Abstract
BACKGROUND:
Urinary incontinence (UI) is a prevalent yet underreported condition that adversely affects the quality of life of older adults. This study aimed to assess the frequency and risk factors of UI and its impact on the quality of life of adults aged 50 years and older attending outpatient clinics of a tertiary care teaching hospital in the Eastern Province, Saudi Arabia.
MATERIALS AND METHODS:
This cross-sectional study was conducted from December 15, 2024, to March 10, 2025. Four hundred persons aged 50 years or older attending outpatient clinics, selected by convenient sampling, filled a structured validated questionnaire in Arabic. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form assessed UI, and the Incontinence Impact Questionnaire Short Form (IIQ-7 SF) determined the impact of UI on the quality of life. Data were analyzed using SPSS and included descriptive statistics, Chi-square test, and logistic regression analysis.
RESULTS:
The majority of participants were Saudis (86.3%), aged 50–64 (75.6%), and females (59.3%); 32.5% participants reported UI. Of the females, a family history of UI (odds ratio [OR] = 2.48 [1.27–4.85], P = 0.008) and uterine prolapse (OR = 6.80 [2.57–18.18), P < 0.001) were the most significant risk factors for UI. Benign prostatic hyperplasia was a significant risk factor for UI (OR = 4.50 [1.88–10.82], P = 0.001) in males. Mean score for interference of urinary leakage with daily life, on a scale of 0–10, was 5.03 ± 3.69. UI showed a mild to moderate impact on participants’ quality of life. However, 20.8% reported a “great” impact on traveling by car or bus for more than 30 minutes from home.
CONCLUSION:
UI is common in adults 50 years or older (32.5%) and has a substantial impact on their quality of life, affecting physical, emotional, and social well-being. Despite its effects, underreporting remains common because of the stigma and the lack of awareness.
Keywords: Older adult, prevalence, quality of life, risk factor, urinary incontinence
Introduction
Urinary incontinence (UI) is a prevalent condition characterized by involuntary loss of bladder control, resulting in unintended leakage of urine. This condition significantly impacts patients’ lives by affecting their psychological well-being, social interactions, and daily functioning.[1] Despite its prevalence, UI has remained largely underestimated, partly because affected individuals frequently avoid seeking medical advice due to embarrassment, social stigma, or misconceptions of the normalcy of the condition, especially among older adults.[2]
In Saudi Arabia, studies on the prevalence of UI have focused predominantly on females and revealed high prevalence rates. For example, a recent study conducted among Saudi women aged 18-70 years in the Western Province reported a prevalence rate of approximately 44.2%.[3] Another study done in Al-Majma’ah region showed a prevalence of 41.7%.[4] However, the literature is deficient in exploring UI prevalence and associated risk factors in Saudi men. This highlights a significant knowledge gap that this study sought to address. Available data suggest that UI in males is primarily linked to benign prostatic hyperplasia (BPH), diabetes mellitus, detrusor muscle overactivity, dementia, physical inactivity, and Parkinson’s disease.[5,6,7,8]
UI can be categorized into several types: stress, urge, overflow, and functional.[9] Stress incontinence arises from increased abdominal pressure combined with a weakened pelvic floor or urethral structures, whereas urge incontinence typically results from detrusor muscle overactivity and impaired neural bladder control. Overflow incontinence occurs with compromised bladder contraction or obstruction at the bladder outlet. Functional incontinence results from mental or physical impediments to toileting.[1,2,10]
A study from Changsha, China, reported a 24.3% prevalence of UI in elderly residents, which underlines such risk factors as immobility, cardiovascular diseases, and constipation.[11] Another study from Al-Medina Al-Munawara, Saudi Arabia, found a 35.82% prevalence in women, which was strongly correlated with such conditions as genital infections, asthma, chronic cough, and pelvic organ prolapse.[12] A systematic review involving 518,465 older women reported an average prevalence of 37.1% globally, which showed variations based on geographical and methodological differences.[13] Furthermore, articles from Egypt and Qatar consistently highlighted significant impacts on the quality of life of those affected. This underlines the universal and multifaceted nature of UI.[14,15]
The purpose of the current study was to provide robust local data, enabling healthcare providers to better understand the prevalence of UI, contributing risk factors, and the profound impact on quality of life. In addition, our aim was to bridge the existing research gap regarding its prevalence and consequences, particularly in the male population in Saudi Arabia, and thereby provide foundational data to support future research.
