Urinary Incontinence's Prevalence, Risk Factors, and Quality of Life Impact on Working Women in Saudi Arabia

Summary

Background:

This study aimed to investigate the prevalence and severity of Urinary incontinence (UI) among working women in Saudi Arabia (SA), identify the associated demographic, lifestyle, medical, and obstetric risk factors, and assess its effect on quality of life and work productivity. The UI is a common underreported condition that affects women's daily functioning and life quality, particularly in the workplace.

Methods:

During 2025, 390 working women in SA who were at least 18 years old and from various work sectors participated in a descriptive cross-sectional survey. Data were gathered using a validated, structured questionnaire; statistical analysis was carried out using SPSS version 27.

Results:

Urinary incontinence prevalence was 30.3%. Significant associations were found between UI and increased age (R² = 0.160) (p < 0.001), obesity (mean difference = 0.20, SE = 0.06, p = 0.002, 95% CI [0.05, 0.35]). Parity and a history of both vaginal and cesarean deliveries were closely associated with stress UI (mean difference = 1.238, SE = 0.401, p = 0.016). Life quality was undesirably affected in 14.4% of women with UI, and 46.3% experienced negative workplace impacts because of UI.

Conclusion:

In SA, UI is a common and complex disorder. To lessen its effects and promote the health and productivity of working women, it is crucial to implement targeted workplace initiatives, public health education, and better access to care.

Introduction

Urinary incontinence (UI) is the involuntary loss of urine and a common condition that can affect the quality of life and daily activities of women [1]. Stress urinary incontinence (SUI) is involuntary urine leakage that occurs when intra-abdominal pressure increases when coughing, sneezing, or lifting heavy objects [2]. Urgency urinary incontinence (UUI) is a sudden, intense urge to urinate followed by spontaneous loss of urine, commonly associated with overactive bladder symptoms [3]. Mixed urinary incontinence (MUI) is characterized by the occurrence of both stress and urgency UI in the same individual [1]. Urinary incontinence is a prevalent but often unreported medical condition that has a significant impact on women's social, psychological, and physical well-being [4]. Aging of the population, changes in lifestyle, and more significant changes in culture, including how women's roles and responsibilities have changed, are all playing a part in its increasing global burden [5].

Urinary incontinence is a major public health concern because it leads to social disengagement, low self-esteem, psychological distress, and a poor quality of life if left unmanaged [1]. Due to social constraints and workplace pressures, working women may face difficulties in managing UI [6]. Limited access to bathrooms, inflexible work schedules, insufficient privacy, and concerns of being judged by co-workers may limit women's ability to handle their symptoms effectively or seek timely medical care [7]. Many women hide their symptoms, which can adversely affect concentration, work performance, and psychological well-being. These work-related issues highlight the importance of raising awareness of UI, implementing screening programs, and providing support through workplace and occupational health regulations [8].

Urinary incontinence is often regarded as a private or sensitive issue across many cultures. It is frequently perceived not as a treatable medical condition, but rather as an inevitable consequence of aging or childbirth [9]. Open discussion of urinary health is further restricted in conservative communities like Saudi Arabia due to cultural traditions that emphasize seclusion and modesty, especially in mixed-gender settings. As a result, many women delay seeking medical care, hide their symptoms, or rely on self-care strategies, which leads to underreporting and a growing disparity between the actual burden of UI and healthcare utilization [10]. These stigma-related constraints not only impede early diagnosis and suitable care but also exacerbate the psychological and social impact of the condition, emphasizing the importance of culturally sensitive awareness and education initiatives [11]. Moreover, physicians may not routinely screen for UI [12].

Globally, 25% to 45% women suffer from UI. Stress urinary incontinence is the most common type, followed by mixed and urgency incontinence [3]. According to national and regional studies, the prevalence of UI among Saudi women in their adult years varies between 30% and 47.5%, indicating a considerable prevalence of the condition. There is a significant disease burden among some subgroups, such as the elderly [13]. A survey conducted among women aged 18 to 70 years living in the western region reported a UI prevalence of 44.2%, with the urge type being the most common. According to Thabet et al. (2023) [14], 155 (15.4%) women reported SUI, 257 (25.6%) women reported urgency UI, and 102 (10.15%) women had MUI.

Given UI's high occurrence and effect on women's quality of life and work, targeted public health actions are required. Research on working women can guide awareness campaigns and workplace policies. Better healthcare access and support focused on working women is critical for prompt diagnosis and better outcomes [15]. Using epidemiological data, this study aims to assess the prevalence of UI among working women in Saudi Arabia, and to identify its types, risk factors, and effect on quality of life.

