Skip to main content

Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women


Introduction and hypothesis

Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria.


This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires.


Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P < 0.05).


Urinary and anal incontinence are common after vaginal delivery in Enugu, Nigeria. Modification of obstetric care and discouraging preventable predisposing factors for incontinence, such as prolonged second stage of labor and vaginal delivery of macrosomic babies, are measures that may reduce the prevalence of postpartum incontinence in our population.

This is a preview of subscription content, access via your institution.


  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A, Standardisation Sub-committee of the International Continence Society (2002) The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the international continence society. Neurourol Urodyn 21:167–178

    Article  PubMed  Google Scholar 

  2. Macmillan AK, Meurie AE, Marshall RJ, Parry BR (2004) The prevalence of fecal incontinence in community dwelling adult: a systematic review of the literature. Dis Colon Rectum 47:1341–1349

    Article  PubMed  Google Scholar 

  3. Hatem M, Pasquier JC, Fraser W, Lepire E (2007) Factors associated with postpartum urinary/anal incontinence in primiparous women in Quebec. J Obstet Gynaecol Can 29:232–239

    PubMed  Google Scholar 

  4. Groutz A, Fait G, Lessing JB, David MP, Wolman I, Jaffa A, Gordon D (1999) Incidence and obstetric risk factors of postpartum anal incontinence. Scand J Gastroenterol 34:315–318

    CAS  PubMed  Google Scholar 

  5. Lal M, HMann C, Callender R, Radley S (2003) Does caesarean delivery prevent anal incontinence? Obstet Gynecol 101:305–312

    Article  PubMed  Google Scholar 

  6. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I (2013) A comparison of the long-term consequences of vaginal delivery versus caesarean section on the prevalence, severity and bothersomeness of urinary incontinence subtypes: a national cohort study in primiparous women. BJOG 120:1548–1555

    CAS  PubMed  Google Scholar 

  7. Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A (2011) Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol 118:777–784

    PubMed Central  PubMed  Google Scholar 

  8. Rogers RG, Leeman LM, Borders N, Qualls C, Fullilove AM, Teaf D, Hall RJ, Bedrick E, Albers LL (2007) Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women. J Obstet Gynaecol Can 29:232–239

    Google Scholar 

  9. National Population Commission (NPC) [Nigeria] and ICF Macro. Nigeria Demographic and Health Survey (2008) Abuja, Nigeria: National Population Commission and ICF Macro

  10. Okonkwo JE, Obionu CN, Okonkwo CV, Obiechina NJ (2002) Anal incontinence among Igbo (Nigerian) women. Int J Clin Pract 56:178–180

    CAS  PubMed  Google Scholar 

  11. Ijaiya MA, Raji HO, Aboyeji AP, Adesina KT, Adebara IO, Ezeoke GG (2011) Non-fistulous urinary leakage among women attending a Nigerian family planning clinic. Int J Womens Health 3:409–413. doi:10.2147/IJWH.S23179

    Article  PubMed Central  PubMed  Google Scholar 

  12. Adaji SE, Shittu OS, Bature SB, Nasir S, Olatunji O (2011) Bothersome lower urinary symptoms during pregnancy: a preliminary study using the international consultation on incontinence questionnaire. Afr Health Sci 11(Suppl 1):S46–S52, PMID:22135644

    PubMed Central  PubMed  Google Scholar 

  13. Kelly J (1995) Ethiopia: an epidemiological study of vesicovaginal fistulas in Addis Ababa. World Health Stat Q 48:15–17

    CAS  PubMed  Google Scholar 

  14. Danso KA, Martey JO, Wall LL, Elkins TE (1996) The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992. Int Urogynecol J Pelvic Floor Dysfunct 7:117–120

    Article  CAS  PubMed  Google Scholar 

  15. Farrell SA, Allen VM, Baskett TF (2001) Parturition and urinary incontinence in primiparas. Obstet Gynecol 97:350–356

    Article  CAS  PubMed  Google Scholar 

  16. Mørkved S, Bø K (1999) Prevalence of urinary incontinence during pregnancy and postpartum. Int Urogynecol J Pelvic Floor Dysfunct 10:394–398

    Article  PubMed  Google Scholar 

  17. Spellacy E (2001) Urinary incontinence in pregnancy and the puerperium. J Obstet Gynecol Neonatal Nurs 30:634–641

    Article  CAS  PubMed  Google Scholar 

  18. Iyoke CA, Ezugwu FO, Onal HE (2010) Prevalence and correlates of maternal morbidity in Enugu, South-East Nigeria. Afr J Reprod Health 14:121–129

    Google Scholar 

  19. Abrams P, Avery K, Gardener N, Donovan J, ICIQ Advisory Board (2006). The international consultation on incontinence questionnaire on urinary incontinence: J Urol1 75(3 Pt 1):1063–1066; discussion 1066

  20. Boyles SH, Li H, Mori T, Osterweil P, Guise JM (2009) Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol 113:134–141

    Article  PubMed  Google Scholar 

  21. Olusanya O, Okpere EE, Ezimokhai M (1985) The importance of social class in voluntary fertility control in a developing country. West Afr J Med 4:205–212

