Urinary incontinence in nulliparous women aged 25-64 years: a national survey

Published:October 06, 2016DOI:


      A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously.


      The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant, nulliparous women, and thereby construct a reference group for comparisons with parous women.

      Study Design

      This postal and World Wide Web–based questionnaire survey was conducted in 2014. The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25-64 years. Four independent age-stratified, random samples comprising 20,000 women were obtained from the total number of eligible nullipara (n = 625,810). A 40-item questionnaire about pelvic floor symptoms, its severity, and its consequences were used. Age-dependent differences for various aspects of urinary incontinence were analyzed with the youngest group (25-34 years) serving as reference. Crude and body mass index–adjusted prevalence and its 95% confidence limits were calculated for each 10-year category.


      The response rate was 52% and the number of study participants was 9197. Urinary incontinence increased >5-fold from 9.7% in the youngest women with a body mass index <25 kg/m2 to 48.4% among the oldest women with a body mass index ≥35 kg/m2. The prevalence of bothersome urinary incontinence almost tripled from 2.8-7.9% among all nulliparas. The proportion with bothersome urinary incontinence among incontinent women increased from 24.4% in the youngest age group to 32.3% in the age group 55-64 years. Nocturia ≥2/night increased 4-fold to 17.0% and leakage ≥1/wk increased 3-fold to 12.8% among the oldest women. Mixed urinary incontinence increased from 22.9-40.9% among the oldest 0-para with incontinence, whereas stress urinary incontinence decreased inversely from 43.6-33.0%. In the total cohort surgical treatment for urinary incontinence occurred in 3 per thousand.


      Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25-64 years. This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth.

