The gestational period is a moment in female reproductive life marked by transformations. Among the several changes that occur in the maternal organism, it is possible to highlight significant changes in the set of structures that make up the pelvic floor and that are fundamental for the evolution of pregnancy. These changes can predispose Floor Dysfunctions (PFD), becoming more prevalent as the pregnancy progresses. Among the main PFDs that can occur during the pregnancy-puerperal period, Urinary Incontinence (UI) can be highlighted, being defined by the International Continence Society (ICS) as the “involuntary loss of urine in any amount” [1]. In view of this, UI presents itself as a condition of global impact with high prevalence, costs and substantial impact on quality of life. Despite this, the behavior of seeking professional care is still low [1]. In order to understand such behavior, studies that evaluate the Knowledge, Attitude and Practice (KAP) of women related to UI have been developed. A systematic review, which aimed to assess the KAP of women related to UI, revealed that out of a total of 19 articles identified, knowledge was assessed by the majority (n = 15) and all concluded that there is misinformation about UI in the studied populations. The intention of seeking health care for UI was studied in seven articles, and only one showed an adequate attitude in more than 70% of the participants. All articles in this review that investigated the practical item revealed low rates of seeking care [2]. These results highlight health education as a fundamental tool in combating inappropriate knowledge, attitude and practices in relation to UI. Therefore, the professionals responsible for assisting women at different stages of their lives should use this tool to develop strategies for the prevention and treatment of UI. In Brazil, few studies have been carried out in relation to the theme presented, also showing gaps that need to be filled in order to improve the assistance provided during the pregnancy-puerperal period. Assessing the knowledge of pregnant women about UI will allow a better understanding of how this population thinks and acts in the face of this condition, being the initial step to direct the construction of interventions aimed at the needs of this clientele. Therefore, this study aimed to assess the knowledge, attitude and practice of pregnant women about urinary incontinence.

This is an observational study, involving 237 pregnant women, selected for convenience, who performed prenatal care at public reference institutions. Data collection took place from May to November 2019, using an electronic form containing two instruments. The first with questions related to sociodemographic and obstetric data; and the second aimed at assessing Knowledge about UI. This is a subscale of the “Scale for assessing the knowledge, attitude and practice of pregnant women about UI” [3], and consists of 10 items that assess women's knowledge about symptoms, risk factors, UI severity and ways of prevention and treatment. The instruments were applied through individualized interviews, in a private environment, and the collection team was composed of three trained researchers. The data were analyzed using IBM SPSS® Statistics version 20.0 for Windows. The project was submitted to and approved by the Research Ethics Committee of the selected institutions and all participants signed, after accepting to participate in the study, the free and informed consent term.

The sample consisted of women aged between 18 and 43 years, the majority being married or in a stable relationship (86.1%), with complete high school (50.6%), secondary pregnancies (n = 83 / 35.0%), primiparous (M: 1.11 ± 1.18), mainly vaginally (M: 0.6 ± 1.1) and who started prenatal care in the first gestational trimester (n = 158 / 66.7). Between 237 participants, 36 (15.2%) reported never having heard about this condition. For the others (n = 201), the majority (91%) recognized that UI is more prevalent in the female population, however, a large part (57.2%) considered urine loss during pregnancy to be normal. More than half (55.7%) did not know how to mention any risk factor for the occurrence of UI. Among those who mentioned one, pregnancy/childbirth/instrumental delivery was the most mentioned (23.4%). Only 10 (5.0%) pregnant women recognized the weakness of the pelvic floor muscle/lack of preparation of the perineum as a risk factor. Most believe that there are ways to avoid (74.6%) and treat (90.5%) UI, however more than half did not know how to mention any form of prevention (55.2%) or treatment (57.2%). Performing pelvic floor strengthening exercises (13.4%) and surgery (26.4%) were, respectively, the most frequent responses to prevent and treat UI. Of all 10 items evaluated, the lowest percentages of correct answers detected were in relation to the knowledge of risk factors (46.8%), with the question "Do you know what can cause the loss of pee?"; prevention (43.8%), with the question “What forms of avoiding UI do you know about?”; and, finally, the treatment of UI (42.8%), with the question “What forms of treating UI do you know about?”

The evaluation of knowledge about UI allowed us to identify that there is still a big deficit related to what the female population knows about the theme. It is emphasized that there are still women who have never heard of UI and that, despite the fact that many participants have already heard about it, the general knowledge on the topic is still deficient. Considering the loss of urine normal during pregnancy and not knowing how to prevent and treat it can be impeding factors for these women to report their complaints to health professionals, showing a direct relationship between the level of knowledge about this condition and the behavior of seeking care. Therefore, establishing educational programs, both collective and individual in prenatal care is a crucial step to improve the levels of knowledge of the female population about UI, making this population take appropriate actions in the face of this condition.

Assessing the knowledge of pregnant women about UI allowed for a better understanding of the women's understanding of the theme, being the initial step for the construction of interventions directed to the needs of them.

ABRAMS, P. et al. Incontinence: 6th International Consultation on Incontinence, Tokyo, September, 2017.
VASCONCELOS, C. T. M. et al. Women’s knowledge, attitude and practice related to urinary incontinence: systematic review. International Urogynecology Journal, 2018.
FIRMIANO, M. L. V. Escala de avaliação do conhecimento, atitude e prática de gestantes sobre incontinência urinária: construção e validação de conteúdo. Universidade Federal do Ceará, v. Dissertação, p. 1–139, 2017.