Original Paper
Urologia Urol Int 2008;80:355–361
Internationalis DOI: 10.1159/000132691
Prevalence of Urinary Incontinence in
the 12-Month Postpartum Period and
Related Risk Factors in Turkey
Emel Ege Belgin Akın Kamile Altuntuğ Saniye Benli Ayten Ariöz
School of Health Sciences, Nursing Department, Selçuk University, Konya, Turkey
Key Words
Postpartum ⴢ Urinary incontinence ⴢ Prevalence ⴢ
Risk factors ⴢ Adverse health effects
Abstract
Aim: The purpose of this study is to determine the preva-
lence of urinary incontinence in the 12-month postpartum
period and the risk factors related to this condition. Meth-
ods: The research is a cross-sectional study of 1,749 first-year
postpartum women living in the metropolis of Konya and
presenting at seven city health centers. The statistical meth-
ods used were the ␹2, the Student’s t test and logistic regres-
sion analysis. Results: Of the women in the study who were
in their 12-month postpartum periods, 19.5% were experi-
encing varying degrees of urinary incontinence. While 42.2%
of the women suffered from stress incontinence, 10.3% had
urge incontinence, 47.5% complained of a mixed type of uri-
nary incontinence, 7.3% reported leakage of urine during
sexual intercourse and 14.4% reported the need to use pro-
tective pads. It was found that 12.3% of the women were
performing pelvic floor muscle exercises and only 15.2% had
consulted their doctors about urinary incontinence. Conclu-
sion: It was seen that urinary incontinence is a serious health
problem in the postpartum period, that it disrupts a wom-
an’s daily activities, affects her sex life but that despite this,
women do not receive needed medical assistance.
Copyright © 2008 S. Karger AG, Basel
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Received: March 21, 2007
Accepted after revision: June 19, 2007
Introduction
Urinary incontinence was described by the Interna-
tional Continence Society in 2002 as ‘the involuntary
passage of urine for any reason’ [1]. Urinary incontinence
is a chronic health problem that is more prevalent in
women, particularly at older ages [2]. The chronic condi-
tion adversely affects social, physical, professional, intra-
familial and individual activities while diminishing the
quality of life [3, 4]. Women frequently experience this
condition, particularly during pregnancy and in the post-
partum period [5, 6].
30–60% of women are affected by urinary inconti-
nence during pregnancy. The type of urinary inconti-
nence manifesting itself during pregnancy is believed to
be a result of the enlarging of the uterus and consequent
pressure on the bladder, increase in hormone levels and
glomerular filtration rate, change in the urethravesical
angle or due to other natural changes experienced in
pregnancy [7, 8]. Incontinence generally improves within
3 months after delivery but this period can be longer in
some women. Studies have reported that the prevalence
of postpartum urinary incontinence is 30–50% [9, 10].
Delivery, in fact, is one of the most important risk factors
identified with urinary incontinence [8, 11, 12]. In addi-
tion, assisted vaginal deliveries [13–15], episiotomy [16],
spontaneous perineal tears [17] and a high number of
pregnancies have all been suggested as factors that in-
crease the risk of urinary incontinence [18, 19].
Emel Ege
Selçuk Üniversitesi Konya Saglik Yüksekokulu
Konya (Turkey)
Tel. +90 332 2233 542, Fax +90 332 2416 211
E-Mail emelege@hotmail.com
 Urinary incontinence is an important health problem
with economic and emotional outcomes that restrict so-
cial life but one that is generally kept secret. Women per-
ceive the problem to be a natural result of fertility and an
inevitable and incorrigible outcome of aging [20, 21]. This
perception leads to a reluctance to seek help and to an
unresolved prolonging of the condition, with the result
that unwelcome symptoms are widely experienced [8,
22]. Early diagnosis of urinary incontinence and securing
effective guidance for the condition will contribute great-
ly to improving female health. Nurses and midwives who
play a role in such early diagnosis and provide protective
services occupy a critical position in this respect. Al-
though there have been many studies conducted in older
age groups in connection with urinary incontinence in
Turkey [23–26], no research has been encountered where
urinary incontinence has been evaluated during preg-
nancy or in the postpartum stage. It is our belief that the
present study will serve an important purpose in identi-
fying the situation in Turkey in this context and that the
