Urinary incontinence (UI), defined by the International Continence Society (ICS) as any involuntary leakage of urine, is a significant public health issue affecting women across all age groups,1 with higher prevalence among older women. Globally, the prevalence of UI varies widely, ranging between 5% and 69%2, reflecting differences in definitions, study designs, and populations. During pregnancy, UI is a common and distressing condition, often attributed to the physiological and anatomical changes that occur, especially those involving the pelvic floor. Vaginal delivery, in particular,3 is known to affect pelvic floor integrity, thereby increasing the risk of pelvic floor dysfunctions. The prevalence of UI during pregnancy varies considerably across regions and countries, with estimates ranging from 14.7% to as high as 84.5% globally. Ethiopian studies report prevalence rates of 11.4% in Gonder, 23% in Mekele, and 24.6% in Addis Ababa, demonstrating that UI is also a significant problem in low-resource settings4. Furthermore, studies have found that UI tends to become more common as pregnancy progresses, due to increasing uterine size, hormonal influences, and growing pressure on the bladder and pelvic floor structures.UI can be classified into three primary types: urgency urinary incontinence (UUI), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI). UUI refers to involuntary urine leakage preceded by a sudden5, compelling desire to void that is difficult to defer. SUI occurs with exertion or increased intra-abdominal pressure, for example during coughing, sneezing, or exercise, in the absence of a detrusor contraction. MUI is a combination of both UUI and SUI. Several studies have consistently identified SUI as the most common form of UI during pregnancy, which is attributed to the weakened pelvic support structures under the stress of the enlarging uterus6.

Numerous risk factors have been implicated in the development of UI during pregnancy. These include advancing maternal age (particularly over 35 years), higher parity, obesity, chronic cough, constipation, depression, smoking, use of certain medications like antihypertensives, and a previous history of vaginal deliveries or cesarean sections. Other contributing factors may include prolonged labor, previous miscarriages, instrumental vaginal deliveries, home deliveries, advanced gestational age, and weak pelvic floor muscle tone. These risk factors often coexist and can synergistically increase the likelihood of experiencing UI during pregnancy7.UI exerts a profound negative impact on women’s quality of life (QoL), affecting physical activities, social interactions, personal relationships, and even mental health, leading to feelings of shame, embarrassment, helplessness, and depression. Despite the substantial negative impact, fewer than 22% of affected pregnant women seek professional help or discuss their symptoms with family or partners, largely due to embarrassment, minimal bother, or the belief that symptoms would resolve spontaneously after childbirth. QoL among women with UI is commonly assessed using validated tools such as the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the ICIQ Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSQoL) questionnaire8. The ICIQ-UI SF, with a Grade A recommendation, reliably assesses the severity and impact of UI and classifies severity from slight to very severe based on score ranges. The ICIQ-LUTSQoL evaluates the impact of UI across seven domains including role limitations, physical limitations, social limitations, emotions, sleep, personal relationships, and severity measures. In Ethiopia, there has been limited research on UI among pregnant women, with no study comprehensively addressing its impact on QoL. Therefore, the purpose of this study is to determine the prevalence of UI during pregnancy, explore its associated risk factors, and assess its impact on quality of life among pregnant women in Ethiopia.

Aim

Study of Urinary incontinence among women attending a tertiary care center

The present cross-sectional study is conducted in the gynecology outpatient department of of K. M. Medical college and Hospital, Mathura on women aged 38 years and older were recruited after providing informed consent, excluding those who were pregnant, postpartum within three months, or had recent gynecological surgery. Data were collected over six months using a semi-structured interview questionnaire capturing sociodemographic data, BMI, comorbidities, and obstetric or gynecological risk factors. The International Consultation Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess frequency, severity, and impact of UI, with higher scores indicating more severe symptoms. UI was further classified as stress, urgency, mixed, or other based on standardized definitions. A total of 350 women participated in the study. The questionnaire ensured consistent, reliable evaluation of UI patterns among the target population.

Table 1: Age distribution of cases:

Urinary incontinence was more prevalent among women aged 61–70 years (18 cases) and those under 50 years (48 cases), compared to lower rates in older age groups.

Table 2: BMI distribution of cases:

Urinary incontinence was most common among women with a normal BMI (52 cases) and those overweight (31 cases), indicating that both normal and elevated BMI categories contributed substantially to UI prevalence in this cohort.

Table 3: Prevalence of urinary incontinence according to Clinical factors:

Urinary incontinence was more prevalent among women with diabetes (30 cases), chronic cough (11 cases), constipation (31 cases), recurrent UTIs (26 cases), and those with a history of prolapse surgery (4 cases), highlighting these as important associated risk factors.

Table 4: Prevalence of urinary incontinence according to obstetrics factors:

Urinary incontinence was more frequent among women with parity less than three (90 cases), a history of vaginal delivery (78 cases), prolonged labor (28 cases), and those who had instrumental delivery (7 cases), suggesting these obstetric factors play a significant role in its occurrence.