Materials and Methods
This study employed a cross-sectional design to assess the prevalence, risk factors, and the impact of UI on the quality of life of adults aged 50 years or older attending outpatient clinics at King Fahd Hospital of the University, Khobar, and Family and Community Medicine Center (FCMC) at Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province. The data was collected from December 15, 2024, to March 10, 2025. Ethical approval was obtained from the Institutional Review Board of Imam Abdulrahman Bin Faisal University vide Letter No. IRB#: IRB-UGS-2024-01-750 dated 15/10/2024, and written informed consent was taken from all participants in the study.
Considering a confidence level of 95%, a margin of error of 5%, and assuming a prevalence of UI in older adults as 50%, the calculated sample size using the formula for a single sample proportion: N = (Z2 × P × (1 − P))/e2, was 384. A total of 400 participants, 300 from KFHU and 100 from FCMC, were targeted to ensure sufficient statistical power. Individuals eligible for participation were adults aged 50 years or older attending outpatient clinics at the hospital and included both patients and persons accompanying them. Anyone with cognitive impairments that hindered comprehension of the study procedures, and those who had undergone urinary tract surgeries within the past 6 months, were excluded from the study.
To select the study participants from outpatient clinics at KFHU, the sample of 300 was divided into strata based on outpatient specialty clinics, proportionate to each clinic’s average patient flow. From each specialty clinic, all eligible participants were selected using convenient sampling till the required sample size for the clinic was achieved.
Data was collected using a structured questionnaire with validated instruments and methods. The questionnaire comprised four sections: Section 1: Sociodemographic data (age, gender, nationality, marital status, education level, employment status, and income). Section 2: Medical history, including BMI, comorbidities, and gender specific risk factors for UI. Section 3: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) to assess UI frequency and severity. The ICIC-UI SF contains 4 items: Frequency of UI, leakage amount, overall impact of UI, and self-diagnostic item. The first three items gave a score ranging from 0 to 21, with higher scores indicating the greater severity of incontinence. The fourth item was not scored but provided diagnostic judgement on the type of UI. Based on the total score, UI was classified as slight (1–5), moderate (6–12), severe (13–18), or very severe (19–21). This questionnaire provides consistent and reproducible data, which effectively measures both symptom severity and the impact on the quality of life as it has strong correlations with objective urodynamic findings. The questionnaire’s simplicity and ease of use make it especially suitable for routine clinical assessments.[16] Section 4: Incontinence Impact Questionnaire Short Form (IIQ-7 SF) to evaluate the impact of UI on participants’ quality of life. This questionnaire consists of 7 items, the first two items address physical activities, the rest focus on social and emotional aspects. Each item is scored as 0 (“not at all”), 1 (“slightly”), 2 (“moderately”), or 3 (“greatly”). The mean of the completed items is then calculated, resulting in an average score between 0 and 3. This value is multiplied by 33⅓ to convert it to a standardized scale ranging from 0 to 100. The Arabic validated version was employed to ensure cultural appropriateness and accuracy.[17] The questionnaire was put online using QuestionPro.
The primary dependent variable was the presence or absence of UI, as determined by responses to the question: “Have you lost bladder control?.” The independent variables included socio-demographics (age, gender, education, body mass index [BMI], employment status, marital status, and income), comorbidities (BMI, diabetes, hypertension, chronic cough, and constipation), family history of UI, and gender specific conditions, such as uterine prolapse in females and BPH in males.
A pilot study was conducted on 25 participants before the main research to assess the feasibility, reliability, and acceptability of the questionnaires. Adjustments were made based on feedback to ensure clarity and ease of questionnaire administration.
The interviewers followed a standardized approach to reduce bias and were advised to maintain a neutral tone and use the same content of the questionnaire to avoid influencing participants’ responses. Questions used clear language and references to recent experiences to minimize recall bias whenever possible.
After identifying the eligible participants, the researchers approached the potential subjects, requested their participation in the study after informing them about the purpose of the study, and what was required of the study participants. After taking written informed consent from those willing to participate, researchers accessed the questionnaire uploaded in QuestionPro using their iPads or laptops to conduct face-to-face interviews.
Data analysis was performed using Statistical Package for the Social Sciences (SPSS, IBM Corporation, Armonk, NY: USA). Quantitative variables were described as means and standard deviations, whereas frequencies and percentages were used to summarize qualitative demographic characteristics and the prevalence of UI. Chi-square tests and logistic regression analyses were employed to identify associations between potential risk factors and the occurrence of UI in older adults. A separate logistic regression analysis was run for females and males, and separate final models were selected containing the significant risk factors for females and males. All analysis were performed at a 0.05 significance level.
