Risk factors and prevalence of urinary incontinence in mid-life Singaporean women: the Integrated Women’s Health Program

  • Kai Lyn Ng
  • K. W. Roy Ng
  • Win Pa Pa Thu
  • Michael S. Kramer
  • Susan Logan
  • Eu-Leong YongEmail author
Original Article


Introduction and hypothesis

The objective was to identify the prevalence and risk factors for urinary incontinence (UI) in healthy midlife Singaporean women.


Healthy women, aged 45–69 years, were assessed for UI and sociodemographic characteristics, including ethnicity, menopausal status, parity, and body mass index (BMI). UI subtypes corresponding to stress (SUI) alone, urge (UUI) alone, mixed (MUI), and leakage (drops only) incontinence were classified using the Urinary Distress Inventory 6 (UDI-6). Risk factors were examined using Chi-squared tests, followed by sequential multivariate logistic regression to estimate adjusted odds ratios (aOR and 95% confidence intervals).


A total of 1,119 women (mean age 56.2 ± 5.2) completed the UDI-6. 52.3% reported any UI; MUI and SUI were the most common, each affecting 20% of women. Post-menopausal women had a lower risk (aOR 0.5 [0.3–0.9]) of SUI, but a higher risk (aOR 4.4 [1.0–19.9]) of UUI compared with premenopausal women. Higher education was negatively associated (aOR 0.3 [0.2–0.7]) with UUI, but positively associated with MUI (aOR 2.3 [1.3–4.0]). Parity (1–2 children) increased the risk of SUI (aOR 1.8 [1.0–3.1]), but reduced the risk of UUI (aOR 0.4 [0.2–0.9]). Obesity was associated with increased risk for MUI (aOR 2.2 [1.4–3.4]) and leakage (aOR 2.0 [1.0–4.1]). Malays and Indians had a higher risk of MUI, having (aOR 2.1 (1.2–3.7) and 1.7 (1.1–2.7) respectively compared with Chinese, a difference mediated by higher BMI.


Urinary incontinence is a major morbidity prevalent in healthy midlife Asian women. Post-menopausal status, education level, parity, BMI (and its link with ethnicity) are independent risk factors in this population, and should be incorporated into counseling and targeted interventions.


Urinary incontinence Prevalence Midlife Asian women Risk factors Urinary distress inventory 6 (UDI-6) 



The authors would like to thank our study participants and all members of the IWHP who coordinated the study visits and performed data collection. We would also like to acknowledge contribution of Ms. Shamini Ganasarajah, who provided initial data analysis support.

Funding information

This study was partially funded by a Singapore National Medical Research Council Grant (Number: CSASI16May007) to E.L. Yong.

This study was supported by Obstetrics and Gynecology Pitch for Fund Research Grant (OG PFFR FY 2014) from the Department of Obstetrics and Gynecology, National University of Singapore.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyNational University Hospital, National University of SingaporeSingaporeSingapore
  2. 2.Departments of Epidemiology, Biostatistics & Occupational Health and of PediatricsMcGill University Faculty of MedicineMontrealCanada

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