Risk factors for urinary, fecal, or dual incontinence in the Nurses' Health Study

Obstet Gynecol. 2013 Sep;122(3):539-45. doi: 10.1097/AOG.0b013e31829efbff.


Objective: To estimate the prevalence of urinary incontinence, fecal incontinence, and dual incontinence in a large cohort of older women and compare risk factors across the three conditions.

Methods: These cross-sectional analyses used data from the Nurses' Health Study. The 2008 questionnaire, mailed to 96,480 surviving participants aged 62-87 years, included two separate items on the prevalence of urinary and fecal incontinence. A response of leakage at least once per month defined incontinence for both urine and stool. Dual incontinence was defined by responses at this frequency for both conditions. Using a polytomous logistic regression model, we assessed each risk factor for prevalence of urinary, fecal, and dual incontinence.

Results: The survey was completed by 64,396 women. Thirty-eight percent had urinary incontinence alone, 4% had fecal incontinence alone, and 7% had dual incontinence. Age older than 80 years compared with age younger than 70 years was associated most strongly with dual incontinence (odds ratio [OR] 2.49, 95% confidence interval [CI] 2.28-2.73) followed by depression (OR 2.28, 95% CI 2.13-2.43), neurologic disease (OR 1.84, 95% CI 1.65-2.07), functional limitations (OR 1.86, 95% CI 1.71-2.02), multiparity (OR 1.66, 95% CI 1.41-1.94), and heavier fetal birth weight (OR 1.24, 95% CI 1.10-1.41). Obesity was associated only with urinary incontinence (OR 1.99, 95% CI 1.90-2.08) and type 2 diabetes mellitus was a stronger risk factor for fecal than urinary incontinence (OR 1.43, 95% CI 1.28-1.59). Black race was associated with a reduced risk of all types of incontinence, especially dual incontinence (OR 0.30, 95% CI 0.21-0.44).

Conclusion: In this large cohort, dual incontinence was primarily associated with advanced age, decompensating medical conditions, depression, and multiparity.

Level of evidence: II.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Cross-Sectional Studies
  • Fecal Incontinence / epidemiology*
  • Female
  • Humans
  • Middle Aged
  • Risk Factors
  • United States / epidemiology
  • Urinary Incontinence / epidemiology*