Results
Table 1 shows the sociodemographic details of adults attending outpatient clinics at the hospital; just over half (54.3%) were aged 50–59 years, the greater proportion being females (59.3%). The majority were Saudi nationals (86.3%), and their educational attainment varied widely, from no formal education (10.3%) to postgraduate degrees (4.5%).
Table 1.
Sociodemographic characteristics of the adults 50 years or older attending outpatient clinics at KFHU, Khobar and FCMC, Dammam, Saudi Arabia, 2025 (n=400)
| Characteristics | N (%) |
|---|---|
| Age (years) | |
| 50–59 | 217 (54.3) |
| 60–64 | 85 (21.3) |
| 65–69 | 40 (10.0) |
| 70–79 | 51 (12.8) |
| 80 or above | 7 (1.8) |
| Gender | |
| Male | 163 (40.8) |
| Female | 237 (59.3) |
| Nationality | |
| Saudi | 345 (86.3) |
| Non-Saudi | 55 (13.8) |
| Marital status | |
| Married | 302 (75.5) |
| Single | 18 (4.5) |
| Widowed | 51 (12.8) |
| Divorced | 29 (7.3) |
| Education | |
| Uneducated | 41 (10.3) |
| Elementary | 44 (11.0) |
| Intermediate | 46 (11.5) |
| High | 100 (25.0) |
| Diploma | 28 (7.0) |
| Bachelors | 123 (30.8) |
| Postgraduation | 18 (4.5) |
| Employment status | |
| Employed | 79 (19.8) |
| Unemployed | 18 (4.5) |
| Retired | 138 (34.5) |
| Housewife | 165 (41.3) |
| Monthly income | |
| <5000 | 107 (26.8) |
| 5000–10,000 | 113 (28.2) |
| 10,000–20,000 | 122 (30.5) |
| >20,000 | 58 (14.5) |
| Residence | |
| Dammam | 111 (27.8) |
| Khobar | 182 (45.5) |
| Dhahran | 38 (9.5) |
| Qatif | 35 (8.8) |
| Al-Ahsa | 17 (4.3) |
| Jubail | 4 (1.0) |
| Other | 13 (3.3) |
Out of 400 study participants, 130 (32.5%) reported loss of bladder control [Table 2]. Of those 130 individuals with UI, 13.8% described their condition as “slight,” 53.1% as “moderate,” 21.5% as “severe,” and 11.5% as “very severe.” Only 35.4% had sought medical care. The reasons for not seeking care included belief that UI affected all older adults and was not worrisome (21.4%),13.1%, hoped for spontaneous recovery, 28.6% thought UI did not affect daily life and for 23.8% there was no reason.
Table 2.
Frequency, severity, and management of urinary incontinence in adults 50 years or older attending outpatient clinics at KFHU, Khobar and FCMC, Dammam, Saudi Arabia, 2025 (n=400)
| Variables | N (%) |
|---|---|
| Lost bladder control | |
| Yes | 130 (32.5) |
| No | 270 (67.5) |
| Severity of urinary incontinence (ICIQ-UI SF total score) (n=130) | |
| Slight | 18 (13.8) |
| Moderate | 69 (53.1) |
| Severe | 28 (21.5) |
| Very severe | 15 (11.5) |
| Seek medical care for urinary incontinence (n=130) | |
| Yes | 46 (35.4) |
| No | 84 (64.6) |
| Type of medical care prescribed (n=46) | |
| Kegel exercise | 21 (45.7) |
| Medical intervention | 24 (52.2) |
| Surgical intervention | 11 (23.9) |
| Reason for not seeking medical care (n=84) | |
| Urinary incontinence affects all older adults, no need to worry about it | 18 (21.4) |
| I hope to recover spontaneously from it | 11 (13.1) |
| Leakage of urine is not curable | 1 (1.2) |
| It does not affect my life | 24 (28.6) |
| No reason | 20 (23.8) |
| Other | 10 (11.9) |
ICIQ-UI SF: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form
Gender (P < 0.001) and employment status (P = 0.005) emerged as the only significant sociodemographic correlates of UI. Females had a greater prevalence of UI (43.0%) compared to males (17.2%), whereas housewives experienced UI at a higher rate (42.4%) than those who were unemployed (27.8%), retired (26.1%), or employed (24.1%) [Table 3]. No other statistically significant associations between UI and other demographic characteristics were observed.
Table 3.
