International Journal of Nursing Science 2014, 4(2): 17-21

DOI: 10.5923/j.nursing.20140402.01

Factors Contributing to the Severity of Urinary

Incontinence and Its Association with Sexual Function:
A Cross Sectional Study
Momenimovahed Zohre1,*, Pakgohar Minoo2, Montazeri Ali3
1

Msc of Midwifery Education, Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical
Sciences, Tehran, Iran
2
PHD of Gerontology, Department of Gerontological nursing, Reproductive Health, School of Nursing and Midwifery, Tehran University
of Medical Sciences, Tehran, Iran
3
Professor of Public Health, Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences
Research, ACECR, Tehran, Iran

Abstract Urinary Incontinence (UI) is a common problem worldwide that affects all age groups. The prevalence of UI

increases with age. This disorder affects various aspects of the quality of life and sexual function. Different levels of the
severity of UI may have different effects on sexual function. Therefore, this study aimed to investigate factors contributing to
the severity of urinary incontinence and to assess the relationship between the severity of UI and sexual function. This cross
sectional study was conducted on 400 women with the complaint of UI. In this study, four questionnaires were used: a
demographic information questionnaire, the questionnaire of urinary incontinence diagnosis (QUID), the Sandvik severity
index (SSI), and the pelvic organ prolapse/ urinary incontinence sexual function questionnaire (PISQ-12). In all, 400 women
were studied. Most subjects were in the age range 40-54 years. There was a significant difference between the severity of UI
and sexual function (P<0.001). The results obtained from multiple regression analysis indicated that the most significant
factors in the severity of UI were age and menopause status (P<0.001, P=0.001 respectively). The results of the study show a
significant difference between the severity of urinary incontinence and the total score and all domains of PISQ (P<0.001).
The relationship between the severity of UI and sexual function in women reflects the need to consider the severity of UI and
its impact on other outcomes.

Keywords Urinary incontinence, Sexual function, Severity of urinary incontinence

1. Introductions
Urinary incontinence (UI) is a common health and social
problem worldwide that affects all age groups [1]. The
prevalence of UI increases with age [2-3]. This disorder is
more common in women than men [4]. Nearly one in every
five women reports that urinary incontinence has affected
her daily life [5]. UI affects various aspects of health related
quality of life. Urinary incontinence has negative effects on
the womens health and many different aspects of their lives.
In different studies, the impact of this disorder on the quality
of life has been shown [6-9]. UI significantly impairs sexual
function as well as the quality of life [10-11]. Women with
urinary incontinence suffer from low libido, vaginal dryness,
pain during intercourse and infrequent orgasm [12].
* Corresponding author:
momeni.z@gmail.com (Momenimovahed Zohre)
Published online at http://journal.sapub.org/nursing
Copyright 2014 Scientific & Academic Publishing. All Rights Reserved

Different levels of the severity of urinary incontinence may

have different effects on sexual function. Few studies have
evaluated the factors contributing to the severity of urinary
incontinence and its association with sexual function. Most
of these studies have only assessed the relationship between
urinary incontinence and the quality of life [13-14].
Therefore, this study aimed to assess the factors contributing
to the severity of UI and the relationship between the severity
of UI and sexual function. Determination of the risk factors
can be useful in strategies for prevention, counseling, and
coping with the complications of UI.

2. Methodology
2.1. Study Design
A cross sectional discriptive design was used in this study
to investigate factors contributing to the severity of urinary
incontinence and to assess the relationship between the
severity of UI and sexual function.

Momenimovahed Zohre et al.: Factors Contributing to the Severity of Urinary Incontinence

and Its Association with Sexual Function: A Cross Sectional Study

18

2.2. Setting
This study was conducted in urogynecology clinic of
Imam Khomeini Hospital, Tehran, Iran.
2.3. Subjects
In this study a convenience sampling method was used.
This study was performed in a sample of 400 women
complaining of UI who attended in the urogynecology clinic
of Imam Khomeini hospital. Inclusion criteria were
complaint of any type urinary incontinence including stress
(SUI), urge (UUI), and mixed urinary incontinence (MUI)
for at least 6 months, age at least 20 years, being married and
sexually active, ability to read and write and lack of
pregnancy. Exclusion criteria were reversible causes of
incontinence, functional disability, mental disorders, and
associated diseases.
2.4. Tools
Tool I: Patient`s information (contributing factors)

Patient`s information was collected by a questionnaire

designed by the researcher. This information included age,
educational level, employement status, height, and weight,
menopause status, number of pregnancies and live child,
mode of delivery, multiple pregnancy and duration of
urinary incontinence. Body mass index (BMI) was
calculated by the researcher using height and weight.
Tool 2: Type of urinary incontinence
UI was determined by the questionnaire for urinary
incontinence diagnosis (QUID) were categorized to SUI,
UUI and MUI [15].
Tool 3: Severity of urinary incontinence
The severity of urinary incontinence was assessed by the
Sandvik Severity Index (SSI). SSI is a valid questionnaire
that includes two questions and its overall score is calculated
by multiplying the frequency of urinary incontinence and the
amount of urine leakage: mild (1-2), moderate (3-6), severe
(8-9) and very severe (12) [16].

