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Risk Factors for Urinary, Fecal, or Dual Incontinence in the Nurses' Health Study

Matthews, Catherine A. MD; Whitehead, William E. PhD; Townsend, Mary K. ScD; Grodstein, Francine ScD

doi: 10.1097/AOG.0b013e31829efbff
Original Research

OBJECTIVE: To estimate the prevalence of urinary incontinence, fecal incontinence, and dual incontinence in a large cohort of older women and compare risk factors across the three conditions.

METHODS: These cross-sectional analyses used data from the Nurses' Health Study. The 2008 questionnaire, mailed to 96,480 surviving participants aged 62–87 years, included two separate items on the prevalence of urinary and fecal incontinence. A response of leakage at least once per month defined incontinence for both urine and stool. Dual incontinence was defined by responses at this frequency for both conditions. Using a polytomous logistic regression model, we assessed each risk factor for prevalence of urinary, fecal, and dual incontinence.

RESULTS: The survey was completed by 64,396 women. Thirty-eight percent had urinary incontinence alone, 4% had fecal incontinence alone, and 7% had dual incontinence. Age older than 80 years compared with age younger than 70 years was associated most strongly with dual incontinence (odds ratio [OR] 2.49, 95% confidence interval [CI] 2.28–2.73) followed by depression (OR 2.28, 95% CI 2.13–2.43), neurologic disease (OR 1.84, 95% CI 1.65–2.07), functional limitations (OR 1.86, 95% CI 1.71–2.02), multiparity (OR 1.66, 95% CI 1.41–1.94), and heavier fetal birth weight (OR 1.24, 95% CI 1.10–1.41). Obesity was associated only with urinary incontinence (OR 1.99, 95% CI 1.90–2.08) and type 2 diabetes mellitus was a stronger risk factor for fecal than urinary incontinence (OR 1.43, 95% CI 1.28–1.59). Black race was associated with a reduced risk of all types of incontinence, especially dual incontinence (OR 0.30, 95% CI 0.21–0.44).

CONCLUSION: In this large cohort, dual incontinence was primarily associated with advanced age, decompensating medical conditions, depression, and multiparity.


In a cohort of more than 64,000 community-dwelling older women, dual incontinence is associated primarily with age-related comorbid medical conditions, depression, and multiparity.

Division of Urogynecology, Department of Obstetrics and Gynecology, and the Division of Gastroenterology, Department of Internal Medicine, University of North Carolina, Chapel Hill, North Carolina; and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

Corresponding author: Catherine A. Matthews, MD, Box 7570, Chapel Hill, NC 27599; e-mail:

Supported by grants P01 CA87969, R01 DK62438, and R01 HS018695 from the National Institutes of Health.

Presented in part at the 38th Annual Meeting of the International Urogynecologic Association, May 28–June 1, 2013, Dublin, Ireland.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.