Association between urinary incontinence status and sociodemographic characteristics of adults 50 years or older attending outpatient clinics at KFHU, Khobar and FCMC, Dammam, Saudi Arabia, 2025 (n=400)
| Characteristics | Urinary incontinence | P-value | ||
|---|---|---|---|---|
|
| ||||
| Yes N (%) | No N (%) | Total N (%) | ||
| Age (mean±SD=59.2±8.2) | ||||
| 50–59 years | 72 (33.2) | 145 (66.8) | 217 (100.0) | 0.958 |
| 60–64 years | 25 (29.4) | 60 (70.6) | 85 (100.0) | |
| 65–69 years | 13 (32.5) | 27 (67.5) | 40 (100.0) | |
| 70–79 years | 18 (35.3) | 33 (64.7) | 51 (100.0) | |
| 80 or above | 2 (28.6) | 5 (71.4) | 7 (100.0) | |
| Gender | ||||
| Male | 28 (17.2) | 135 (82.8) | 163 (100.0) | <0.001 |
| Female | 102 (43.0) | 135 (57.0) | 237 (100.0) | |
| Nationality | ||||
| Saudi | 117 (33.9) | 228 (66.1) | 345 (100.0) | 0.131 |
| Non-Saudi | 13 (23.6) | 42 (76.4) | 55 (100.0) | |
| Marital status | ||||
| Married | 94 (31.1) | 208 (68.9) | 302 (100.0) | 0.146 |
| Single | 3 (16.7) | 15 (83.3) | 18 (100.0) | |
| Widowed | 20 (39.2) | 31 (60.8) | 51 (100.0) | |
| Divorced | 13 (44.8) | 16 (55.2) | 29 (100.0) | |
| Education | ||||
| Uneducated | 19 (46.3) | 22 (53.7) | 41 (100.0) | 0.266 |
| Elementary | 18 (40.9) | 26 (59.1) | 44 (100.0) | |
| Intermediate | 14 (30.4) | 32 (69.6) | 46 (100.0) | |
| High | 33 (33.0) | 67 (67.0) | 100 (100.0) | |
| Diploma | 9 (32.1) | 19 (67.9) | 28 (100.0) | |
| Bachelors | 32 (26.0) | 91 (74.0) | 123 (100.0) | |
| Postgraduation | 5 (27.8) | 13 (72.2) | 18 (100.0) | |
| Employment status | ||||
| Employed | 19 (24.1) | 60 (75.9) | 79 (100.0) | 0.005 |
| Unemployed | 5 (27.8) | 13 (72.2) | 18 (100.0) | |
| Retired | 36 (26.1) | 102 (73.9) | 138 (100.0) | |
| Housewife | 70 (42.4) | 95 (57.6) | 165 (100.0) | |
| Monthly income | ||||
| <5000 | 38 (35.5) | 69 (64.5) | 107 (100.0) | 0.472 |
| 5000–10,000 | 39 (34.5) | 74 (65.5) | 113 (100.0) | |
| 10,000–20,000 | 39 (32.0) | 83 (68.0) | 122 (100.0) | |
| >20,000 | 14 (24.1) | 44 (75.9) | 58 (100.0) | |
| Residence | ||||
| Dammam/Khobar/Dhahran | 108 (32.6) | 223 (67.4) | 331 (100.0) | 0.904 |
| Others | 22 (31.9) | 47 (68.1) | 69 (100.0) | |
SD: Standard deviation
Of the examined risk factors for UI in adults aged 50 or older, obesity showed a borderline significant relationship, with obese participants reporting a higher UI prevalence (38.3%) than those with a healthy weight (25.0%) and overweight (28.0%) (P = 0.05) [Table 4]. Chronic obstructive pulmonary disease (COPD) was strongly associated with UI (53.8% vs. 29.3%; P < 0.001), as were joint problems (44.4% vs. 26.4%; P < 0.001), constipation (47.1% vs. 29.4%; P = 0.004), and chronic cough (60.6% vs. 30.0%; P < 0.001). In addition, a family history of UI was significantly associated with increased UI prevalence (49.3%) compared to those without such a history (26.4%; P < 0.001). In females, pelvic or uterine prolapse significantly increased the risk of UI (77.8% vs. 36.8%; P < 0.001). In males, BPH was strongly associated with UI (35.7% vs. 11.0%; P = 0.001) [Table 4].
Table 4.