Table 5: International consultation on incontinence questionnaire-urinary incontinence short form (ICIQ-UI SF):

Among 95 women with urinary incontinence, most reported leakage once a week or less (47 cases), with small amounts (73 cases), minimal QoL impact (56 cases scoring 0–3), stress incontinence being the most common type (58 cases), and ICIQ scores indicating predominantly mild to moderate severity.

In this study, urinary incontinence was most commonly observed in women below 50 years of age, with 48 cases affected out of 95 total. Women aged 51–60 years contributed 21 cases, showing a moderate prevalence in this age group. Notably, women aged 61–70 years had 18 cases, suggesting a rising risk with advancing age. Only 8 cases were reported among women aged 71–80 years. Overall, these findings highlight that urinary incontinence affects women across age groups, with higher prevalence among middle-aged and early elderly women.

In this study, urinary incontinence was most prevalent among women with a normal BMI, accounting for 52 out of 95 cases. Overweight women also showed a considerable number of cases (31), reflecting a significant burden. Underweight women contributed 8 cases, while only 4 obese women reported urinary incontinence. These findings suggest that UI affects women across all BMI categories, but is particularly common among those with normal or overweight status.

In this study, urinary incontinence was more frequent among women with diabetes (30 cases) compared to non-diabetics (65 cases). Chronic cough was associated with 11 cases of UI, while constipation contributed to 31 cases. Women with a history of recurrent urinary tract infections reported 26 cases of UI, and those with prior prolapse surgery accounted for 4 cases. These results emphasize that comorbidities such as diabetes, chronic cough, constipation, recurrent UTIs, and previous prolapse surgery are significant contributors to urinary incontinence risk. Study by  Izci Y9, Diabetes was shown to be associated with a 2.5-fold risk increase for urinary incontinence (UI), similarly by Ghaly10, Chronic   cough was linked to a sharply elevated UI risk (OR 5.7, 95% CI 1.7–18.9) .Nygaard I11, showed Women with ≥ 3 UTIs/year had up to 5× increased UI risk compared to those without , matching your report of 26 cases among UTI-affected women. In a study by Mathew R12, the UI displayed strong correlations with chronic cough (p=<0.0001), constipation (p=0.03), previous vaginal birth (p=0.029), In addition, almost 77% of the participants experienced small amounts of leakage and majority had a negative impact on quality of life.

In this study, urinary incontinence was more prevalent among women with lower parity, affecting 90 women with fewer than three children compared to only 5 with higher parity. A history of vaginal delivery was associated with 78 cases of UI, suggesting its impact on pelvic floor function. Women who experienced prolonged labor showed a higher prevalence (28 cases) compared to those without prolonged labor. Instrumental delivery was also linked with UI, reported by 7 women. These findings indicate that obstetric factors such as parity, vaginal delivery, prolonged labor, and instrumental birth play significant roles in urinary incontinence risk.In a study by Connolly TJ13,a large Boston Area Community Health Survey of 3,205 women (aged 30–79) found that having ≥ 1 vaginal delivery doubled the odds of moderate–severe UI compared to women who were nulliparous or delivered via cesarean alone. Similarly, Farrell SA14,A study on primiparous women showed spontaneous vaginal delivery was associated with a relative risk of UI of 2.8 compared to cesarean, and instrumental (forceps) delivery increased UI risk by a further 1.5×.Study by Wikander l15.Women with prolonged second stage of labor—even if ultimately delivered vaginally—showed a significantly higher likelihood of UI post-partum, particularly when combined with instrumental delivery

Among the 95 women with urinary incontinence, nearly half (47) experienced leakage once a week or less, while 22 reported leakage two to three times per week, and 17 had leakage once daily. Most women described the amount of leakage as small (73 cases), with only a minority reporting moderate (20) or large (2) volumes. The impact on quality of life was minimal (scores 0–3) in 56 women, moderate (4–6) in 27, and severe (7–10) in 12. Stress urinary incontinence was the most common type, affecting 58 women, followed by urge incontinence (21) and mixed types (16). These results suggest that mild, stress-related incontinence with limited QoL disruption predominated in this cohort.

This study highlights that urinary incontinence affects women across all age groups, with the highest prevalence among middle-aged and early elderly women. Normal and overweight BMI categories were most affected, while diabetes, chronic cough, constipation, recurrent UTIs, and previous prolapse surgery emerged as significant comorbid risk factors. Obstetric factors, including lower parity, vaginal delivery, prolonged labor, and instrumental births, also played important roles. Most participants experienced stress urinary incontinence with small amounts of leakage and minimal to moderate impact on quality of life. Weekly leakage was most common. Overall, the findings emphasize a multifactorial etiology of UI involving age, BMI, comorbidities, and obstetric history. These insights underscore the need for targeted prevention and early intervention strategies to address urinary incontinence in women.

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