Prevalence of Incontinence in Black Women’s Health Study

Objectives: Several epidemiologic studies estimate the prevalence of incontinence, urinary (UI), fecal (FI) and dual (DI) in US women, however none have specifically examined the prevalence of UI, FI, and DI in a large cohort of self-identified black women. Thus, the primary objective was to estimate the prevalence of the incontinence types in the Black Women’s Health Study (BWHS) and extrapolate these findings to black women in the US by integrating BWHS prevalence with the 2020 US Census data.

Methods: In 2011, the BWHS administered follow-up surveys among women 35 years and older which inquired about their experiences with UI, FI and DI in the previous year. Survey included questions about frequency and severity of leakage of urine and stool in the previous year. Using this cross-sectional data, we assessed prevalence of UI in women 35 years or older and prevalence of FI and DI in post-menopausal women. We compared participant characteristics of women with and without incontinence. We then standardized age-specific prevalence’s from BWHS with the 2020 US Census weights to extrapolate findings to self-identified black women in the US. All analyses were conducted using R version 4.3.

Results: Based on data from 38,100 women the estimated prevalence of any UI was 50.57%. The prevalence of any UI increased with age; the prevalence of UI was 63% in women 85 years or older. Stress (SUI), urge (UUI), mixed (MUI), and other incontinence, accounted for 33%, 34%, 20%, and 13%, respectively among women with UI. Most women had mild urinary incontinence (56.5%) with 24% having moderate UI and 19.5% having severe UI. A total of 19,244 post-menopausal women were included in the analysis regarding FI. Approximately 14% of post-menopausal women reported any FI, and 10% reported having DI. Extrapolating estimates from BWHS data to the US Census data for women 35 years or older, we report in 2020, approximately 5.6 million black women (95% CI = 5.24, 5.80) have UI, 1.4 million women have FI (95% CI =1.27, 1.73) and 1 million women have DI (95% CI = 0.91, 1.32).

Conclusions: To our knowledge this is the first large epidemiologic study to assess prevalence of UI, FI, and DI amongst community dwelling black women in the United States. Unlike pelvic organ prolapse, incontinence is just as prevalent amongst community dwelling black women over the age of 35. We report similar prevalence of any UI and FI as reported by other studies. However, amongst women with UI we observed a higher proportion reporting UUI and lower proportion reporting MUI than previously reported in black women. We also estimate a higher prevalence of dual incontinence (10%) in black post-menopausal women than previously published (4 to 6%).