Methodology

A descriptive cross-sectional study was performed with working women across Saudi Arabia from September 2025 to January 2026. Participants were recruited from a range of work environments. A systematic random sampling approach was used to recruit working women from selected workplaces in Saudi Arabia. Eligible participants were women currently employed (full-time or part-time) who had been in their present job for at least 6 months prior to participation. The sampling frame comprised a comprehensive list of eligible workplaces—including hospitals, healthcare centers, schools, universities, corporate offices, and government institutions—provided by the local labor office. From this list, workplaces were randomly selected to ensure a broad representation of different work sectors. Within each selected workplace, eligible female employees aged 18–54 were invited to participate. Recruitment was conducted through workplace announcements, electronic invitations, and informational sessions coordinated with human resources departments. To minimize selection bias, every nth eligible woman was approached according to a predetermined interval based on workforce size at each site.

A total of 580 women were approached, of whom 390 consented and completed the survey, yielding a response rate of 67.2%. This rate aligns with or exceeds typical response rates in similar occupational health studies.

Data were gathered using a validated questionnaire adapted from approved instruments, including the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). The instrument covered UI awareness, attitudes, medical and obstetric history, lifestyle factors, and quality of life impact. Expert evaluation and pilot testing confirmed both content and face validity. Reliability was confirmed (Cronbach's alpha for main domains = 0.82–0.90).

To assess severity, participants were asked two key questions regarding urinary incontinence: (i) “Over the past month, how often have you experienced an involuntary loss of urine when you had a sudden urge to urinate?” and (ii) “Over the past month, how often have you experienced an involuntary loss of urine when you cough, sneeze, laugh, or change position?” Responses were recorded using a standardized scale: 0 = Not at all, 1 = Less than 1 time in 5, 2 = Less than half the time, 3 = About half the time, 4 = More than half the time, and 5 = Almost always. This response scale was explicitly described and applied to ensure consistent assessment of urinary incontinence severity. The impact of urinary incontinence on daily life and workplace functioning was evaluated through direct questions. For daily life, participants indicated the effect of urinary incontinence on their overall well-being, with response options ranging from “Very pleased” to “Terrible.” For workplace effects, participants were asked whether they felt embarrassed about urinary incontinence at work and whether it affected their work performance, with “Yes” or “No” response options. This approach provided a clear and standardized evaluation of the personal, psychological, and occupational effects of urinary incontinence.

The research was approved ethically by the King Khalid University Research Ethics Committee (KKU-40/46). Written informed consent was obtained from all participants. Anonymity and data confidentiality were rigorously upheld.

Statistical analysis

Coded data were analyzed using SPSS version 27. Descriptive statistics like frequencies, percentages, means, and standard deviations summarize participant characteristics and research variables. Inferential analyses included Chi-square tests, t-tests, ANOVA and binary logistic to determine associations; p < 0.05 is the threshold for statistical significance with 95% confidence interval.

Results

A total of 390 working women participated in this study. The majority (85.3%) were under 40 years of age, with a mean age of 30.8 years (SD ± 7.1; range: 19–54), and a median age of 29.0 years (interquartile range (IQR) = 25.0–35.0). Most held a university degree (73.8%) or a postgraduate degree (17.9%). Body mass index (BMI) analysis showed that 42.6% of the subjects had a normal BMI, 32.8% were overweight, and 22.3% were classified as obese. The mean BMI was 26.5 kg/m² (SD ± 4.9) and the median was 25.5 kg/m² (IQR = 23.2–29.4) (Table 1). The overall prevalence of UI within the past 3-month period was 30.3% (n = 118). Among these, 20.5% (80) reported having MUI. Stress UI was reported as occurring “almost always” by 13 (3.3%) of the participants, while urgency UI at the same severity was reported by 9 (2.3%) women. The detailed frequency distribution of UI types is presented in Table 2.

Table 1.

Distribution of the studied cases according to demographic data (N = 390).