Risk factors for urinary incontinence in adults 50 years or older attending outpatient clinics at KFHU, Khobar and FCMC, Dammam, Saudi Arabia, 2025 (n=400)
| Risk factors | Urinary incontinence | Total N (%) | |
|---|---|---|---|
|
| |||
| Yes N (%) | No N (%) | ||
| General risk factors | |||
| BMI (mean±SD=30.3±5.5) | |||
| Healthy weight | 16 (25.0) | 48 (75.0) | 64 (100.0) |
| Overweight | 40 (28.0) | 103 (72.0) | 143 (100.0) |
| Obese | 74 (38.3) | 119 (61.7) | 193 (100.0) |
| Comorbidity | |||
| Yes | 120 (34.9) | 224 (65.1) | 344 (100.0) |
| No | 10 (17.9) | 46 (82.1) | 56(100.0) |
| High blood pressure | |||
| Yes | 62 (32.5) | 129 (67.5) | 191 (100.0) |
| No | 68 (32.5) | 141 (67.5) | 209 (100.0) |
| Diabetes mellitus | |||
| Yes | 65 (33.5) | 129 (66.5) | 194 (100.0) |
| No | 65 (31.6) | 141 (68.4) | 206 (100.0) |
| Hyperlipidemia | |||
| Yes | 68 (37.8) | 112 (62.2) | 180 (100.0) |
| No | 62 (28.2) | 158 (71.8) | 220 (100.0) |
| Coronary heart disease | |||
| Yes | 23 (29.9) | 54 (70.1) | 77 (100.0) |
| No | 107 (33.1) | 216 (66.9) | 323 (100.0) |
| COPD | |||
| Yes | 28 (53.8) | 24 (46.2) | 52 (100.0) |
| No | 102 (29.3) | 246 (70.7) | 348 (100.0) |
| Neurological condition | |||
| Yes | 18 (36.7) | 31 (63.3) | 49 (100.0) |
| No | 112 (31.9) | 239 (68.1) | 351 (100.0) |
| Joints problem | |||
| Yes | 60 (44.4) | 75 (55.6) | 135 (100.0) |
| No | 70 (26.4) | 195 (73.6) | 265 (100.0) |
| Psychiatric condition | |||
| Yes | 7 (46.7) | 8 (53.3) | 15 (100.0) |
| No | 123 (31.9) | 262 (68.1) | 385 (100.0) |
| Autoimmune diseases | |||
| Yes | 106 (31.0) | 236 (69.0) | 342 (100.0) |
| No | 24 (41.4) | 34 (58.6) | 58 (100.0) |
| Other comorbid condition | |||
| Yes | 16 (39.0) | 25 (61.0) | 41 (100.0) |
| No | 114 (31.8) | 245 (68.2) | 359 (100.0) |
| Constipation | |||
| Yes | 33 (47.1) | 37 (52.9) | 70 (100.0) |
| No | 97 (29.4) | 233 (70.6) | 330 (100.0) |
| Chronic cough | |||
| Yes | 20 (60.6) | 13 (39.4) | 33 (100.0) |
| No | 110 (30.0) | 257 (70.0) | 367 (100.0) |
| History of genital infections | |||
| Yes | 2 (33.3) | 4 (66.7) | 6 (100.0) |
| No | 126 (32.1) | 266 (67.9) | 392 (100.0) |
| Family history of urinary incontinence | |||
| Yes | 36 (49.3) | 37 (50.7) | 73 (100.0) |
| No | 78 (26.4) | 217 (73.6) | 295 (100.0) |
| Don’t know | 16 (50.0) | 16 (50.0) | 32 (100.0) |
| Diagnosis of congenital malformation of the urinary system | |||
| Yes | 2 (66.7) | 1 (33.3) | 3 (100.0) |
| No | 126 (31.9) | 269 (68.1) | 395 (100.0) |
| Don’t know | 2 (100.0) | 0 | 2 (100.0) |
| Wheelchair use | |||
| Yes | 12 (48.0) | 13 (52.0) | 25 (100.0) |
| No | 118 (31.5) | 257 (68.5) | 375 (100.0) |
| Risk factors for female (n=237) | |||
| Number of normal vaginal deliveries | |||
| None | 17 (32.7) | 35 (67.3) | 52 (100.0) |
| 1–2 | 12 (37.5) | 20 (62.5) | 32 (100.0) |
| 3–4 | 20 (47.6) | 22 (52.4) | 42 (100.0) |
| >4 | 53 (47.7) | 58 (52.3) | 111 (100.0) |
| Cesarean section | |||
| None | 70 (44.0) | 89 (56.0) | 159 (100.0) |
| One | 17 (41.5) | 24 (58.5) | 41 (100.0) |
| Two or more | 15 (40.5) | 22 (59.5) | 37 (100.0) |
| Age at the time of marriage (years) | |||
| <18 | 38 (44.2) | 48 (55.8) | 86 (100.0) |
| 18–24 | 43 (44.3) | 54 (55.7) | 97 (100.0) |
| 25–30 | 16 (50) | 16 (50) | 32 (100.0) |
| Over 30 | 3 (27.3) | 8 (72.7) | 11 (100.0) |
| NA | 2 (18.2) | 9 (81.8) | 11 (100.0) |
| Diagnosis of pelvic or uterine prolapse | |||
| Yes | 21 (77.8) | 6 (22.2) | 27 (100.0) |
| No | 74 (36.8) | 127 (63.2) | 201 (100.0) |
| Don’t know | 7 (77.8) | 2 (22.2) | 9 (100.0) |
| Risk factors for males (n=163) | |||
| Diagnosis of Benign prostatic hyperplasia | |||