information gathered will be useful in establishing how
widespread the condition is and what the related risk fac-
tors are.
The purpose of the study is to determine the preva-
lence of urinary incontinence in postpartum women in
the first 12 months, establishing at the same time the pos-
sible risk factors that give way to the condition.
Materials and Methods
This is a cross-sectional study conducted at a total of 7 health
centers (Nos. 10 and 25 located in the Meram, Nos. 1 and 11 in the
Selçuklu and Nos. 3, 24, 15 in the Karatay districts) in the Konya
metropolitan area.
The Study Group
The required permission was obtained from the Provincial
Health Directorate and from the administrators of the various
health centers prior to the study. With the help of the nurses and
midwives working at the health centers, who made baby monitor-
ing cards available to the researchers, 2,200 women residing in the
area of Konya who were in their 12-month postpartum period
were recorded as the study population. No sampling was taken;
the population comprised the entire scope of the study. 451 wom-
en were excluded from the study as they either did not wish to
participate or were not at home during the visits. The study group
represented non-pregnant women who had delivered within the
last year and had voluntarily accepted participating in the re-
search. There were 302 women from Health Center No. 1, 212
women from No. 3, 147 from No. 10, 298 from No. 11, 175 from
No. 15, 310 from No. 24 and 305 from No. 25; a total of 1,749
women, all in their 12-month postpartum period.
356 Urol Int 2008;80:355–361
Instruments
The researchers used a questionnaire prepared through guid-
ance provided by the literature on data collection [6–16]. The
questionnaire used for data collection contained 33 questions that
evaluated the participating women’s sociodemographic, obstetric
and urinary incontinence characteristics. Socio-demographic
characteristics comprised age, monthly income, length of mar-
riage, BMI, woman’s occupation, family type, smoking status, lev-
el of education; obstetric characteristics comprised information
on the length of the postpartum period, number of pregnancies
experienced, number of deliveries, number of children, baby’s
birth weight, length of breastfeeding period, patient’s urinary
complaints, normal delivery, planned cesarean, vacuum delivery,
episiotomy, assistance in the second stage of delivery and sponta-
neous perineal tears; characteristics related to urinary inconti-
nence included data on urinary incontinence experienced before
and during pregnancy and after delivery, type of urinary incon-
tinence experienced, frequency and amount of urine leakage, re-
stricted activities due to urinary incontinence, effects of urinary
incontinence on sexual life, leakage of urine during sexual inter-
course, obtaining information about pelvic floor muscle exercis-
es, performing pelvic floor muscle exercises, and seeking medical
care because of urinary incontinence. Data were gathered in the
form of closed questions.
Data Collection
Data was collected by 10 trained 4th-year students from the
Midwifery and Nursing Department of the School of Health over
the period May 1–30, 2006 by means of face-to-face interviews
during home visits.
Data Analysis
An SPSS 10.0 program was used in the evaluation of data; in-
ferential assessments were made in addition to evaluation of de-
scriptive statistics. Data analysis was carried out using mean and
percentage calculations, the Student’s t test, ␹2 testing and meth-
ods of logistic regression analysis.
Results
It was established that the mean age of the women tak-
ing part in the study was 26.8 8 5.1 years, that the aver-
age number of years married was 6.7 8 4.9, the average
number of pregnancies experienced was 2.3 8 1.4, and
the number of deliveries was 2.1 8 1.1.
The prevalence of urinary incontinence in the women
participating in the study and the distribution of their
characteristics is shown in table 1. It was found that 12.7%
of the women suffered from urinary incontinence prior
to pregnancy, 42.0% experienced it during pregnancy
and that 19.5% complained of the condition during the
postpartum period (fig. 1). In the postpartum period, it
was seen that 42.2% of the women with urinary inconti-
nence had stress incontinence, 10.3% suffered from urge
incontinence and 47.5% had a mixed type of urinary in-
Ege/Akın/Altuntuğ/Benli/Ariöz
Table 1. Prevalence of urinary incontinence and distribution of
characteristics 100 Yes No
90 87.3
n %
80.5
80
Prevalence of urinary incontinence (n = 1,749)
Urinary incontinence in pre-pregnancy 70