Variables	n	(%)
Age group
<30	201	(51.5)
30–39	132	(33.8)
40–49	50	(12.8)
>49	7	(1.8)
Age (years)
Min. – Max.	19.0 – 54.0
Mean ± SD.	30.82 ± 7.09
Median (IQR)	29.0 (25.0 – 35.0)
Education level
Primary	1	(0.3)
Intermediate	14	(3.6)
Secondary	17	(4.4)
University Graduate	288	(73.8)
Postgraduate	70	(17.9)
Height (cm)
Min. – Max.	142.0 – 182.0
Mean ± SD.	162.82 ± 6.40
Median (IQR)	163.0 (159.0 – 167.0)
Weight (kg)
Min. – Max.	38.0 – 115.0
Mean ± SD.	70.31 ± 13.81
Median (IQR)	69.50 (60.0 – 80.0)
BMI group
Underweight (<18.5)	9	(2.3)
Normal (18.5–24.9)	166	(42.6)
Overweight (25–29.9)	128	(32.8)
Obese (≥30)	87	(22.3)
BMI (kg/m2)
Min. – Max.	17.16 – 46.07
Mean ± SD.	26.50 ± 4.91
Median (IQR)	25.54 (23.23 – 29.38)

IQR: Inter quartile range, SD: Standard deviation, BMI: body mass index, IQR: Interquartile range.

Table 2.

Distribution of the studied cases according to Section 1: UI assessment (N = 390).

Section 1: Urinary Incontinence (UI) Assessment	n	(%)
Have you experienced any involuntary urine leakage (even a few drops) in the past three months?
Yes	118	30.3
No	272	69.7
Women who suffer from both types of urinary incontinence
Yes	80	20.5
No	310	79.5
1. Urinary Stress Incontinence
Over the past month, how often have you experienced an involuntary loss of urine when you cough, sneeze, laugh, or change position?
Not at all	282	72.3
Less than 1 time in 5	58	14.9
Less than ½ the time	18	4.6
About ½ the time	13	3.3
More than ½ the time	6	1.5
Almost always	13	3.3
Minimum – Maximum	0.0 – 5.0
Mean ± SD	0.57 ± 1.18
Median (IQR)	0.0 (0.0 – 0.0)
2. Urinary Urgency Incontinence
Over the past month, how often have you experienced an involuntary loss of urine when you had a sudden urge to urinate?
Not at all	300	76.9
Less than 1 time in 5	43	11.0
Less than ½ the time	21	5.4
About ½ the time	13	3.3
More than ½ the time	4	1.0
Almost always	9	2.3
Minimum – Maximum	0.0 – 5.0
Mean ± SD	0.47 ± 1.07
Median (IQR)	0.0 (0.0 – 0.0)

IQR: Inter quartile range, SD: Standard deviation.

The UI was more common and more severe in older women and those with a higher BMI (p < 0.001 for both). Assessment of lifestyle and risk factors in women with UI (n = 118) highlighted a mean daily fluid consumption of 1883.5 mL (SD ± 768.2, median 2000 mL, IQR 1400–2250), with water being the main beverage for 86.4% of respondents. Regarding the different kinds of fluids consumed, no significant associations were found with the presence or severity of SUI. Smoking was an uncommon habit, with only 3 women (2.5%) reporting current or former use. Notably, 35 (29.7%) women indicated that weight gain worsened their UI. Regarding obstetric history, among the women with UI (n – 118), 80.5% were parous (mean parity 2.5, SD ± 1.0, range 1–6), and more than half (51.6%) had all deliveries by cesarean section. Women who had given birth were significantly more likely to have MUI (p = 0.022).

A binary logistic regression was conducted to assess predictors of urinary incontinence (UI) among 390 working women. The final model included age group and BMI group as independent variables. Both age group (OR = 0.47, 95% CI: 0.35–0.64, p < 0.001) and BMI group (OR = 0.68, 95% CI: 0.51–0.91, p = 0.010) were significant predictors of UI. The model explained approximately 10–15% of the variance (Nagelkerke R² = 0.147) and correctly classified 70% of cases. Older age and higher BMI were associated with increased odds of UI.

Statistical Analysis revealed a substantial positive association between parity and SUI, whereby women with higher parity typically had a severe form of SUI. In contrast, the number of children was not significantly related to UUI. Women who had both vaginal and cesarean deliveries experienced significantly higher SUI than those with only cesarean deliveries; however, the type of delivery showed no significant correlation with UUI. Multivariate analysis found that the mode of delivery (vaginal, cesarean, or mixed) does not have a statistically significant overall effect on the degree of incontinence (Wilks’ Lambda, p = 0.141 for any incontinence; p = 0.999 for mixed incontinence). However, there is a trend toward higher incontinence among women with both vaginal and cesarean deliveries. Adjusted pairwise comparisons revealed that women with both types of deliveries report a significantly higher degree of any urinary incontinence compared to women who have not given birth (mean difference = 1.238, standard error = 0.401, p = 0.016, 95% CI: 0.159 to 2.317).

