The impact of urinary incontinence on multiple health outcomes: an umbrella review of meta-analysis of observational studies

Pinar Soysal, Nicola Veronese, Simona Ippoliti, Damiano Pizzol, Anne Marie Carrie, Simina Stefanescu, Guillermo F López-Sánchez, Yvonne Barnett, Laurie Butler, Ai Koyanagi, Louis Jacob, Ramy Abou Ghaydya, David Sheyn, Adonis K Hijaz, Jose M Oliva-Lozano, Jose M Muyor, Mike Trott, Andreas Kronbichler, Igor Grabovac, Mark A TullyLin Yang, Jimin Hwang, Jong Yeob Kim, Seoyeon Park, Junmin Song, Jae Il Shin, Petre-Cristian Ilie, Lee Smith

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BACKGROUND AND AIM: We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses.

METHODS: We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV).

RESULTS AND DISCUSSION: From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10-6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV).

CONCLUSIONS: UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.

Original languageEnglish
Pages (from-to)479-495
Number of pages17
JournalAging Clinical and Experimental Research
Issue number3
Early online date13 Jan 2023
Publication statusPublished online - 13 Jan 2023

Bibliographical note

© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

No financial support was provided for research conduct and/or preparation of the article.


  • Urinary incontinence
  • Health outcomes
  • Umbrella review
  • Meta-analysis


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