Incontinence (%)
Yes 222 12.7 58.0
60
No 1,527 87.3
Urinary incontinence during pregnancy 50
42.0
Yes 735 42.0
40
No 1,014 58.0
Postpartum urinary incontinence 30
Yes 341 19.5 19.5
No 1,408 80.5 20
12.7
Characteristics of postpartum urinary incontinence (n = 341)1 10
Types of incontinence 0
Mixed 162 47.5 Prepregnancy Pregnancy Postpartum
Stress 144 42.2
Urge 35 10.3
Frequency of urine leakage Fig. 1. Prevalence rates of urinary incontinence in women.
Less than once a month (rarely) 162 47.5
More than twice a month (moderate) 130 38.1
Necessitating use of protective pads (serious) 49 14.4
Amount of urine leakage
One or two drops 195 57.2
Moistening of pad or lingerie 103 30.2 their activities were restricted because of incontinence,
Wetting of pad or lingerie 43 12.6 7.6% said that their sexual lives had been affected and
Restricted activities due to urine leakage 7.3% complained that they experienced urine leakage
(leaving the house, social activities, etc.) during sexual intercourse. Additionally, 14.7% of the
Yes 47 13.8
No 294 86.2 women said that they knew about pelvic floor muscle ex-
Effect of urinary incontinence on sexual life ercises but only 12.3% said they practiced these exercises
Yes 26 7.6 and only another small percentage of 15.2% said that they
No 315 92.4 had consulted the doctor because of this condition (ta-
Urine leakage during sexual intercourse ble 1).
Yes 25 7.3
No 316 92.7 The relationship between urinary incontinence and
Obtaining information about pelvic floor muscle exercises sociodemographic characteristics and related risk factors
Yes 50 14.7 is shown in table 2 as the results of a logistic regression
No 291 85.3 analysis. While a correlation was found between urinary
Performing pelvic floor muscle exercises incontinence and age (t = 7.153, p = 0.000), monthly in-
Yes 42 12.3
No 299 87.7
come (t = –3.758, p = 0.000), length of marriage (t = 7.413,
Seeking medical p = 0.000), family type (␹2 = 5.496, p = 0.019), and educa-
Yes 52 15.2 tional level (␹2 = 9.386, p = 0.002), no correlation was seen
No 289 84.8 between incontinence and BMI, occupation and smok-
1 Only women experiencing postpartum urinary incontinence
ing.
were assessed. According to the results of the logistic regression anal-
ysis, younger ages (OR: 0.950, 95% CI: 0.911–0.991) and
lower monthly incomes (OR: 1.001, 95% CI: 1.000–1.001)
were found to constitute risks in terms of urinary incon-
continence. A look into the frequency of urine leakage tinence. It was also established that among the women
showed that 47.5% experienced this sensation once a participating in the study, the length of the woman’s mar-
month or less (rare) and 14.4% complained of the condi- riage (years), family type, BMI, occupation, smoking
tion enough to require the continuous use of a protective habits and educational levels did not appear to be risk fac-
pad (serious). A proportion of 13.8% of the women said tors for urinary incontinence (p 1 0.05) (table 2).