From the women with UI, 34.7% reported chronic constipation and 28% reported at least one chronic disease. The most prevalent comorbid illnesses were obesity (11%), diabetes (7.6%), and hypertension (6.8%). Additionally, 7.6% of women with UI were menopausal or post-menopausal, and 14.4% reported regular medication use. Conversely, there was no significant association between comorbidities and the severity of UI (Table 3).

Table 3.

Distribution of the studied cases according to risk factors (N = 118).

Section 4: Past Medical & Obstetric History	n	%
1. Have you given birth?
Yes	95	80.5
No	23	19.5
Number of children (n = 95)
Min. – Max.	1.0 – 6.0
Mean ± SD.	2.47 ± 1.02
Median (IQR)	2.0 (2.0 – 3.0)
Type of delivery: (n = 95)
All vaginal deliveries	17	17.9
All CS	49	51.6
Some vaginal and some cesarean deliveries	29	30.5
2. Do you have chronic constipation?
Yes	41	34.7
No	77	65.3
3. If you have gained weight recently, have your urinary incontinence symptoms worsened?
Yes	35	29.7
No	83	70.3
4. Have you ever smoked, or are you currently smoking?
Never	115	97.5
No (I Quit)	1	0.8
Yes	2	1.7
1. Are you currently menopausal or post-menopausal?
Yes	9	7.6
No	109	92.4
2. Do you have any medical conditions? (Select all that apply)
None	85	72.0
Diabetes	9	7.6
Hypertension	8	6.8
Thyroid disease	4	3.4
Cardiac disease	2	1.7
Obesity	13	11.0
Other	10	8.5
3. Do you take any medications regularly?
Yes	17	14.4
No	101	85.6

IQR: Inter quartile range, SD: Standard deviation.

Embarrassment and workplace stigma were prominent, with 59.3% feeling ashamed at the workplace and 33.1% reporting detrimental effects on job performance. Quality of life assessment among females with UI revealed that while most participants reported being pleased (30.5%) or mostly satisfied (26.3%) with their quality of life, a significant percentage described their quality of life as unhappy (12.7%) terrible (1.7%) and 22.9% reported that they have mixed feelings. More working women with MUI reported being “unhappy” (18.8%) or feeling “terrible” (2.5%), while none in those with one type of UI reported these negative feelings (p = 0.013) indicates a statistically significant association between suffering from MUI and lower quality of life Fig. 1. Among the 80 women with MUI, 60% were affected more by SUI than by UUI.

Fig. 1.

The effect of mixed urinary incontinence on quality of life (n = 118). P = 0.013^* (Statistically significant at p ≤ 0.05).

Discussion

This study offers significant insights into the impact of UI on quality of life, its prevalence, and associated risk factors, specifically among working women in Saudi Arabia, a demographic that is rapidly expanding and taking an increasingly vital role in the workforce. Our research fills an important gap in the literature by focusing on this expanding group. The results show a significant prevalence of UI (30.3%) in this population, with 20.5% of working women reporting MUI. These figures are consistent with other studies conducted in SA and other countries, which found that the prevalence of UI in adult women ranges from 25% to 47% [3,13,14]. The high prevalence of MUI also corresponds with recent regional data, suggesting a substantial burden of combined symptoms in productive-age women [15].

The results show strong associations between UI and both increasing age and higher BMI, with the prevalence and severity of UI rising among older and overweight/obese women (p < 0.001). This supports a robust body of evidence delineating age and obesity as principal risk factors for UI, likely due to age-related changes in pelvic floor support and the effect of excess weight on intra-abdominal pressure [1,3]. Vaginal delivery has historically been highlighted in the literature as a risk factor for UI [13,14]. Our study highlights that a significant percentage of women with UI had a history of childbirth (80.5%), and parity was substantially associated with an elevated incidence of MUI (p = 0.022). Moreover, the degree of SUI and parity were found to be significantly positively correlated, suggesting that women with greater parity typically have a severe form of SUI, but parity was not associated with UUI. These findings are aligned with Zhou et al. [19] meta-analysis, which found that while parity significantly increased the risk and severity of SUI (odds ratio ≈ 2.32), there was no significant association between parity and UUI [19].

