Pregnancy is known for its inducing effect on urinary incontinence (UI), however, pregnant women seem to differ in the degree of discomfort experienced regarding UI, which may influence help-seeking behavior. Studies on this topic are scarce. Additionally, it is not clear which factors are related to help-seeking behavior for UI treatment. Thus, the aim of this work was to investigate the prevalence of self-reported UI in pregnant women, the impact of urinary loss on daily life, and the factors related to help-seeking behavior for treatment.

This is a cross-sectional excerpt from a randomized controlled trial conducted to evaluate the knowledge, attitude, and practice of postpartum women regarding UI. The study was approved by the ethics committee (CAAE 56539116.4.3002.5050) and carried out after informed consent from the participants. Eligible women were those in immediate postpartum, aged ≥18 years, capable of answering the questions. Women were recruited through researchers' invitation in person at the postpartum ward of a public maternity hospital from July 2018 to August 2021. Participants provided personal information about age, education level, income, gynecological-obstetric history, and participation in educational activities during prenatal care. The prevalence and impact of UI were assessed using the International Consultation Incontinence Questionnaire - Short Form (ICIQ-SF). Women who reported UI also had their help-seeking behavior for UI treatment evaluated through the practice domain of the KAP-IU questionnaire by Ribeiro and colleagues (2022). The prevalence of UI among the interviewees was calculated as the percentage of postpartum women who reported UI during pregnancy. The impact of urinary loss was calculated using the third and fourth questions of the ICIQ-SF. Pearson's chi-square test and Mann-Whitney U test were used to verify factors related to help-seeking behavior. A significance level of 5% and a 95% confidence interval were adopted for all tests. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 20 for Windows.

The initial sample was 138 women, mostly young (M: 25.9 ± 5.8), with good education (> 9 years of study), low economic status, early initiation of prenatal care, and only a few women participated in childbirth education activities (<10%). The prevalence of UI during pregnancy was 44.9% (N=62). Stress urinary incontinence was the most reported type (N=27/43.5%). Almost 47% (N=29) of the respondents reported UI episodes once a week or less, with 79.0% (N=49) reporting a small amount of urine per episode. On average, the impact of UI in daily life had 5.89 (±3.36) scores. Just over 35.0% (n=22/62) of women sought help for UI treatment, with doctors (59.1%) and nurses (31.8%) being the most sought-after healthcare providers, respectively. Reasons for not seeking treatment included: normalizing urinary loss (57.5%), lack of interest in treatment (17.5%), and considering it to be in small amounts (12.5%). Therefore, women with UI complaints (n=62) were divided by help-seeking behavior (n=22) and those who did not seek medical assistance (n=40). They were compared to identify related factors. There was no difference in most sociodemographic and obstetric variables. Help-seeking behavior was higher among women with lower monthly family income (p=0.007), higher knowledge assessment scores (p=0.044), and increased frequency of urinary loss (p=0.034).

This study demonstrated a significant prevalence of self-reported UI during pregnancy, with stress urinary incontinence being the most frequently reported type. Although the reported frequency and amount of urinary loss were lower, the impact in daily life warrants consideration. Respondents who sought help mainly turned to doctors and nurses, likely due to their accessibility in our healthcare system. Normalizing urinary loss during pregnancy was the most commonly cited reason for not seeking help, indicating the majority of women's lack of awareness about pelvic floor issues and the risks of remaining incontinent after childbirth. Thus, women with higher levels of knowledge about UI are more likely to seek treatment; however, a higher frequency of urinary loss may also encourage help-seeking behavior. Women with lower income may have sought more help for UI treatment due to limited resources to manage this condition.

Women with lower income, higher knowledge about UI, and more episodes of urinary loss tend to develop a help-seeking behavior for treatment. Women's knowledge about UI is an important factor to consider in healthcare planning.

Ribeiro GL, Firmiano MLV, Vasconcelos CTM, Vasconcelos Neto JA, Lopes MHBM, Damasceno AKC (2023) Conhecimento, atitude e prática de gestantes sobre incontinência urinária: estudo observacional. ESTIMA, Braz. J. Enterostomal Ther., 21: e1324.
Moossdorff-Steinhauser, H. F., Berghmans, B. C., Spaanderman, M. E., & Bols, E. M. (2021). Urinary incontinence during pregnancy: prevalence, experience of bother, beliefs, and help-seeking behavior. International urogynecology journal, 32, 695-701.
Ribeiro, G. L., Firmiano, M. L. V., Vasconcelos, C. T. M., Saboia, D. M., de Moraes Lopes, M. H. B., & Vasconcelos Neto, J. A. (2022). Scale of pregnant women’s assessment of knowledge, attitude, and practice related to urinary incontinence. International Urogynecology Journal, 33(6), 1503-1509.

Continence 12S (2024) 101654
DOI: 10.1016/j.cont.2024.101654