UI in the 12-Month Postpartum Period Urol Int 2008;80:355–361 357

and Related Risk Factors
Table 2. Relationship between urinary incontinence and sociodemographic characteristics and a regression analysis of risk factors

Sociodemographic Urinary incontinence (x 8 SD) Significance OR (95% CI)

characteristics test
yes no

Age 28.686.0 26.484.8 t = 7.153, p = 0.000a 0.950 (0.911–0.991), p = 0.018c

Monthly income 559.78318.0 671.08523.7 t = –3.758, p = 0.000a 1.001 (1.000–1.001), p = 0.000a
Length of marriage, years 8.585.7 6.384.5 t = 7.413, p = 0.000a 0.970 (0.921–1.021), p = 0.240
BMI 25.584.4 26.0863.6 t = –0.152, p = 0.879 1.000 (0.997–1.004), p = 0.889
Occupation
Working 14 (14.9%) 80 (85.1%) ␹2 = 1.341, p = 0.247 1.721 (0.809–3.663), p = 0.159
Not working 327 (19.8%) 1,328 (80.2%)
Family type
Nuclear family 257 (20.9%) 970 (79.1%) ␹2 = 5.496, p = 0.019c 0.903 (0.672–1.214), p = 0.499
Extended family 84 (16.1%) 438 (83.9%)
Smoking
Yes 47 (20.5%) 182 (79.5%) ␹2 = 0.177, p = 0.674 0.974 (0.675–1.404), p = 0.886
No 294 (19.3%) 1,226 (80.7%)
Educational level
Elementary school 263 (21.4%) 967 (78.6%) ␹2 = 9.386, p = 0.002b 1.371 (0.905–2.076), p = 0.136
Middle school and above 78 (15.0%) 441 (85.0%)
a p < 0.0001; b p < 0.001; c p < 0.01.

The relationship between urinary incontinence and Discussion

obstetric characteristics as well as the logistic regression
analysis conducted for risk factors is presented in table 3.
It was found that the number of pregnancies (t = 6.425,
p = 0.000), number of deliveries (t = 7.091, p = 0.000),
number of children (t = 7.151, p = 0.000) and urinary in-
fection complaints (␹2 = 78.700, p = 0.000) were related
to urinary incontinence but that there was no correlation
between urinary incontinence and normal delivery,
planned cesarean, vacuum delivery, episiotomy, assis-
tance in the second stage of delivery, spontaneous peri-
neal tears, length of postpartum period, baby’s birth
weight or length of breastfeeding period. Logistic regres-
sion analysis carried out to study the relationship be-
tween incontinence experienced by the women in the re-
search and their obstetric characteristics showed that
women who complained of urinary infection (OR = 2.967,
95% CI: 2.322–3.791) and who had had heavier babies at
birth (OR = 1.000, 95% CI: 1.000–1.001) were at higher
risk of developing urinary incontinence. It was estab-
lished that spontaneous tears, length of postpartum pe-
riod, number of pregnancies, number of deliveries, num-
ber of children, length of breastfeeding period, normal
delivery, planned cesarean, vacuum delivery, episioto-
mies and assistance in the second stage of the delivery did
not constitute risks in terms of urinary incontinence (p 1
0.05) (table 3).
This study was conducted for the purpose of establish-
ing the prevalence of postpartum urinary incontinence
and the risk factors involved. The study results showed
that while 42% of women complained of urinary incon-
tinence during their pregnancies, only 19.5% of women
in their first year postpartum period complained of the
condition. Chaliha et al. [8] reported a prevalence of
43.7% in incontinence during pregnancy and of 14.6% in
the postpartum period, while Dolan et al. [27] indicated
a 35.6% prevalence during pregnancy and 13% preva-
lence in the third month after delivery. Bugg et al. [22]
found that the prevalence of urinary incontinence in pri-
mipara in their 10th month postpartum is 34.2%. Burgio
et al. [12], however, report a prevalence of 13.25% in the
12th month postpartum, while Farrell et al. [28] found
this percentage to be 26% in the 6th month postpartum.
It can be seen that the prevalence of urinary incontinence
during pregnancy and during the postpartum period is
considerably high, a finding also supported by the results
of the present study.
It was established in the study that 42.2% of women
complain of stress incontinence, 10.3% of urge inconti-
nence and 47.5% from a mixed type of urinary inconti-
nence. While it was found that a proportion of 14.4%
complain of frequent urine leakage necessitating the con-

358 Urol Int 2008;80:355–361 Ege/Akın/Altuntuğ/Benli/Ariöz

Table 3. Relationship between urinary incontinence and obstetric characteristics and a logistic regression analysis of risk factors

Obstetric characteristics Urinary incontinence (x 8 SD) Significance OR (95% CI)

test
yes no

Postpartum period 7.183.3 7.283.3 t = –0.425, p = 0.671 1.012 (0.942–1.086), p = 0.751

