Urinary incontinence (UI) is a common but underreported condition among postmenopausal women, influenced by hormonal decline, obstetric factors, metabolic comorbidities, and lifestyle exposures. Its impact on physical, psychosocial, and sexual well-being makes early recognition and management essential. However, region-specific epidemiological data from northern Karnataka—particularly Kalaburagi—are limited. This study aimed to estimate the prevalence, subtype distribution, associated risk factors, and severity of UI among postmenopausal women attending outpatient clinics, using the validated International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF). Methods: A cross-sectional study was conducted among 300 postmenopausal women selected through systematic random sampling at a tertiary care centre in Kalaburagi. Sociodemographic, obstetric, and clinical information was collected using a structured questionnaire. UI presence, severity, and subtype were assessed using the ICIQ-SF. Variables significant at p < .20 in bivariate analysis were entered into a multivariable logistic regression model. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were computed to identify independent predictors. Results: The prevalence of UI was 32.7%. Stress UI was the most common subtype (42.3%), followed by mixed UI (29.1%) and urgency UI (28.6%). The mean ICIQ-SF score was 9.8 ± 3.6, with moderate severity being most prevalent (52.0%). In bivariate analysis, UI was significantly associated with BMI ≥ 25 kg/m² (p = .002), multiparity ≥ 3 (p = .020), prolonged labor (p < .001), diabetes mellitus (p = .011), chronic cough (p < .001), and >10 years since menopause (p = .043). Multivariable analysis identified chronic cough (aOR = 3.05), prolonged labor (aOR = 2.62), BMI ≥ 25 (aOR = 2.14), multiparity ≥ 3 (aOR = 1.76), and diabetes mellitus (aOR = 1.71) as independent predictors of UI. Conclusion: The strong influence of obstetric factors, obesity, diabetes, and chronic cough highlights the need for routine screening, targeted pelvic floor rehabilitation, metabolic optimization, and respiratory health interventions. Region-specific, community-based prevention strategies and pelvic floor muscle training programs are recommended to mitigate UI burden.