| Yes | 15 (35.7) | 27 (64.3) | 42 (100.0) |
| No | 13 (11.0) | 105 (89.0) | 118 (100.0) |
| Don’t know | 0 | 3 (100.0) | 3 (100.0) |
| Diagnosis of prostate cancer | |||
| Yes | 0 | 0 | 0 |
| No | 28 (17.2) | 135 (82.8) | 163 (100.0) |
| Surgical removal of the prostate | |||
| Yes | 2 (50.0) | 2 (50.0) | 4 (100.0) |
| No | 26 (16.4) | 133 (83.6) | 159 (100.0) |
SD: Standard deviation, COPD: Chronic obstructive pulmonary disease, NA: Not applicable, BMI: Body mass index
Table 5 summarizes urinary leakage characteristics in adults 50 years or older who experience UI obtained from the ICIQ-UI SF. Regarding frequency, the most common response was that leakage occurred approximately once a week (34.6%), followed by several times a day (20.8%), and two or three times a week (16.2%), and all the time (8.5%). The majority reported leaking only small amounts of urine (57.7%) or moderate (23.8%).
Table 5.
Frequency and amount of urinary leakage in adults 50 years or older with urinary incontinence (n=130)
| N(%) | |
|---|---|
| Frequency of urine leak | |
| Never | 11 (8.5) |
| About once a week | 45 (34.6) |
| Two or three times a week | 21 (16.2) |
| About once a day | 15 (11.5) |
| Several times a day | 27 (20.8) |
| All the time | 11 (8.5) |
| Amount of urine leaked | |
| None | 2 (1.5) |
| A small amount | 75 (57.7) |
| A moderate amount | 31 (23.8) |
| A large amount | 22 (16.9) |
Figure 1 shows the impact score of UI on daily life. The mean score for interference of urinary leakage with daily life was 5.03 ± 3.69 on a scale from 0 (least interference) to 10 (highest interference). The scores varied widely, with the largest single group rating interference as 0 out of 10 (no impact; 29.2%), followed by the highest interference as 10 out of 10 (14.6%). While a considerable proportion of participants experienced minimal or no disturbance from UI, a significant proportion expressed severe interference that affected their daily activities. This variation in scores highlights how individuals experienced differing burdens of UI.
Figure 1.
Impact of urinary incontinence on daily life (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score distribution)
When asked about the circumstances under which urine leaks, 76.4% reported that the leak occurred before they can reach the toilet. About 61.0% had leakage when coughing or sneezing, 12.6% while asleep, and 18.1% when physically active or exercising [Figure 2].
Figure 2.
When does urine leak? (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form)
The impact of UI on various dimensions of quality of life is illustrated in Figure 3. Most participants reported that UI had no impact on their ability to do household chores (67.7%), physical recreation (63.8%), entertainment activities such as movies (63.8%), participate in social activities (63.8%), and emotional health. However, the ability to travel by car or bus for more than 30 min from home showed the greatest reported impact, when only 47.7% indicated no impact, and 20.8% experienced a “great” impact. Other notable impacts were moderate to great frustration (23.9%), emotional health concerns (25.4%), and difficulty in physical recreation activities on the overall quality of life.
Figure 3.
Incontinence impact on quality of life (Incontinence Impact Questionnaire Short Form)
Based on the IIQ-7 SF, where responses range from 0 (“not at all”) to 3 (“greatly”), the participants had a mean item response score of 0.74 ± 0.88. When scaled from 0 to 100, the total mean impact score was 24.61 ± 29.34, indicating a mild to moderate overall impact of UI on the participants’ quality of life [Table 6].
