rosângela
authors.initials: R
authors.lastname: Higa
authors.forename: Vera Lucia Soares
authors.initials: VL
authors.lastname: Chvatal
authors.forename: Maria Helena Baena
authors.initials: MH
authors.lastname: de Moraes Lopes
authors.forename: Egberto Ribeiro
authors.initials: ER
authors.lastname: Turato
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D017677:Age Distribution; D001938:Brazil / Q000453:epidemiology; D003466:Cultural Characteristics; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008875:Middle Aged; D012307:Risk Factors; D012494:Sampling Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000523:psychology*