Risk Factors for Urge Incontinence
Urge incontinence has distinct risk factors that differ from stress incontinence, with advancing age, diabetes, obesity, and recurrent urinary tract infections being the most significant modifiable and non-modifiable predictors. 1
Primary Risk Factors
Age-Related Risk
- Advancing age is the strongest independent risk factor for urge incontinence, with prevalence increasing from 13% in young nulligravid women to 75% in older women. 1
- Urge incontinence is most common in women over age 75 years (24.2% prevalence), unlike stress incontinence which peaks in middle age. 2
- Each 5-year increase in age increases the odds of weekly urge incontinence by 1.2-fold. 3
Metabolic and Medical Conditions
- Diabetes mellitus is a major independent risk factor, associated with a 30-100% increased risk of urge incontinence compared to non-diabetic women. 1
- Diabetic women treated with insulin are at considerably higher risk of urge incontinence than those treated with oral medications or diet alone. 1
- The mechanism involves detrusor muscle paralysis, impaired bladder sensation, and altered urothelial signaling from chronic hyperglycemia. 1
Obesity and Body Composition
- Obesity increases risk of urge incontinence, with each 5-unit increase in BMI associated with higher odds (OR 1.1 per 5 units). 3
- Being overweight or obese is significantly associated with mixed incontinence (which includes an urge component). 2
- Higher waist-to-hip ratio independently predicts urge symptoms. 3
Infectious and Inflammatory Factors
- Recurrent urinary tract infections are strongly associated with urge incontinence, with women reporting two or more UTIs in the prior year having double the odds (OR 2.0). 3
- Previous urinary tract infection is associated with higher risk of incontinence in diabetic women. 1
Secondary Risk Factors
Neurological and Cognitive Factors
- Impaired cognitive function and orientation predict severity of urge incontinence, particularly incontinence resistant to anticholinergic therapy. 4
- Cerebral cortical underperfusion is associated with persistent urge incontinence after treatment. 4
- Functional and cognitive impairment alter the clinical presentation and treatment approach. 5, 6
Gynecologic and Obstetric History
- Hysterectomy is significantly associated with mixed incontinence (p=0.021). 2
- Vaginal delivery is a predictor of urge incontinence (as well as stress and mixed types). 7
- Posterior pelvic organ prolapse is associated with both stress and urge incontinence. 7
Potentially Modifiable Lifestyle Factors
- Constipation increases risk of all types of urinary incontinence including urge type. 7
- Excessive fluid intake predicts amount of urine loss in geriatric urge incontinence. 4
- Smoking and caffeine consumption are associated with urinary incontinence symptoms. 1
Bladder-Specific Factors
- Reduced bladder sensation predicts persistent urge incontinence after anticholinergic treatment. 4
- Increased voiding frequency before treatment predicts greater urine loss. 4
- Detrusor overactivity from urothelial dysfunction and altered prostaglandin release contributes to urgency symptoms. 1
Important Clinical Distinctions
Urge vs. Stress Incontinence Risk Profiles
- Urge and stress incontinence have fundamentally different risk factor profiles, suggesting distinct pathophysiology and requiring type-specific prevention strategies. 3
- While stress incontinence is associated with parity and mechanical factors, urge incontinence relates more to age, metabolic disease, and neurological factors. 2, 3
- White race is more strongly associated with stress incontinence (OR 2.8), while racial differences are less pronounced for urge incontinence. 3
Clinical Implications for Screening
- Although increasing parity, advancing age, and obesity increase risk, these factors should not be used to limit screening - annual screening is recommended for all women regardless of risk factors. 1
- Many women do not volunteer symptoms despite significant impact on quality of life, making systematic screening essential. 1