Furthermore, women who had both vaginal and cesarean deliveries reported considerably higher levels of SUI than women who had only cesarean deliveries. A 2025 longitudinal analysis using data from the SWAN (Study of Women's Health Across the Nation) cohort examined middle-aged women who had undergone different delivery modes, including vaginal, cesarean, or a combination of both. It found that women with a combination of cesarean and vaginal deliveries were significantly more likely to experience MUI during midlife [20]. In general, these results indicate that parity and mixed modes of delivery are significantly associated with SUI. This indicates that cumulative obstetric history is still a major determinant, and cesarean birth may not provide complete protection against UIs.

Diabetes and hypertension were the most commonly reported comorbidities among the UI group. Nonetheless, multivariate analysis did not reveal a significant correlation between UI severity and specific comorbidities, fluid intake, or smoking. This aligns with some studies but differs from others that have linked certain chronic conditions or lifestyle factors to UI risk [3,21]. The importance of weight control in prevention and symptom control is further supported by the fact that 29.7% of working women in this study reported that weight gain made their UI worse. A Danish National Birth study found that gaining more than 5 BMI units across the childbearing years was associated with a 41% increase in the probability of experiencing any UI, with MUI showing the greatest increase, up to 68% compared to women whose weight remained stable [22]. This cohort also had a high prevalence of chronic constipation (34.7%), which supports research showing that this factor contributes to UI and pelvic floor dysfunction [13,21].

A considerable minority (14.4%) rated their experience as terrible or unhappy, despite the fact that the majority of working women with UI said that their quality of life was adequate. This underscores the psychosocial and occupational burden related to UI, which is well-documented in the literature [1]. The association between UI severity and negative impact on work was statistically significant emphasizing the need for workplace awareness and support for affected women.

In this study, among women with MUI, the majority (60%) reported being more bothered by of SUI than UUI. This aligns with previous research indicating that SUI often constitutes the predominant concern for women with MUI, potentially due to the unpredictable nature and social implications of leakage during physical activities [23].

Several studies have documented the negative impact of UI, particularly SUI, on women's work life and psychosocial well-being. For instance, Port et al. [7] reported that UI, especially when severe, is associated with work absenteeism, decreased concentration, and social withdrawal [7]. Similarly, Taastrøm et al. (2024) [22] found that women with UI were more likely to report work-related limitations and embarrassment, reinforcing the link between incontinence and occupational functioning [22].

The prevalence and burden of UI reported in this study align with findings from other national and regional surveys, affirming that UI continues to be under-recognized and inadequately treated among working women, despite enhanced awareness initiatives and improved healthcare access in SA [10,15]. The findings support earlier recommendations for certain therapies, such as pelvic floor training, weight control, and routine screening in occupational health settings [23,24].

Study limitations

This study has many strengths, including the use of validated data collection tools and a representative and thorough sampling method. However, it has some limitations, such as being cross-sectional, which makes it difficult to determine causality, and a reliance on self-reported data, which could cause reporting or recall bias. The final sample was predominantly younger and highly educated, reflecting the demographics of the participating workplaces. This may limit the generalizability of findings to all women.

In conclusion, urinary incontinence is a prevalent and significant problem among working women living in SA. Age, BMI, and obstetric history were identified as major risk factors in this study. These results emphasize the need for focused preventive initiatives, enhanced workplace support, and easily accessible management pathways. The effectiveness of workplace-based interventions and longitudinal monitoring should be the focus of future studies in order to reduce the burden of UI in this important cohort. Urinary incontinence could be detected and managed more effectively if healthcare providers’ awareness and performance were improved.

Future studies should focus on identifying and addressing gaps in healthcare providers’ knowledge and practices regarding UI. Further research is recommended to explore effective strategies for integrating UI screening into primary health care settings and routine clinical practice. This will help improve early detection, management, and overall patient outcomes related to UI.

Disclaimer

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Disclosure

The authors confirm that AI tools were not utilized specifically in writing the article, creating images or data analysis.

The authors have no conflict of interests and the work was not supported or funded by any drug company.

Acknowledgments

The authors extend their appreciation to the Deanship of Research and Graduate Studies at King Khalid University, KSA, for funding this work through General Research Project under grant number GRP/40/46, academic year 1446.

Disclosure

This study was funded by the Deanship of Research and Graduate Studies at King Khalid University, KSA through General Research Project under grant number GRP/40/46, academic year 1446.