Chronic constipation is a disorder that can be directly associated with female urinary incontinence due to compression of the bladder by the rectum as well as pelvic floor injuries caused by distention during evacuation1,2. This study aimed to identify the prevalence of chronic constipation in urinary incontinence and other associated factors. The hypothesis is that even though constipation can be prevented by behavioral changes, it still has high rates and is directly associated with female urinary incontinence.

This was a cross-sectional study, whose data collection was performed using a semi-structured form with sociodemographic variables and obstetric history, as well as the Bristol stool scale to identify the consistency of bowel movements, ROME IV criteria to identify constipation, and the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS). The ICIQ-FLUTS is a validated questionnaire composed of twelve items for evaluating female lower urinary tract symptoms and impact on quality of life, with a maximum total score of 48 points, in which higher values represent greater severity in urinary symptoms. The scoring related to the filling symptoms ranges from 0 to 16, voiding symptoms from 0 to 12, and incontinence symptoms from 0 to 20. The form was made available online, non-probabilistically, for women from all regions of Brazil, from December 2020 to April 2021. Women aged 18 years and over were included. During the research period, 734 women answered the form, however 158 did not answer all the questions, being excluded from the study, thus resulting in a final sample of 576 women. Statistical analyzes were performed using the Statistical Package for the Social Sciences (SPSS) version 23. Descriptive analysis was performed (simple frequencies, mean, standard deviation). For association between explanatory variables, binary logistic regression was applied, considering p-value<0.05, Odds Ratio, with a 95% Confidence Interval (95% CI). The Research Ethics Committee of UNIFAMETRO University Center approved the project.

These results are unprecedented. Mean age of women was 35.22 years (±12.6), in which 175 (30.38%) reported urinary loss for no apparent reason. Regarding the type of feces according to the Bristol stool scale, there was a predominance of type 3 (n=234, 40.6%), and 333 (57.8%) presented constipation according to ROMA IV criteria. Table 1 presents the sample characterization.Among the 175 women who reported urinary incontinence, there was a 68% (n=119) prevalence of constipation. 
Table 2 presents logistic regression, association between urinary incontinence and constipation, and other associated factors.

Results confirmed the statistical association between urinary incontinence and constipation, in which women with constipation were 125% more likely to manifest incontinence than those who did not suffer from constipation. Regression analysis revealed other factors associated with urinary incontinence: vaginal delivery (66% more likely), menopause (75% more likely), and pregnancy (58% more likely), corroborating the results of other studies. Not using quantitative measures (such as the pad test) is considered a possible limitation of this study.

Results demonstrate that among non-modifiable factors, such as the hormonal condition presented by menopause, constipation is still significantly associated with urinary incontinence. This finding leads us to consider the need for interventions with behavioral conditions (food and water intake, physical activity) that can prevent constipation and thus minimize the occurrence of female urinary incontinence.