The present investigation aimed to describe knowledge concerning urinary incontinence (UI) of adults from a higher education health institution, and to study the associations of sociodemographic and clinical characteristics with demonstrated UI knowledge.

In a sample aged between 17-80 years selected from a higher education health institution, data were collected by means of an online survey performed between January and March 2022. The questionnaire included sociodemographic information (age, weight, height, marital status, field of study and level of education) and clinical data, including presence of chronic health conditions, UI symptoms and recurrent lower urinary tract infections. The International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the Incontinence Quiz Questionnaire (IQQ) 1 were applied to assess UI symptoms and knowledge related to UI, respectively. The IQQ comprised 14 questions under 4 different domains: 1) Relationship between aging and UI, 2) Causes of UI, 3) Physician-patient discussion about UI, and 4) Treatments and effects of UI. The considered primary endpoints were the percentages of correct, incorrect, and “don't know” answers on the IQQ. 
Knowledge was analysed according to age, sex, education level, field of study, report of chronic health conditions, recurrent lower urinary tract infections, and presence of UI, by using Mann-Whitney U tests (α=0.05).

The sample included 557 adult participants, with 424 of them being women (76.1%). Most of the sample were under 45 years of age (84.4%). A majority were single (n=389; 69.8%). More than half had already obtained a higher education degree (n=335; 60.1%), mainly in the field of health sciences (n=425; 83.3%). Less than one-third reported having a chronic health condition (n=159; 28.5%) with only a few reporting recurrent lower urinary tract infections (n=46; 8.3%). UI symptoms were declared by 89 participants (16.0%). 

Considering the results in the different answer options of the IQQ, correct answers were marked by half or more of the participants, either considering the total number of questions (median 57.1%) or considering the different questionnaire domains (Causes of UI and Physician-patient discussion about UI with median 50%) – except for the relationship between aging and UI domain in which the most common responses were incorrect (median 50%) (Table 1).

Regarding the considered determinants for UI knowledge, being 45 years or over, having a higher educational background and in the health field was associated with a higher percentage of correct answers in the IQQ (64.3%, 57.1% and 57.1%, respectively) (Table 2).

The fact that there were no differences in UI knowledge between men and women was interesting and to our knowledge has not been covered in previous studies [2]. The fact that UI is more prevalent in women than in men could suggest that they had greater knowledge about the dysfunction. However, the fact that more than half of the sample had a higher education degree and the majority were in the field of health sciences could explain these results.

Interestingly, the fact of having recurrent lower urinary tract infections or even symptoms of UI was not associated with a greater knowledge of this dysfunction. However, this result is in line with what has been reported in other studies – most doctors do not talk to or question their patients about continence changes nor do patients discuss this issue with their doctor.

Being at least 45 years of age was associated with a better knowledge of UI. Based on the results of epidemiological studies, the prevalence of UI is higher in this age group which may somehow lead women to have more interest in the problem and perhaps search for UI-related information.

Having a clinical condition, such as chronic health conditions was not associated with better knowledge. The fact that people with non-urinary-related medical conditions are not more aware than healthy individuals may in part be related to the fact that consultations with their specialist doctors will only cover the specific problems related to the disease. 

Regarding the different domains of the IQQ, the domain related to the knowledge of the Relationship of aging and UI was the only one showing a higher percentage of incorrect answers than correct ones. This previous fact is concordant with previous reported beliefs that urinary leakage is considered a ‘normal’ occurrence of aging and that it worsens with age [3].

The domain “Treatments and effects of UI” had a higher proportion of correct answers. Since the sample comprised participants from a higher education institution for health, this finding was partially expected. The associations of a higher level of education and having a background in health education with the percentage of correct answers can further explain the relationship.

The results of this study show that in a population mostly with higher education levels and mainly in the field of health science there is space for improvement concerning knowledge about UI. The negative impact of UI on quality of life, sexual function, and social life has been described in several studies. Thus, educational actions should cover the necessary information for the individual or someone from his/her family or social circle to be encouraged to seek treatment as early as possible when symptoms are present or even prevent their onset. The expenses related to the management and treatment of UI are heavy for both family budgets and health systems. Given the identification of modifiable risk factors for the development of UI in the scientific literature, there is an urgent need to provide education actions in this area that enable the empowerment of individuals to reduce the impact of this dysfunction.

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