It is well known that prevalence of female urinary incontinence (UI) increases with the age. According to several epidemiologic studies UI emerges as troublemaker in a quite young cohort of women aged 20-39 years varying from 3% to 17% (mostly discrepancy among estimates is due to the degree of reported severity taken into account). However, neglecting non-bothersome cases can conceal true situation. While UI is in a bud, it is high time for efforts to curb it despite scarce array of available treatment modalities at this stage. Although these behavioral approaches would cost nothing except personal time and physical efforts, but alluding to the lack of time and no improvement after short erratic use many patients just fail to confess that they are reluctant to make a point of doing this when low-grade UI does not push them to the limits. Procrastination to have recourse to pelvic floor muscle training (PFMT) makes exercises less capable to harness UI when perimenopause is looming. Therefore caregivers should raise awareness among women aged 20-39 years about significance of mild UI, which heralds deterioration at perimenopausal age. Recognition of risk groups, guidelines for them should provide a ground for long-term preventive strategy with good compliance as the keystone. Pregnancy, especially full-term, is an event, which weakens pelvic floor, thereby affects extrinsic support mechanism entailing urethra hypermobility, intricate neuromuscular relationship and bladder neck competence. Furthermore, substantial weight gain during pregnancy can linger then as persistent obesity, low estrogen production inherent for breastfeeding hinders the pace of regaining preexistent pelvic floor muscle tone. Therefore UI (mainly stress UI, SUI) can appear within this timespan. Our study aimed to sort out factors, which make a woman prone to develop early debut of UI after pregnancy. Next objective was to offer easy preventive program of PFMT for women with recognized substantial UI risk and expect good compliance.

A cross-sectional study involved 530 female patients aged 20-39 years who came for gynecological visit driven by any other reasons except UI. They were offered a questionnaire (written consent was obtained) that was expected to collect information about their anthropometry and socio-demographic status, risk factors for UI, detailed obstetric history, low genital tract infections, any experience of slightest urine leakage, features of UI (if any) and (if any) attitude to the urine leakage (if reported to medical assistance, what was the management and whether it met their expectations). The questionnaire also included block of questions requested for those who gave affirmative reply regarding UI experience. It meant to identify the type and severity of UI. At the second stage of the study intervention (easy 5-minutes-long combination of exercises of alternating hooking up anus / interrupted imitation of micturition with an empty bladder performed on the forced exhalation with the use of fitball) was recommended to 96 women discharging from maternity hospital after uneventful vaginal or abdominal delivery who had evident high risk to develop UI in the near future. It was supposed to get started after complete healing of any sutures and implied reinforced regaining pelvic floor support. Compliance was assessed every 3 months. 
The prevalence between dichotomous categories was compared with the use of chi-square tests. The continuous variables were expressed as mean, percentage value and frequency. Probable risk factors of UI were evaluated by binary logistic regression models with positive/negative UI as dependent variable and others as independent variables using the Backward Stepwise elimination of non-significant variables. The odds ratios (OR) and 95% Confidence interval (CI) were estimated. All calculations were conducted via SPSS for Windows, version 18.0, considering p value <0.05 as statically significant.

The mean age was 29.87±3.46 years. UI was reported by 20.6% (n=109) women, mostly classified as SUI (88,1%, n=96), others: urge UI (UUI) – 9.2% (n=10), mixed UI (MUI) – 2.7% (n=3). Among women of 30-39 years UI occurred more than twofold often than those of 20-29 years (70.6%, n=77 and 29.4%, n=32 respectively). Majority of women (70.6%, n=77) defined leakage as trace amount of UI, others reported one and more episodes of UI per day. Despite the fact that overwhelming number of patients (95.4%, n=104) described the impact on their quality of life (QoL) as negative, but just 15,4% (n=16) of them addressed their preoccupation to a physician (gynecologist or urologist). Only in 2 patients medical assistance met their expectations (surgery), others received either no recommendation (condition was explained as almost inherent for women or not worth treating at this stage) or vague suggestion (PFMT but without precise instructions), which they abandoned very soon due to “futility” according to their perception. 
Binary logistic regression analysis revealed risk factors of early debut of UI associated with antecedent pregnancy: obesity and excessive gain weight persistent after delivery (p<0.013), short stature – height <164 cm (p<0.001), fetal weight >3800.0 (p<0.001), constipation persistent after pregnancy (p<0.015), family history of UI (p<0.001). Unexpectedly abdominal delivery (even elective cesarean section) failed to show statistically significant more favorable prognosis regarding UI comparatively with vaginal delivery (women after vaginal deliveries complicated by lacerations of substantial degrees or postpartum fistula were eliminated from accrual  though).
Regarding recommended PFMT complex (daily, two times per day) it is worth mentioning that even after 9 months compliance with PFMT remained quite satisfactory: 76.0% (n=73) women were adherent to it, another 9.4% (n=9) made a point of doing exercises at least once per day missing just 1-2 days in a week. 98% of these “good responders” reported no leakage, but, of course, much longer time of surveillance would be much more informative with respect to this PFMT complex’s protective capacity.

Comparison of our study results with other data showed that rate of UI among women aged 20-39 was underreported due to mainly trace amount of UI, which did not push social inconvenience to the limits of patience. Lack of proper infrastructure of care for UI, low awareness of physicians at the primary level, whom a women can address her trouble to, explain why mild UI in young is often neglected at the high time to handle it by PFMT.

UI emerges as a very common condition among postmenopausal women affecting substantially their QoL, but the roots of this issue lurks in reproductive lifespan since the beginning of childbearing. However its significance is often underestimated by patients as well as caregivers, therefore its rate is underreported. Furthermore awareness among caregivers who are not specifically involved in dealing with UI is low, because low-recourse settings mainly lack the proper infrastructure to render qualified medical assistance with this regard. Even the first event of childbearing can bring along traits of incipient SUI (obesity, short stature, fetal macrosomia, persistent constipation, family history as risk factors) and PFMT can deter UI progression, but vague suggestion how to do PFMT delivered by caregivers, unpleasant feelings from use of “internal” tools, weak incentive when it is just trace amount of UI explain low compliance as well as low effectiveness due to wrong performance. Easy complex of PFMT administered soon after delivery without use of inserting tools could improve compliance and provide protection in selected cases. Obviously modern devices of pelvic muscle stimulation can provide better result in regaining pelvic support, but they are expensive and time-consuming, so as preventive step PFMT looks reasonable.