The objective of this study was to determine the prevalence and associated risk factors for urinary incontinence (UI) among antenatal clinic attendees in a low resourced setting.

This study was a cross-sectional study involving pregnant women aged 18 to 45 years. Sample size was calculated using the prevalence obtained by Adaji et al (21.1%) [1] 95% confidence interval and 4% degree of error allowance, 10% attrition; minimum sample size of 440 was obtained. Five hundred and seventeen women were considered for the study. Inclusion criteria included pregnant women aged 18 to 45years and willingness to participate in the study; while the exclusion criteria were diabetes mellitus, history of urinary incontinence prior to pregnancy, symptom of acute lower urinary tract infection, current use of parasympathomimmetic or sympatholytic drug, history of urological surgery, gynecological surgery such as myomectomy and vaginal repair. Data was obtained from 442 pregnant women using the English version International Consultation on Incontinence Questionnaire—Urinary Incontinence—Short form (ICIQ-UI-SF) from July 2017-September 2017. ICIQ-UI is a questionnaire used for assessment of prevalence, frequency and perceived cause of urinary incontinence, and impact on quality of life over the past four weeks. [2] Sociodemographic and obstetric data was also collected. The questionnaires were self-administered. The ICIQ score was derived from the addition of scores of the frequency of urinary leakage, amount of urinary leakage and interference with daily activities. The questionnaire defines ICIQ score 1 to 3 as light impact, from 4 to 6 as moderate impact, from 7 to 9 as severe impact; while 10 and above is taken as very severe impact. Data was analyzed with SPSS version 20. Logistic regression was also used to derive the adjusted odds ratio for risk factors of urinary incontinence among the respondents. A p value <0.05 was taken as statistically significant

During the study period, 442 out of 517(85.5%) women receiving antenatal care at the hospital participated in this study. The mean age of participants was 29.93± 5.33.  Among the respondents, 318(71.9) women were continent while 124(28.1%) women were incontinent. The prevalence of urinary incontinence in this study was 28.1%. UI prevalence among the nulliparous and multiparous women were 28.7% and 27.7% respectively. The prevalence of Stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI) were 17.4%, 6.8% and 3.9% respectively. Out of the affected women, 51 (41.1%) reported lifestyle changes; and sexual relation was the most affected lifestyle (22.6%). The mean ICIQ score was 5.65± 4.50. Overweight (AOR 1.39, p=0.03), obesity (AOR 1.60, p=0.009), third trimester (AOR 2.09, p=0.011), previous instrumental vaginal delivery (AOR 11.54, p<0.001), Ibo tribe (AOR 3.29, p=0.006); and Ebira tribe (AOR 8.86, p=0.028) were associated with UI in pregnancy.

The prevalence reported in this study was higher than the reports from black populations but lower than reports from the Caucasians. This may be a pointer to under-reporting of UI in pregnancy among Africans as majority of the affected women do suffer in silence. The observation of higher prevalence among the nullipara was surprising and same findings documented in Turkey and Ethiopia has been attributed to patients’ characteristics and health care system. The mean ICIQ score revealed moderate impact on quality of life. Sexual relation was the most affected and this occurred in those with moderate to severe symptoms. Overweight and obese pregnant women were at increased risk of developing UI in pregnancy compared to eutrophic pregnant women as reported by previous studies. Respondents in third trimester were twice more likely to develop UI in pregnancy than those in first trimester and this is in tandem with findings that UI in pregnancy increases with gestational age. The seemingly high probability with instrumental vaginal delivery was because most of those women had forceps delivery. Ethnicity is known to affect prevalence of UI in pregnancy; this may be responsible for the significant differences among different tribes.

Urinary incontinence affects more than a quarter of pregnant women; with substantial lifestyle changes; and sexual relation is the most affected activity. Health care providers should endeavor to enquire about symptoms of UI among pregnant women. Efficacy of interventions needs to be investigated in this population.

Adaji SE, Shittu OS, Bature SB, Nasir S, Olatunji O. Suffering in silence: pregnant women's experience of urinary incontinence in Zaria. Eur J Obstet Gynecol Reprod Biol 2010; 150:19-23.
Avery K, Donovan J, Peters T, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodynamics 2004; 23(4):322-330.