Number of pregnancies 2.881.5 2.281.3 t = 6.425, p = 0.000a 1.058 (0.828–1.271), p = 0.543
Number of deliveries 2.481.2 2.081.1 t = 7.091, p = 0.000a 0.933 (0.626–1.388), p = 0.731
Number of children 2.481.1 1.981.0 t = 7.151, p = 0.000a 0.928 (0.624–1.382), p = 0.714
Birth weight of baby, g 3,190.08562.5 3,259.58911.1 t = –1.348, p = 0.178 1.000 (1.000–1.001), p = 0.017**
Breastfeeding period, months 6.583.2 6.583.3 t = –0.234, p = 0.815 0.993 (0.925–1.069), p = 0.871
Complaining of urinary infection
Yes 214 (29.6%) 510 (70.4%) ␹2 = 78.700 2.967 (2.322–3.791)
No 127 (12.4%) 898 (87.6%) p = 0.000a p = 0.000a
Normal delivery
Yes 74 (22.3%) 258 (77.7%) ␹2 = 2.034, p = 0.154 0.737 (0.626–1.388), p = 0.131
No 267 (18.8%) 1,150 (81.2%)
Planned cesarean
Yes 52 (16.3%) 267 (83.7%) ␹2 = 2.538, p = 0.111 0.989 (0.641–1.525), p = 0.960
No 289 (20.2%) 1,141 (79.8%)
Vacuum delivery
Yes 10 (25.0%) 30 (75.0%) ␹2 = 0.789, p = 0.374 0.783 (0.361–1.698), p = 0.536
No 331 (19.4%) 1,378 (80.6%)
Episiotomy
Yes 132 (20.2%) 521 (79.8%) ␹2 = 0.342, p = 0.559 0.784 (0.561–1.096), p = 0.155
No 209 (19.1%) 887 (80.9%)
Assistance in second stage of delivery
Yes 131 (22.8%) 464 (78.0%) ␹2 = 3.646, p = 0.056 0.743 (0.534–1.036), p = 0.080
No 210 (18.2%) 944 (81.8%)
Spontaneous perineal tears
Yes 57 (22.4%) 198 (77.6%) ␹2 = 1.551, p = 0.213 0.982 (0.681–1.417), p = 0.923
No 284 (19.0%) 1,210 (81.0%)
a p < 0.0001.

tinuous use of protective pads, it was also seen that urine
leakage in 12.6% of the women was only enough to moist-
en their underwear. Another finding was that although
women were restricted in their social activities due to uri-
nary incontinence, despite the fact that their sexual activ-
ity was hampered and that they experienced urine leak-
age during sexual intercourse, they did not go to the doc-
tor for such complaints (table 1). Similarly, Glazener et al.
[5] report a 51.3% prevalence of stress incontinence, 16.8%
of urge incontinence and 31.9% of a mixed type of uri-
nary incontinence. Dolan et al. [27] have established a
prevalence of 36.8% for stress incontinence, of 7.9% for
urge incontinence and 55.3% for the mixed type of incon-
tinence. Burgio et al. [12] state that 5.9% of the women in
their study, and Siracusano et al. [21] say that 17.7% of the
subjects in their study complained that their pads or un-
derwear were getting wet due to urine leakage. Yip et al.
[29] have established that 3.8% and Dolan et al. [26, 27]
that 6.4% of women experience urinary incontinence
during sexual intercourse. Other studies also show that
despite such urinary incontinence complaints, women do
not receive adequate professional help for this condition
[8, 21, 22]. Research shows that urinary incontinence is a
health problem that affects a woman’s social and emo-
tional health and causes social isolation. In support of
this, Fultz and Herzog [30] found that women with uri-
nary incontinence are lonelier, unhappier and more de-
pressive than women without the condition.
The majority of the women in the present study group
(85.3%) were seen to be unaware of the existence of pelvic
floor muscle exercises. It was found that only a small per-
centage (12.3%) did these exercises regularly (table 1).
Other studies have shown that women who do pelvic
floor muscle exercises regularly during pregnancy reduce
their risk of suffering from urinary incontinence in their
postpartum periods [5, 31, 32]. Contrary to the results of

