Original Article: Clinical Investigation Prevalence and risk factors of female urinary incontinence in eastern Turkey Rahmi Onur, 1 Suleyman Erhan Deveci, 2 Suheyla Rahman, 2 Feyza Sevindik 2 and Yasemin Acik 2 Departments of 1 Urology and 2 Public Health, Firat University Faculty of Medicine, Elazig, Turkey Objectives: To evaluate the prevalence of urinary incontinence (UI) and determine risk factors for its development in women living in eastern Turkey. Methods: A cross-sectional study was conducted on 2275 women aged between 17 and 80 years. A questionnaire examining demographic characteristics, parity and pelvic organ prolapse was given. Presence and types of incontinence were examined using a validated form of the Turkish version of the urogenital distress inventory questionnaire-short form (UDI-6). Results: A total of 1054 (46.3%) women reported involuntary loss of urine. Stress UI was present in 46% of women, whereas urge UI was detected in 43% of them. Mean age of patients with and without UI were 44.57 + 11.04 and 35.04 + 9.51, respectively. Age, total number of pregnancies and number of deliveries were shown to be significantly different in patients with and without any type of UI. Multiple logistic regression analysis of the factors revealed that age, total delivery number, pelvic organ prolapse and difficult labor were significantly associated with the presence of UI. Conclusions: This is the first study examining the prevalence of UI in women living in eastern Turkey. By using a validated questionnaire, several risk factors for the development of UI were determined. Pelvic organ prolapse and increased number of births were found to be two most significant ones. Key words: female, prevalence, Turkey, urinary incontinence. Introduction Urinary incontinence (UI), which is defined as ‘the complaint of any involuntary leakage of urine’ by the International Continence Society (ICS), is a common and distressing condition especially affecting women. 1 Studies carried out for estimating the prevalence and inci- dence of UI revealed considerable variations. These variations may be attributed to the definition of incontinence, assessment of different study populations and data collection methods. 2,3 Similarly, women from different racial and ethnic groups were reported to have different symptoms and different predisposing factors. 4 Many epidemiological studies revealed prevalence rates for UI ranging from 12% to 53%, whereas the prevalence assessed for only young adult and middle-aged women were between 26% and 58%. 5–7 Race was reported to be an important factor in the development of UI andAsian-American women were found to have a lower prevalence of UI than white or Hispanic women. 8 Previous studies showed that the overall prevalence rate for UI inTurkish women was similar to those determined in Western populations. 2,9,10 However, patients evaluated in those studies were sampled from westernTurkey. In the present study, we aimed to evaluate the prevalence of UI by a validated tool in eastern Turkey, where women have a different lifestyle, childbearing properties and urban/rural life. We examined the role of age, marital and educa- tional status, number of pregnancies, number of live deliveries, mode of delivery, difficult labor, number of abortus, use of forceps or vacuum device, and presence of pelvic organ prolapsus on development of UI. Methods Study population The population of women older than 17 years in Elazig city is 127 531. Primary health care for all residents of Elazig city is provided at 18 different health care centers. In this cross-sectional study, we used computer records to sample one of 48 women from all of these 18 primary health care centers systematically.We used a table of random- ized numbers with each health center being in direct relation to the exact population in the area. So the sample health centers represented the exact population in the area. In most of the studies, the prevalence rate of UI was reported as 20–40%, 2,9,10 thus we estimated a minimum sample size of subjects to be 2628. Using the charts of each family member in the primary health care centers, we randomly selected 2628 women. Each health care center was represented according to the rate of population in the sample. A total of 2275 women could be contacted after multiple visits and the response rate was 86.6%. The Turkish version of the urogenital distress inventory questionnaire-short form (UDI-6) was used to estimate the prevalence of UI. 11,12 Risk factors for UI were assessed by specific questionnaires completed by previously educated nurses during face-to-face inter- views with each participant. Patient age, marital status (married or divorced), age at marriage, education status, number of pregnancies, number of live deliveries, normal vaginal delivery or difficult labor, number of abortus, use of forceps or vacuum device, and presence of pelvic organ prolapsus were assessed in all women. Questionnaire The local ethics committee approved the study protocol and written informed consent was obtained from each individual to complete the questionnaires. The questionnaire consisted of three parts: the demo- graphic characteristics, past medical history (pelvic organ prolapse as Correspondence: Rahmi Onur MD, Firat Universitesi Hastanesi, Uroloji klinigi, Elazig 23200, Turkey. Email: rahmionur@yahoo.com Received 24 October 2008; accepted 30 March 2009. Online publication 28 April 2009 International Journal of Urology (2009) 16, 566–569 doi: 10.1111/j.1442-2042.2009.02311.x 566 © 2009 The Japanese Urological Association