Urinary incontinence (UI) is a prevalent condition that significantly impacts quality of life, particularly for women(1). As a urologist, recognizing how culture influences UI management is essential. Despite available treatments, cultural barriers often impede access to and acceptance of care(2). This study synthesizes evidence on how culture, ethnicity, and religion shape perceptions and experiences of UI, focusing on Muslim-majority countries and the Middle East. Drawing from our 15-year experience in three Middle Eastern countries—Iran, the United Arab Emirates, and Kuwait—we explore how cultural and religious beliefs affect patient complaints, management, treatment selection, and satisfaction with treatment for women with UI.

This study combines a single-center experience with a comprehensive literature review. The literature review was conducted using PubMed and Google Scholar, with search terms including "urinary incontinence," "culture," "Islam," "Middle East," "women's health," "stigma," "ethnicity," and "religion." Studies exploring the influence of cultural beliefs, religious practices, and social norms on UI-related behaviors were prioritized. No date restrictions were imposed. Articles were selected based on their relevance to the research question and geographical focus. Our single-center experience involved a retrospective analysis of patient data from our treatment team, focusing on how cultural factors influenced patient interactions and treatment outcomes.

Cultural barriers profoundly influenced UI management. Modesty concerns and beliefs about urine impurity deterred 68% of women from seeking care. Restrictions due to clothing (e.g., hijab) and limited access to private facilities delayed treatment in 42% of cases. Family involvement in healthcare decisions was reported by 75% of patients, often prioritizing traditional remedies over medical interventions. Regionally, UI prevalence varied by socioeconomic status (15–30%), parity, and comorbidities. Digital pelvic floor training tools showed promise but lacked cultural adaptation for widespread use.

Cultural factors have a profound impact on women's experiences with UI(3). Modesty, privacy, and traditional beliefs about cleanliness often prevent women from seeking medical help. In cultures where urine is viewed as impure, this perception can exacerbate the stigma surrounding UI, discouraging open discussion about symptoms. For women who wear the hijab or follow strict dress codes, managing UI can be complicated by restrictions on clothing and outdoor environments, particularly when accessing public facilities. The stigma associated with UI leads to concealment and delayed treatment. Family dynamics, including the influence of older family members and men, significantly influence healthcare decisions. Experiences from the Middle Eastern region suggest that culturally tailored interventions, involving community leaders and healthcare workers, may improve awareness and acceptance of UI treatments. In low- and middle-income countries, UI prevalence varies significantly among older women, influenced by socio-demographics, gynecological factors, comorbidities, and behaviors (e.g., smoking status). The use of digital technologies for pelvic floor muscle training offers potential benefits but requires cultural relevance and scientific validation. In Africa, healthcare providers face challenges in managing UI due to limited diagnostic tools and treatment options. These findings highlight the need for culturally sensitive healthcare services that address the unique challenges faced by women in diverse cultural contexts.

Greater focus on cultural barriers, attention to diversity in patients, and consideration of patients' expectations are crucial for improving UI management. By aiming to satisfy patients through personalized treatment methods tailored to each individual, healthcare providers can enhance the effectiveness and compassion of care. This approach will not only improve UI management but also increase patient satisfaction and quality of life for women affected by UI.

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Chaliha C, Stanton S. The ethnic cultural and social aspects of incontinence–a pilot study. International Urogynecology Journal. 1999;10:166-70.