UI in the 12-Month Postpartum Period Urol Int 2008;80:355–361 359

and Related Risk Factors
the present study, Burgio et al. [12] state that 84.6% of the
women in their study had heard of pelvic floor muscle
exercises and that 46.7% had done these exercises regu-
larly during pregnancy. Baessler and Schuessler [33] have
asserted that preventing obesity during pregnancy and
doing physical and pelvic floor exercises during pregnan-
cy and during the postpartum period will reduce the risk
of postpartum urinary incontinence. It has been asserted
that if midwives and nurses in primary care in particular
could teach pelvic floor muscle exercises as part of their
prenatal routines, this would be beneficial in the control
of postpartum urinary incontinence as far as symptoms
and findings are concerned.
While a relationship was discovered between urinary
incontinence and age, monthly income, length of mar-
riage, family type and the woman’s level of education, no
correlation was seen between urinary incontinence and
BMI, the woman’s occupation and smoking. Logistic re-
gression analysis carried out showed only that being
younger and having lower income signified a risk for de-
veloping urinary incontinence and that length of mar-
riage, BMI, occupation, smoking and level of education
did not constitute risks for the condition. Burgio et al. [12]
on the contrary, found that smoking increased the risk of
urinary incontinence due to coughing. Peschers et al. [15]
established that there was no relationship between age,
BMI and urinary incontinence. Education is an impor-
tant determining factor in epidemiological studies. In
groups where education levels are high, income levels
also rise. The present study revealed a relationship be-
tween level of education and urinary incontinence, also
establishing that individuals with more restricted eco-
nomic means faced an increasing risk. This result may be
explained by the fact that as educational levels increase,
so do income levels and, parallel to this, sensitivity to-
ward maintaining good health and benefiting from avail-
able services is more developed.
In the study, a relationship was found between urinary
incontinence and complaints of urinary infection, num-
ber of pregnancies, number of deliveries and number of
children. No relationship was seen between incontinence
and incidence of normal delivery, planned cesarean, vac-
uum delivery, episiotomies, assisting the mother to push
out the baby in the second stage of delivery, spontaneous
tears, length of postpartum period, baby’s birth weight
and length of breastfeeding. Logistic regression analysis
indicated that women who complained of urinary infec-
tion and had babies of higher birth weight were at risk of
suffering from urinary incontinence. Özerdoğan et al.
[26] also recorded similar findings indicating that wom-
360 Urol Int 2008;80:355–361
en who complained of bladder infections ran a greater
risk of encountering urinary incontinence. There are
other studies that support the present study’s findings to
the effect that obstetric factors do not constitute a risk in
terms of urinary incontinence [8, 9, 28, 34]. Chaliha et al.
[8] state that having a normal delivery is in itself a risk
factor for urinary incontinence while Farrell et al. [28]
assert that normal delivery as opposed to cesarean deliv-
ery increases risks of developing the condition. Schaffer
et al. [35] have indicated that helping the mother push the
baby out in the second stage of delivery increases the risk
of incontinence. Burgio et al. [12] have reported that
spontaneous tears do not signify a risk but that using for-
ceps, vaginal delivery, episiotomies and length of breast-
feeding do increase the risk of urinary incontinence. In
industrialized and developing countries, ratios of cesar-
ean delivery are steadily rising [36]. Some research has
shown that planned cesarean deliveries prevent urinary
incontinence [28, 37] but some studies have reached the
conclusion that planned cesarean births play no role in
preventing urinary incontinence [19, 38].
Conclusions
Urinary incontinence in the postpartum period ad-
versely affects a woman’s physical, psychological and so-
cial health. It has been seen that urinary incontinence is
a prevalent condition in the postpartum period and that
women do not seek professional guidance for this prob-
lem. It is suggested that evaluation of urinary inconti-
nence during prenatal monitoring, teaching of pelvic
floor exercises and ensuring that women seek profession-
al support for this condition will reduce the risks of de-
veloping urinary incontinence.
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