Table 6.
Incontinence impact on quality of life in adults, 50 years or older with urinary incontinence (n=130)
| Impact on quality of life | Mean±SD | Median | SIQR |
|---|---|---|---|
| IIQ7 score (out of 21) | 5.196±6.16 | 2.5 | 4.125 |
| Average score (0–3) | 0.738±0.88 | 0.357 | 0.589 |
| Total score (out of 33) | 24.61±29.34 | 11.90 | 19.6 |
| Slight (IIQ7 score 0–5), n (%) | 85 (65.4) | ||
| Moderate (IIQ7 score 6–12), n (%) | 23 (17.7) | ||
| Severe (IIQ7 score 13–21), n (%) | 22 (16.9) |
IIQ7: Incontinence Impact Questionnaire Short For, SIQR: Semi interquartile range, SD: Standard deviation
Table 7 presents the results of logistic regression analysis, separate final models for males and females, including the significant risk factors for UI. In the final logistic regression model for the females, family history of UI had significantly higher odds of developing the condition (OR = 2.48, 95% confidence interval [CI]: 1.27–4.85, P = 0.008). Uterine prolapse emerged as the strongest predictor in females, increasing the odds of UI nearly seven-fold (OR = 6.80, 95% CI: 2.57–18.18, P < 0.001). Although constipation (OR = 1.79, P = 0.081) and chronic cough (OR = 2.40, P = 0.073) were associated with increased risk of UI in females, these associations were not statistically significant. In the final logistic regression model for the males, chronic cough (OR = 5.33, 95% CI: 1.31–21.67, P = 0.019) and BPH (OR = 4.50, 95% CI: 1.88–10.82, P = 0.001) were significantly associated with increased risk of UI.
Table 7.
Logistic regression analysis final models: Risk factors for urinary incontinence among older males and females (n=130)
| Variable | OR | 95% CI for OR | P-value |
|---|---|---|---|
| Risk factors for females | |||
| Constipation | 1.79 | 0.93–3.47 | 0.081 |
| Chronic cough | 2.40 | 0.92–6.25 | 0.073 |
| Family history of UI | 2.48 | 1.27–4.85 | 0.008 |
| Uterine prolapse | 6.80 | 2.57–18.18 | 0.001 |
| Risk factors for males | |||
| Chronic cough | 5.327 | 1.31–21.67 | 0.019 |
| BPH | 4.504 | 1.88–10.82 | 0.001 |
CI: Confidence interval, UI: Urinary incontinence, BPH: Benign prostatic hyperplasia, OR: Odds ratio
Discussion
The findings of this study revealed that a substantial proportion (32.5%) of those attending outpatient clinics experience UI, which underscores the high prevalence of this condition in geriatric populations. The distribution of severity, with over half reporting moderate to very severe symptoms, highlights the significant impact of UI on the quality of life. However, the most concerning aspect is that only 35.4% of those with UI sought medical management. This suggests a significant unmet need and indicates potential barriers to accessing care. Several reasons were cited for not seeking care, including the belief that UI was a normal part of aging and not worrisome. This underlines the lack of awareness and acceptance of UI as a treatable condition, which perhaps is the result of societal stigma or misconceptions about aging. The hope for spontaneous recovery reveals a lack of understanding regarding the progressive nature of UI and the potential of improving or managing symptoms by intervention.[18] The perception that UI does not affect daily life, reported by a significant percentage of patients, may indicate that individuals are underestimating the impact of UI on their physical, psychological, and social well-being or have adapted their lives to accommodate the condition without realizing the potential for improvement.
The higher prevalence of UI in females (43.0%) compared to males (17.2%) aligns with established epidemiological patterns, as females are generally at a greater risk for UI owing to anatomical and hormonal factors, as well as factors related to pregnancy and childbirth.[19,20,21] The finding that housewives experienced UI at a higher rate (42.4%) compared to employed or retired individuals may be multifactorial. This could reflect differences in physical activity levels, access to healthcare, or other lifestyle factors. In addition, it is possible that housewives may experience different stressors or have different perceptions of UI, that influence their reporting of symptoms. Obesity showed a significant borderline relationship with UI, since obese participants reported a higher prevalence. This is consistent with other studies that have identified obesity as a risk factor for UI.[22,23,24] Increased abdominal pressure and hormonal changes associated with obesity may contribute to this association. The significant association between comorbidities and UI agrees with the understanding that systemic diseases can impact bladder function and pelvic floor support. Specifically, the strong associations observed with hyperlipidemia, COPD, joint problems, constipation, and chronic cough highlight potential pathophysiological mechanisms. For example, a chronic cough increases intra-abdominal pressure, potentially weakening pelvic floor muscles.[25] Constipation can also contribute to UI by causing fecal impaction and pressure on the bladder.[26] The significant association between a family history of UI and its prevalence suggests a genetic predisposition or shared environmental factors.[27] The strong association between pelvic or uterine prolapse and UI in females underscores the importance of pelvic floor support in maintaining continence.[28] Pelvic organ prolapse can directly impact bladder function and urethral support, leading to UI.