Table 1. Demographic characteristic of the study sample (n=400)

Age groups (years)

25-39
45-54
55-69
Type
SUI
UUI
MUI
Education
Elementary
Secondary
Higher
Employment
Employed
Housewife
BMI
<18.50
18.50-24.99

Total(n=400)
No(%)
124(31)
188(47)

Mild(n=109)
No(%)

Severity of UI
Moderate(n=268)
Sever(n=21)
No(%)
No(%)

78(62.9)

46(37.1)

Very sever(n=2)
No(%)
0

31(16.5)

156(83.0)

1(0.5)

88(22)

66(75.0)

20(22.7)

2(2.3)

223(55.8)
97(24.2)

74(33.2)
21(21.6)

138(61.9)
69(71.1)

10(4.5)
6(6.2)

1(0.4)
1(1.0)

80(20)

14(17.5)

61(76.2)

5(6.2)

163(40.8)
177(44.2)

20(12.3)
55(31.1)

126(77.3)
116(65.5)

17(10.4)
4(2.3)

0
2(1.1)

60(15.0)

34(56.7)

26(43.3)

44(46.3)

51(53.7)

65(21.3)

217(71.1)

21(6.9)

2(0.7)

95(23.8)
305(76.2)
3(0.8)
193(48.2)

1(33.3)

2(66.7)

62(32.1)

123(63.7)

7(3.6)

1(0.5)

25-29.99

190(47.5)

40(21.1)

136(71.6)

13(6.8)

1(0.5)

30
Menopause
Yes
No
Mode of delivery
NVD
C/S

14(3.5)

6(42.9)

7(50.0)

1(7.1)

128(32.0)
272(68.0)

109(40.1)
-

163(59.9)
105(82/0)

0
21(16.4)

0
2(1.6)

305(76.2)
43(10.8)

54(17.7)
33(76.7)

229(75.1)
10(23.3)

20(6.6)
0

2(0.7)
0

52(13)

109(72.2)

268(67.0)

21(5.2)

2(0.5)

13(3.2)
387(96.8)

1(7.7)
108(27.9)

11(84.6)
257(66.4)

1(7.7)
20(5.2)

0
2(0.5)

Both of them
Multiple pregnancy
Yes
No

SUI: Stress Urinary Incontinence, UUI: Urge Urinary Incontinence, MUI: Mixed Urinary Incontinence, BMI: Body Mass Index, NVD: Natural Vaginal Delivery,
C/S: Cesarean Section

International Journal of Nursing Science 2014, 4(2): 17-21

19

Table 2. Comparison of PISQ-Score by Severity of UI

Total PISQ

Mild
(n=109)

Moderate
(n=268)

Sever
(n=21)

Very sever
(n=2)

37.43(1.54)

30.88(4.56)

21.00(2.75)

20.00(1.41)

<0.001
<0.001

Physical

11.45(0.05)

8.45(2.06)

4.38(1.65)

3.50(0.70)

Behavioral- emotive

18.05(1.13)

15.16(2.51)

10.52(1.53)

10.50(0.70)

<0.001

Partner related

7.94(0.24)

7.28(0.83)

6.10(1.04)

6.00(1.41)

<0.001

Table 3. The results obtained from logistic regression

P

OR(95% CI)

OR(95% CI)

Type
SUI

1.0(ref)

1.0(ref)

UUI

1.72(1.0-2.95)

<0.001

1.38(0.36-5.2)

0.63

MUI

3.66(2.12-6.31)

<0.001

3.22(0.87-11.9)

0.79

Age

1.51(1.38-1.66)

<0.001

1.21(1.08-1.36)

<0.001

Education
Higher

1.0(ref)

1.0(ref)

Secondary

11.64(4.03-33.60)

<0.001

0.91(0.05-14.64)

0.95

Primary

3.70(1.26-10.86)

<0.001

1.21(0.08-17.48)

0.88

Employment
Employed

1.0(ref)

Housewife

3.95(2.01-7.73)

<0.001

0.39(0.06-2.46)

1.0(ref)
0.31

BMI

1.08(0.98-1.19)

0.06

1.17(0.91-1.52)

0.21

Menopause
No

1.0(ref)

Yes

627.66(179.35-201.19)

<0.001

57.62(9.03-367.74)

1.0(ref)
0.001

Pregnancy

2.05(1.68-2.50)

<0.001

0.92(0.31-2.78)

0.89

Child

2.36(1.88-2.96)

<0.001

1.17(0.37-3.74)

0.78

Mode of delivery
Both NVD &C/S

1.0(ref)

