Anal and urinary incontinence in nulliparous women - Prevalence and associated risk factors.

Objective: To establish the prevalence and risk factors of urinary and anal incontinence in nulliparous women.
Study Design: Thirty-one catholic convents were sent a validated questionnaire to determine the prevalence and severity of urinary incontinence, and a similarly structured questionnaire to assess anal incontinence. Multivariable regression models were used to determine independent risk factors associated with the likelihood of urinary incontinence or anal incontinence.
Main Outcome Measures: Urine/faecal/flatal incontinence and symptom severity.
Results: Of 202 nuns, 167 (83%) returned the questionnaire. Twenty-two women were excluded due to history of childbirth. Of 145 nulliparous women, 56.2% reported urinary incontinence and 53.8% reported anal incontinence. Women aged 66-76 years had significantly increased odds of experiencing urinary incontinence in comparison to women aged 40-65 years: OR: 2.35 (95% CI: 1.02-5.45) ( p  = 0.04). The risk of urinary incontinence was increased in women with a body mass index ≥ 30 in comparison to those with a body mass index < 19: OR: 6.25 (95% CI: 1.03-38.08) ( p  = 0.04). With regards to anal incontinence, although none of the differences with age and body mass index groups reached statistical significance, there was a trend towards women in higher body mass index groups having an increased prevalence of anal incontinence. Current/previous hormonal replacement therapy was also associated with significantly increased odds of experiencing urinary incontinence: OR: 2.53 (95% CI: 1.01-6.36), ( p  = 0.04). However, when adjusting for age and body mass index, there was no significant association with urinary incontinence.
Conclusions: This study highlights that while childbirth is an important risk factor, urinary incontinence and anal incontinence also occur in over 50% of nulliparous women. Additional studies are required to identify other risk factors that may be associated with incontinence in this population.