    Google Scholar 

  22. Brincat C, Lewicky-Gaupp C, Patel D, Sampselle C, Miller J, Delancey JO, Fenner DE (2009) Fecal incontinence in pregnancy and postpartum. Int J Gynaecol Obstet 106:236–238

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rubens BS, Tissot WD, Diokno AC (2006) Epidemiology: USA. In: Cardozo L, Staskin D (eds) Textbook of female urology and urogynaecology, vol 1, 2nd edn. Informa Healthcare Ltd, London, pp 13–22

    Google Scholar 

  24. Fenner DE, Trowbridge ER, Patel DA, Fultz NH, Miller JM, Howard D, DeLancey JO (2008) Establishing the prevalence of incontinence study: racial differences in women’s patterns of urinary incontinence. J Urol 179:1455–1460

    Article  PubMed Central  PubMed  Google Scholar 

  25. Hoyte L, Thomas J, Foster RT, Shott S, Jakab M, Weidner AC (2005) Racial differences in pelvic morphology among asymptomatic nulliparous women as seen on three-dimensional magnetic resonance images. Am J Obstet Gynecol 193:2035–2040

    Article  PubMed  Google Scholar 

  26. Howard D, Delancey JO, Tunn R, Ashton-Miller JA (2000) Racial differences in the structure and function of the stress urinary continence mechanism. Obstet Gynecol 95:713–717

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Solans-Domènech M, Sánchez E, Espuña-Pons M, Pelvic Floor Research Group (Grup de RecercadelSòlPelvià; GRESP) (2010) Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol 115:618–628

    Article  PubMed  Google Scholar 

  28. Ezegwui HU, Ikeakor LC, Egbuji C (2011) Fetal macrosomia: obstetric outcome of 311 cases in UNTH, Enugu, Nigeria. Niger J Clin Pract 14:332–336

    Article  Google Scholar 

  29. Baydock SA, Flood C, Schulz JA, MacDonald D, Esau D, Jones S, Hiltz CB (2009) Prevalence and risk factors for urinary and fecal incontinence 4 months after vaginal delivery. J Obstet Gynaecol Can 31:36–41

    PubMed  Google Scholar 

  30. Sampselle CM (1990) Changes in pelvic muscle strength and stress urinary incontinence associated with childbirth. J Obstet Gynaecol Neonatal Nurs 19:371–377

    Article  CAS  Google Scholar 

Download references


1. K.C. Obioha: Protocol/project development, data collection, data analysis, manuscript writing/editing

2. E.O. Ugwu: Protocol/project development, data collection, data analysis, manuscript writing/editing

3. S.N. Obi: Protocol/project development, data analysis, manuscript writing/editing

4. C.C. Dim: Protocol/project development, data analysis, manuscript writing/editing

5. T.C. Oguanuo: Protocol/project development, data analysis, manuscript writing/editing

Conflicts of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Emmanuel Onyebuchi Ugwu.


Appendix 1

International Consultation on Incontinence Questionnaire on Urinary Incontinence–Short Form (ICIQ-UI-SF):

1. How often do you leak urine (tick one box)?

0 □ Never

1 □ About once a week or less often

2 □ Two or three times a week

3 □ About once a day

4 □ Several times a day

5 □ All the time

II. We would like to know how much urine you think leaks. How much urine do you usually leak (whether you wear protection or not)? (Tick one box)

0 □ None

2 □ A small amount

4 □ A moderate amount

6 □ A large amount

III. Overall, how much does leaking urine interfere with your everyday life? Please circle a number between 0 (not at all) and 10 (a great deal). 0 1 2 3 4 5 6 7 8 9 10

ICIQ-UI-SF score = sum I+II+III.

ICIQ-UI-SF Score > 0 = urinary incontinence

ICIQ-UI-SF Score 1–6 = mild urinary incontinence

ICIQ-UI-SF Score >6 = moderate/severe urinary incontinence

IV. When does urine leak? (Please tick all that applies to you.)

1 □ Never—urine does not leak

2 □ Leaks before you can get to the toilet

3 □ Leaks when you cough or sneeze

4 □ Leaks when you are asleep

5 □ Leaks when you are physically active or exercising

6 □ Leaks when you have finished urinating and are dressed

7 □ Leaks for no obvious reason

8 □ Leaks all the time

The unscored self-diagnostic item IV helps indicate the patient’s perception of the cause of her incontinence.

Appendix 2

Anal Incontinence Questionnaire

  1. 1)

    Are you having uncontrolled (involuntary) leakage of feces or flatus? [ ]YES, [ ]NO

  2. 2)

    If yes which one? [ ]Faeces, [ ]Flatus, [ ]Both

  3. 3)

    Does it soil your pants? [ ]YES, [ ]NO

  4. 4)

    Does it soil your bed? [ ]YES, [ ]NO

  5. 5)

    Do you wear diapers (such as Pampers) to prevent soiling of yourself/bed? [ ]YES, [ ]NO

  6. 6)

    Does the leakage hamper your relationship with your husband? [ ]YES, [ ]NO

  7. 7)

    Does the leakage hamper sexual intercourse with your husband? [ ]YES, [ ]NO

  8. 8)

    Does the leakage cause people to avoid/isolate you? [ ]YES, [ ]NO

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Obioha, K.C., Ugwu, E.O., Obi, S.N. et al. Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women. Int Urogynecol J 26, 1347–1354 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: