Proportion and Predictors of Urinary Incontinence among Perimenopausal women - A Community based Cross Sectional Study from Central Kerala

 

Anu Jacob Kachappillil¹, Anumol P.B², Anumol Saju², Aparna T.K², Ashily Alex²

¹Associate Professor, Department of Medical Surgical Nursing, M.O.S.C College of Nursing, Kolenchery, Aikaranad North, Kerala, India.

²II Year Post Basic BSc Nursing Students, M.O.S.C College of Nursing, Kolenchery,

Aikaranad North, Kerala, India.

 

ABSTRACT:

Background: Urinary incontinence (UI) is a significant psychosocial and health concern affecting perimenopausal women, often impacting their quality of life. Despite its prevalence, it remains underdiagnosed due to social stigma and lack of awareness. Objectives: To estimate the proportion of urinary incontinence and to identify its predictors among perimenopausal women. Methods: A cross-sectional analytical study was conducted among 133 perimenopausal women in a selected rural community of Ernakulam district. A quantitative research approach was adopted, and participants were selected using a convenience sampling technique. Data were collected using the Questionnaire for Urinary Incontinence Diagnosis (QUID) and a structured questionnaire to assess potential predictors. Statistical significance was considered at p<0.05. Results: Urinary incontinence was reported in 42.1% of the participants, with 30.1% experiencing stress urinary incontinence, 9.8% urge urinary incontinence, and 2.2% mixed urinary incontinence. Stress urinary incontinence was significantly associated with the total number of deliveries, number of vaginal deliveries, duration of labor, and history of episiotomy (p<0.05). Urge urinary incontinence showed significant associations with the number of deliveries, presence of chronic cough, asthma, constipation, and regular intake of medications (p < 0.05). Conclusion: Urinary incontinence is prevalent among perimenopausal women and has significant associations with obstetric and chronic health factors. Early identification and appropriate management are essential to reduce the psychosocial burden and enhance quality of life.

 

 

 

 

INTRODUCTION:

Urinary incontinence (UI), defined by the International Continence Society as the involuntary loss of urine that represents a social or hygienic problem, is a prevalent condition among women and may occur at any age.¹ The two major subtypes are stress urinary incontinence–leakage associated with physical exertion, coughing, or sneezing–and urgency urinary incontinence–leakage associated with a sudden, compelling urge to void. These subtypes often coexist, resulting in mixed incontinence.²

 

 

Although not life-threatening, UI significantly impacts physical, emotional, and social well-being, and is associated with reduced quality of life. Many women delay seeking treatment due to stigma or the misconception that UI is a natural part of aging.³ Perimenopause, marked by hormonal fluctuations, particularly a decline in estrogen, contributes to weakened pelvic floor muscles and thinning of urogenital tissues, increasing the risk of UI.⁴ This condition is especially common during pregnancy, childbirth, and menopause.⁵ Despite being a multifactorial health issue linked to age, BMI, education, and occupation, many women remain untreated due to cultural and psychological barriers.⁶ Therefore, raising awareness and offering effective, supportive care are essential roles for healthcare professionals in managing urinary incontinence among perimenopausal women.

 

OBJECTIVES:

1.     To estimate the proportion of urinary incontinence among perimenopausal women.

2.     To determine the predictors of urinary incontinence among perimenopausal women.

 

HYPOTHESIS:

H₀₁ There is no significant relationship between urinary incontinence and socio- demographic, obstetric and clinical variables of perimenopausal women.

 

MATERIALS AND METHODS:

Research Approach:

Quantitative research approach.

 

Research design:

Cross sectional analytical study design.

 

Research variables:

Proportion of urinary incontinence and Predictors of urinary incontinence (Socio demographic, obstetrical, clinical and health related variables of perimenopausal women).

Setting of the study:

The study was conducted in a selected rural community of Ernakulam district, Kerala.

 

Population:

Perimenopausal women in Ernakulam district.

 

Sample and sampling technique:

Sample:

Perimenopausal women residing in a selected rural community of Ernakulam district.

 

Sampling technique:

Non-Probability Convenience Sampling Technique.

Sample size:

The estimated sample size was 133.

 

Sample selection criteria:

Inclusion criteria:

Women in the age group of 40-50 years approaching menopause, having menstrual irregularities associated with menopausal transition.

 

Exclusion criteria:

·       Women who were bedridden due to any illness.

·       Women with cognitive impairment.

·       Women who underwent hysterectomy.

·       Women who underwent corrective surgeries for urinary incontinence.

 

Data collection tools:

Data were collected using a self-administered structured questionnaire to assess the predictors of urinary incontinence, which included sociodemographic, obstetric, clinical, and health-related factors of perimenopausal women, along with the standardized Questionnaire for Urinary Incontinence Diagnosis⁷ (QUID).

 

RESULTS:

Section A: Description of socio demographic, obstetric, clinical and health related factors of perimenopausal women.

Sl. No	Variables	Category	Frequency (f)	Percentage (%)
a. Socio Demographic Variables
1	Age (in years)	40–45	42	31.58
		46–50	91	68.42
2	Employment Status	Employed	35	26.32
		Unemployed	98	73.68
b. Obstetric Variables
3	Number of deliveries	None	0	0
		One	15	11.28
		Two	100	75.19
		More than two	18	13.53
4	Mode of delivery	Normal vaginal delivery	78	58.65
		LSCS	28	21.07
		Both vaginal delivery and LSCS	26	19.55
		Instrumental vaginal delivery	1	0.75
5	Number of vaginal deliveries	None	28	21.07
		One	20	15.02
		Two	71	53.38
		More than two	14	10.53
6	Prolonged duration in any delivery	Yes	52	39
		No	81	61
7	Surgery related to genitourinary system	Yes	6	4.52
		No	127	95.48
8	History of fibroid uterus /uterine mass	Yes	26	19.55
		No	107	80.45
9	Episiotomy in at least one delivery	Yes	105	78.94
		No	28	21.06
c. Clinical and health related variables
10	Hypertension	Yes	42	31.58
		No	91	68.42
11	Diabetes mellitus	Yes	34	25.56
		No	99	74.44
12	COPD	Yes	4	3.01
		No	129	96.99
13	Chronic cough	Yes	32	24.06
		No	101	75.94
14	Asthma	Yes	8	6.02
		No	125	93.98
15	Constipation	Yes	41	30.83
		No	92	69.17
16	Recurrent urinary tract infection	Yes	35	26.32
		No	98	73.68
17	Thyroid disorder	Yes	33	24.81
		No	100	75.19
18	Neurological diseases	Yes	3	2.26
		No	130	97.74
19	Urinary stone	Yes	1	0.75
		No	132	99.25
20	Tumor in the urinary tract	Yes	2	1.5
		No	131	98.5
21	Regular medications	Yes	85	63.91
		No	48	36.09
22	Exercise	Yes	69	51.88
		No	64	48.12
23	Alcohol use	Yes	0	0
		No	133	100

 

 

Section B: Proportion of urinary incontinence among perimenopausal women.            (n =133)

Sl No	Type of urinary incontinence	Frequency (f)	Percentage (%)
1	Stress urinary incontinence	40	30.1
2	Urge urinary incontinence	13	9.8
3	Mixed incontinence	3	2.2
4	No incontinence	77	57.9

 

Among the participants, 30.1% had stress urinary incontinence, 9.8% had urge incontinence, and 2.2% had mixed incontinence, while 57.9% reported no urinary incontinence. Stress incontinence was the most prevalent type.

 

Section C: Association of urinary incontinence with selected socio demographic, obstetric, clinical and health related variables of perimenopausal women:

The association between urinary incontinence and selected variables was analyzed using the Chi-square test and Fisher’s Exact Test, wherever appropriate. A statistically significant association was observed between stress urinary incontinence and obstetric variables such as the total number of deliveries, number of vaginal deliveries, duration of labor, and history of episiotomy (p<0.05). Urge urinary incontinence also showed significant associations with the number of deliveries, presence of chronic cough, asthma, constipation, and regular intake of medications (p< 0.05).

 

MAJOR FINDINGS:

The study results showed that 42.1% of perimenopausal women had urinary incontinence (30.1% stress, 9.8% urge, and 2.2% mixed). Stress incontinence was significantly associated with total number of deliveries, number of vaginal deliveries, prolonged delivery duration, and episiotomy (p<0.05). Urge incontinence was significantly associated with number of deliveries, chronic cough, asthma, constipation, and regular medication intake (p<0.05).

 

DISCUSSION:

The prevalence of urinary incontinence (UI) in this study was 42.1%. Of these, 30.1% had stress UI (SUI), 9.8% had urge UI (UUI), and 2.2% had mixed UI. This rate is notably higher than the 26.5% reported in a hospital‐based study from Kerala, which found 13.9% SUI, 5.4% UUI, and 7.2% mixed UI⁸. Another tertiary care center study reported a 34.5% UI prevalence, predominantly SUI⁹. Differences in study populations and settings likely account for these higher findings.

 

Our finding that stress urinary incontinence (SUI) is associated with higher parity, vaginal deliveries, prolonged labor, and episiotomy aligns with an Indian tertiary‐care study, which reported that multiparous women with a history of vaginal births and extended second‐stage labor had significantly increased SUI risk (p<0.05), and that episiotomy further exacerbated pelvic floor trauma leading to SUI¹. In terms of urge urinary incontinence (UUI), an Indian community‐based investigation found significant associations with chronic cough, asthma, constipation, and regular medication intake, suggesting that repeated intra‐abdominal straining and detrusor overactivity contribute to UUI development (p<0.05)¹⁰. Together, these studies underscore that both obstetric factors and comorbid conditions play a multifactorial role in urinary incontinence among Indian women.

 

CONCLUSION:

Perimenopausal women in this study exhibited a high urinary incontinence prevalence of 42.1%, with stress incontinence linked to higher parity, vaginal deliveries, prolonged labor, and episiotomy, and urge incontinence associated with multiparity, chronic cough, asthma, constipation, and regular medication use. These findings highlight the multifactorial etiology of urinary incontinence, driven by obstetric history and comorbid conditions. Routine pelvic floor assessment and targeted interventions–such as pelvic floor muscle training, optimized labor management, and management of chronic respiratory or gastrointestinal issues–should be integrated into perimenopausal care to reduce incontinence risk.

 

ACKNOWLEDGEMENT:

Here we extend our sincere thanks to all people who participated in the study.

 

CONFLICT OF INTEREST:

The author declares no conflict of interest in the study.

 

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Received on 31.05.2025         Revised on 17.06.2025 Accepted on 02.07.2025         Published on 13.08.2025 Available online from August 20, 2025 Asian J. Nursing Education and Research. 2025;15(3):171-174. DOI: 10.52711/2349-2996.2025.00035 ©A and V Publications All right reserved
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