Although UI was more prevalent in the women in our study, 17.2% of male participants also had UI, indicating that this condition is not exclusive to women. In men, BPH was the most associated factor, like other studies, in which the enlargement of the prostate is accompanied by obstruction of the bladder outlet, excessive detrusor activity, and postvoid residual urine, which leads to incontinence. In a study by Cheng et al., out of 4076 participants, 17.3% reported UI. The results showed that UI increased with age in males, peaking at 24.9% in men ≥60 years, which suggests a significant association of increasing age with risk of UI. Furthermore, male lower urinary tract symptoms and incontinence had strong associations with prostate volume, age, and the presence of overactive bladder symptoms, all of which negatively have an impact on the quality of life. The cultural stigma concerning UI and the tendency of men to underreport urinary symptoms leads to underdiagnosis and undertreatment.[29]
A study in Bahrain found that 24.8% of women experienced UI.[30] Research on Saudi women reported prevalence rates ranging from 29% to 41.4% depending on the population studied.[3,4,31] A study in Palestine reported a UI prevalence of around 30% in women with type 2 diabetes.[32] In comparison, our study revealed a 32.5% prevalence of UI in older adults attending outpatient clinics. Importantly, differences in study populations, methodologies, and definitions of UI can influence prevalence rates. For example, some studies focus specifically on women,[33] whereas the current study included both men and women. Besides, the age range of participants can affect the prevalence, as UI becomes more common with increasing age. Despite these variations, the available data suggest that UI is a significant health concern in the Middle East, with prevalence rates comparable to those observed in our study.[34]
The study showed that UI has a mild to moderate impact on the participants’ quality of life. While UI may not be considered a severe physical disease,[35] even mild to moderate impact can significantly affect various aspects of daily living, emotional well-being, and social interactions.[36,37] UI can lead to psychosocial distress, including feelings of embarrassment, anxiety, and depression.[38] The need to manage symptoms, such as frequent urination or leakage, can limit social activities, productivity, and overall sense of well-being.[39] The impact on the quality of life can also extend to sexual function and relationships.[40] It is important to note that the impact of UI on the quality of life varies depending on the type and severity of UI, as does the individual’s coping mechanisms and support systems. Some studies have shown that the frequency and severity of UI are negatively associated with quality of life scores.[41,42] In addition, factors such as age, education level, and access to healthcare can influence the extent to which UI affects an individual’s overall well-being.[35] In the same vein, social and religious factors can also play a role in the quality of life of incontinent women.[42]
This study’s limitations include its single-center design, which may limit generalizability. The reliance on self-reported UI and reasons for not seeking care may also be subject to biases of recall and social desirability. Future research should explore these barriers in more depth, using qualitative methods to understand the lived experiences of older adults with UI and the factors influencing their decisions to seek or not seek medical care. Intervention studies are also needed to evaluate the effectiveness of educational programs and outreach efforts to increase awareness, reduce stigma, and promote timely access to appropriate UI management.
Conclusion
The current study findings showed a 32.5% prevalence of UI in older adults attending outpatient clinics. Gender, employment status, obesity, specific comorbidities, family history, and certain conditions such as pelvic prolapse and BPH were significantly associated with UI, which underscores the complex interplay of factors that contribute to UI in this population. These associations highlight the multifactorial nature of UI, particularly in older populations, and underline the importance of comprehensive screening strategies. Furthermore, this study demonstrates that UI substantially affects quality of life, influences physical activity, emotional well-being, and social participation. Despite its impact, underreporting is prevalent because of stigma or lack of awareness.
This study calls for heightened awareness campaigns, improved clinical practices for early detection, and patient education to promote prompt management. In addition, healthcare providers should consider modifiable risk factors when planning interventions to help reduce the burden of UI at both the level of the individual and that of the healthcare system.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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