C/S

3.52(1.53-8.08)

<0.001

2.92(0.31-27.33)

1.0(ref)
0.34

NVD

0.000

<0.001

0.000

0.99

Multiple pregnancy
No

1.0(ref)

1.0(ref)

Yes

1.57(0.50-4.91)

0.21

1.27(0.04-40.26)

0.89

duration of UI

1.40(1.19-1.64)

<0.001

0.84(0.64-1.09)

0.19

Obtained from univariate logistic regression analysis

Obtained from multivariate logistic regression analysis

Tool 4: Sexual function

Sexual function was measured using the pelvic organ
prolapse/ urinary incontinence sexual function questionnaire
(PISQ-12). PISQ is a valid, condition specific and self report
questionnaire that assesses sexual function in women with
urinary incontinence and pelvic organ prolapse. The short
form of the questionnaire (PISQ-12) includes 12 items and
three different domains: physical, behavioral- emotive and
partner related. Each question is rated on a 5-point scale from
0-4, indicating worse to better conditions. Reverse scores are
used for questions 1-4. The highest score is 48 that is
achieved in people with better sexual performance [17].

Psychometric properties of the Iranian version of the

questionnaire are well documented [18].
2.5. Statistical Analysis
The SPSS version 16 was used for statistical analysis.
Data was analyzed using descriptive and analytical methods.
Factors associated with the severity of urinary incontinence
were studied using ANOVA and chi-square test. In addition,
multivariate logistic regression analysis was used to
determine potential confounding factors. The relationship
between the severity of UI and sexual function was assessed
using ANOVA. A P-value less than 0.05 was considered

20

Momenimovahed Zohre et al.: Factors Contributing to the Severity of Urinary Incontinence

and Its Association with Sexual Function: A Cross Sectional Study

statistically significant.
2.6. Ethics
This article is part of masters degree thesis and the Ethics
Committee of Tehran University of Medical Sciences
approved this study. All participants completed informed
consent forms prior to entering the study. To maintain
confidentiality a separate room prepared for the participants.

3. Results
3.1. Demographic Characteristics of the Study Sample
In all, 400 women participated in this study and most
subjects were in the age range 40-54 (47%). Most
participants had secondary education (44.2%) and were
housewives (76.2%) (Table-1).
3.2. Relationship between Severity of Urinary
Incontinence and Sexual Function
Evaluation of the relationship between UI and sexual
function using ANOVA show a significant difference
between the severity of urinary incontinence and the total
score and all domains of PISQ (P<0.001) (Table-2).
As shown in Table-3, the results of univariate regression
analysis show a significant associations between the severity
of urinary incontinence and the type of urinary incontinence,
age, educational level, employment, menopause status,
number of pregnancies and live child birth, mode of delivery,
and the duration of incontinence (P<0.05). To find out the
factors that affected severity of urinary incontinence,
multivariate regression analysis was performed. The
multivariate regression analysis revealed that only age
significantly affected the severity of urinary incontinence
(P<0.001, P=0.001 respectively) (Table-3).

4. Discussion
This study was conducted to explore the factors
contributing to the severity of urinary incontinence. The
results of this study indicated that age and menopause status
were the most important factors that influenced the severity
of UI. It can be stated that the most important factor is age;
because age can also affect the menopause status. The impact
of UI and the higher severity in older age groups reflect the
importance of screening in health care systems.
The relationship between the severity of UI and sexual
function was an important finding of this study. These
findings indicate the need for considering the severity of UI
in women and its impact on other outcomes.
The findings of the present study are similar to the results
of a study by Miller et al (2003). This study demonstrated
that the severity of UI increased with age. According to their
findings, young women had the lowest severity of UI. They
concluded that age and BMI were associated with the
severity of UI [19]. Casquet et al (2006) concluded that the

severity of UI was associated with older age, longer duration

of symptoms, more urinary symptoms, and changes in the
quality of life [20]. Study conducted by Barentson et al (2012)
showed that more severe UI affected the quality of life more
[13]. Also, Saadoun et al (2006) conducted a similar study
and concluded that more severe symptoms of UI were
associated with more impacts on the quality of life [14].
Since sexual health is an important part of womens health,
UI can lead to the reduced quality of life and influences
marital relationship. Sexual dysfunction involves physical,
social and mental life [21]. Women with UI complain of
sexual function to a greater extent [22]. Our study showed
that in comparison with patients with mild UI, more severe
UI was associated with a lower sexual function.
Paick et al carried out a study in 2007. The severity of UI
was assessed using the patient perceived incontinence
severity (PPIS). Sexual function was measured with the
female sexual function index (FSFI). The results of this study
indicated that PPIS substantially affected different aspects of
quality of life and sexual function [23]. Our study had some
limitations which need to be addressed. Exclusion of
illiterate women and conducting the study in the referral
center were some of the limitations of this study. In order to
have better finding, further studies are necessary.

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