      Key words

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        • Olsen A.L.
        • Smith V.J.
        • Bergstrom J.O.
        • Colling J.C.
        • Clark A.L.
        Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.
        Obstet Gynecol. 1997; 89: 501-506
        • DeLancey J.O.L.
        The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment.
        Am J Obstet Gynecol. 2005; 192: 1488-1495
        • Michel M.C.
        • Barendrecht M.M.
        Physiological and pathological regulation of the autonomic control of urinary bladder contractility.
        Pharmacol Ther. 2008; 117: 297-312
        • Thomas T.M.
        • Plymat K.P.
        • Blannin J.
        • Mead T.W.
        Prevalence of urinary incontinence.
        Br Med J. 1980; 281: 1243-1245
        • Coyne K.S.
        • Sexton C.C.
        • Thompson C.L.
        • et al.
        The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study.
        BJU Int. 2009; 104: 352-360
        • Hellstrom A.
        • Hanson E.
        • Hansson S.
        • Hjalmars K.
        • Jodal U.
        Micturition habits and incontinence at age 17–reinvestigation of a cohort studied at age 7.
        Br J Urol. 1995; 76: 231-234
        • Milsom I.
        • Altman D.
        • Herbison P.
        • et al.
        Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI).
        in: Abrams P. Cardozo L. Khoury S. Wein A. Incontinence. 5th ed. Health Publications Ltd, Paris2013: 15-107
        • Rortveit G.
        • Hannestad Y.S.
        • Daltveit A.K.
        • Hunskaar S.
        Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study.
        Am J Obstet Gynecol. 2001; 98: 1004-1010
        • MacLennan A.H.
        • Taylor A.W.
        • Wilson D.H.
        • Wilson D.
        The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery.
        BJOG. 2000; 107: 1460-1470
        • Sandvik H.
        • Hunskaar S.
        • Seim A.
        • Hermstad R.
        • Vanvik A.
        • Bratt H.
        Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey.
        J Epidemiol Community Health. 1993; 47: 497-499
        • Tegerstedt G.
        • Miedel A.
        • Maehle-Schmidt M.
        • Nyren O.
        • Hammarstrom M.
        A short-form questionnaire identified genital organ prolapse.
        J Clin Epidemiol. 2005; 58: 41-46
        • Jorge J.M.
        • Wexner S.D.
        Etiology and management of fecal incontinence.
        Dis Colon Rectum. 1993; 36: 77-97
        • Haylen B.T.
        • de Ridder D.
        • Freeman R.M.
        • et al.
        An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.
        Int Urogynecol J. 2010; 21: 5-26
        • Nygaard I.
        • Barber M.D.
        • Burgio K.L.
        • et al.
        Prevalence of symptomatic pelvic floor disorders in US women.
        JAMA. 2008; 300: 1311-1316
        • Zhang L.
        • Zhu L.
        • Xu T.
        • et al.
        A population-based survey of the prevalence, potential risk factors, and symptom-specific bother of lower urinary tract symptoms in adult Chinese women.
        Eur Urol. 2015; 68: 97-112
        • McKinnie V.
        • Swift S.E.
        • Wang W.
        • et al.
        The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence.
        Am J Obstet Gynecol. 2005; 193: 512-518
        • Foldspang A.
        • Mommsen S.
        • Lam G.W.
        • Nager C.W.
        • Luber K.M.
        Parity, mode of delivery, and pelvic floor disorders.
        Obstet Gynecol. 2006; 107: 1253-1260
        • Brown S.J.
        • Donath S.
        • MacArthur C.
        • McDonald E.A.
        • Krastev A.H.
        Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors.
        Int Urogynecol J. 2010; 21: 193-202
        • O’Halloran T.
        • Bell R.J.
        • Robinson P.J.
        • Davis S.R.
        Urinary incontinence in young nulligravid women.
        Ann Intern Med. 2012; 157: 87-93
        • Bardino M.
        • Di Martino M.
        • Ricci E.
        • Parazzini F.
        Frequency and determinants of urinary incontinence in adolescent and young nulliparous women.
        J Pediatr Adolesc Gynecol. 2015; 28: 462-470
        • Milsom I.
        • Ekelund P.
        • Molander U.
        • Arvidsson L.
        • Areskoug B.
        The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women.
        J Urol. 1993; 149: 1459-1462
        • Simeonova Z.
        • Milsom I.
        • Kullendorff A.M.
        • Molander U.
        • Bengtsson D.
        The prevalence of urinary incontinence and its influence on the quality of life in women from an urban Swedish population.
        Acta Obstet Gynecol Scand. 1999; 78: 546-551
        • Elving L.B.
        • Foldspang A.
        • Lam G.W.
        • Mommsen S.
        Descriptive epidemiology of urinary incontinence in 3,100 women age 30-59.
        Scand J Urol Nephrol Suppl. 1989; 125: 37-43
        • Norton P.
        • Brubaker L.
        Urinary incontinence in women.
        Lancet. 2006; 367: 57-67
        • DeLancey J.O.L.
        • Kearney R.
        • Chou Q.
        • Speights S.
        • Binno S.
        The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery.
        Obstet Gynecol. 2003; 101: 46-53
        • Mitchell W.K.
        • Williams J.
        • Atherton P.
        • Larvin M.
        • Lund J.
        • Narici M.
        Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review.
        Front Physiol. 2012; 3: 260
        • Kyle U.G.
        • Genton L.
        • Hans D.
        • Karsegard L.
        • Slosman D.O.
        • Pichard C.
        Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years.
        Eur J Clin Nutr. 2001; 55: 663-672
        • Deschenes M.R.
        Effects of aging on muscle fiber type and size.
        Sports Med. 2004; 34: 809-824
        • Silva A.M.
        • Shen W.
        • Heo M.
        • et al.
        Ethnicity-related skeletal muscle differences across the lifespan.
        Am J Hum Biol. 2009; 22: 7682
        • Rothman K.J.
        • Greenland S.
        • Lash T.L.
        Design strategies to improve study accuracy, restriction.
        in: Rothman K. Greenland S. Lash T. Modern epidemiology. 3rd ed. Lippincott Williams and Wilkins, Philadelphia2008: 168-182
        • Bauer K.W.
        Conducting longitudinal studies.
        in: Porter S. Umbach P. New techniques for survey research. Jossey-Bass. NDIR, San Francisco2004: 75-90