To assess the long-term impact of types of commodes and duration of its use on urinary incontinence (UI). 
Objective:
Developing a nomogram to predict the probability of UI among women from the details of types and duration of commode used.

A virtual cross-sectional questionnaire survey was conducted from August 2020 to May 2022, involving 845 healthy women professionals. Details about age, UI, commode type (Indian commode - IC, Western commode – WC and mixed users - IC + WC), and duration of usage were collected. Participants aged 21–40 years were categorized as Group A (n=417), and those aged 41–60 years as Group B (n=304) and analysed.
Binary logistic regression was used to predict the probability of UI and nomogram was developed. Univariate non-linear regression fit identified the pattern of P(UI).

Among the total participants, 49% (418/845) were mixed users (used both IC and WC), 45% (380/845) were exclusive WC users, 3% (25/845) were exclusive IC users, and 3% (22/845) did not specify their usage.
24.2% (101/418) of mixed users and 16.3 % (62 /380) of exclusive WC users reported UI. UI was significantly more among mixed users (P-value: 0.004). None of the exclusive IC users reported UI.
In Group A, 20.8% (86/417) & in Group B, 18.4% (56/304) reported UI.
Fig 1 : Non - linear Regresssion - Commode type vs P(UI)
Table1 : Non-linear Regression Analysis 
Comparison of IC & WC in Group A & B: 
In Group A, as the duration of usage increases from 10 to 40 years, the probability of UI steadily rises in both IC users (18.8 to 29.2%) and WC users (16.5 to 33%). However, the probability of UI and its rate of increase are higher among WC users.
In Group B, a rise in UI probability (15.6 to 26.9%) was observed with increase in duration of usage among IC users. Similar increase was absent in WC users.
Fig 2: Nomogram for prediction of UI 

In Group A, the probability of UI remains below 20% for up to 45 years of IC usage. In contrast, among WC users, the probability increases to 40% for the same period.
In Group B, beyond 45 years of IC usage the P(UI) was more than 30%. However, even after 45 years of WC usage, the P(UI) remained at 20%. WC users take 27 years whereas IC users take a longer time (45 years) to attain the same P(UI) of 20 %.

The risk of developing UI among women of different ages is significantly affected by the type of commode used and the duration of its use.
In the age group of 20 – 40 yrs, irrespective of the commode type, extended duration of usage increases the likelihood of UI.
Among IC users, extended duration of usage increases the P(UI), regardless of age group.
The study supports the use of IC for women aged 20 - 40 years, as WC users have a twice higher probability of developing UI and experience a more rapid increase in risk compared to IC users.
The study did not identify any advantage of using IC in Group B. On the contrary, WC appear to be advantageous. 
The nomogram, a prediction tool, enables self risk assessment of UI among women based on the type of commode (exclusive or mixed) & its duration of usage.

The study supports the use of IC for women aged 20 - 40 years. The nomogram predicts the likelihood of UI, enabling women to self assess their risk of developing UI based on the commode type, duration of use and age.