In women, lower urinary tract symptoms (LUTS) are common in urogynecological practice [1]. This condition involves involuntary urination that can be objectively detected, leading to hygiene issues and posing challenges in social interactions [2]. Among women, there are three basic types of nonneurogenic LUTS: stress urinary incontinence (SUI), overactive bladder (OAB), and mixed urinary incontinence (MUI) [1]. SUI refers to the involuntary leakage of urine during activities like sneezing, coughing, physical exertion, or sudden changes in body position, without direct pressure on the bladder [3, 4]. OAB is characterized by a feeling of strong, sometimes uncontrollable urge to urinate, accompanied by a sense of urgency, even immediately or soon after using the toilet.

This condition can also lead to nocturnal incontinence (known as nocturia). Nocturia is the complaint that the individual has to wake at night one or more times for voiding [5]. MUI is a combination of stress and urgency incontinence, resulting in leakage during both physical exertion and bladder pressure [1].

LUTS stands out as one of the most serious global health issues in the 21st century and ranks among the most prevalent chronic conditions affecting women [6]. The exact prevalence of LUTS is difficult to determine because a large proportion of patients do not disclose their complaints, considering them embarrassing symptoms and, above all, a natural sign of aging [7], since both the prevalence and severity of incontinence problems increase with age [6] and is associated with high financial, social, and emotional costs [8]. Studies conducted in developed countries have revealed that about 200 million people suffer from LUTS, of which about 10–25% of women after the age of 30 have periodic symptoms of incontinence, while among women over the age of 50, this number increases to about 1/3 [9, 10].

Due to the above, people suffering from incontinence frequently withdraw from social and professional life [9]. These challenges impact not only the patients themselves, who are dealing with incontinence symptoms but also their families and the immediate environment. The basis for undertaking proper treatment lies in diagnosing the type of LUTS, and the goal of treatment, regardless of the type of incontinence, is certainly to improve quality of life. The collaboration among a medical specialist, a psychologist, and the cooperation of the patient, including their family, enhances the effectiveness of therapy. Uncontrolled urinary leakage, given its widespread prevalence in the community, takes on the characteristics of a disease that necessitates establishing a system of preventive, educational, and therapeutic measures [9, 11]. The purpose of this study was to assess knowledge subjectively, compare knowledge resources, and evaluate health-promoting behaviors related to LUTS in women.

The research was carried out among women diagnosed with LUTS. An original questionnaire (was not validated), from September 2022 to March 2023, developed through an online Google Forms survey, was utilized as the research instrument and distributed through social networks and support groups for verified women facing LUTS. Participation in the survey was voluntary and anonymous, conducted via an online platform. The study was conducted among 100 female respondents, each with a different age, education level, marital status, and place of residence. Factors such as diuretic usage, past births, and comorbidities were important considerations in the survey. Inclusion criteria were female gender and a diagnosis of LUTS. Exclusion criteria were male gender.

A questionnaire consisting of 27 questions was created to conduct this study. The first four questions gathered information about the women’s age, education, marital status, and place of residence. Subsequent questions focused on comorbidities, diuretic use, occupation, and the occurrence of incontinence symptoms. The next questions assessed women’s knowledge of incontinence, for example, the number of acceptable micturitions per day, the number of acceptable micturitions per night, risk factors for urinary incontinence (UI), the least invasive method of treating UI, and incontinence prevention methods. The final question assessed women’s knowledge of incontinence (self-evaluation): how do you rate your knowledge about UI?

Based on the questionnaire responses about women’s incontinence knowledge, the subjects’ knowledge was verified and evaluated using an assessment scale as outlined in Table 1.

For data analysis, we used TIBCO Software Inc. (2017), Statistica (data analysis software system), version 13, and Microsoft Excel (version 2019) from Microsoft Office (Redmond, WA, USA). The distribution of variables was assessed using the Shapiro–Wilk test. The Mann–Whitney U test was used for comparisons between groups. Comparisons between the assessment results and self-assessment of knowledge were conducted using the Wilcoxon paired rank order test. Spearman’s R test and the $\chi$² NW (highest reliability) test were used to examine relationships between variables. The significance level in all calculations was set at p 0.05.

The study was conducted in a group of 100 women, aged 18–68 years, with an average body mass index (BMI) of 25.69 $\pm$ 4.89 kg/m² (ranging from 17.63 to 40.26 kg/m²). Among the study group, the following diseases were present: respiratory and pulmonary diseases in 5% of the respondents, renal and urinary diseases in 7%, gastrointestinal diseases in 9%, metabolic diseases in 19%, thyroid diseases in 31%, and cardiovascular diseases in 22% (with no additional diseases observed in 40% of the study population). Diuretic usage was reported by 20% of the women, while 30% used incontinence prophylaxis in their daily lives. The characteristics of the study group are shown in Table 2.

3.3 Assessment of Knowledge of Urinary Incontinence

The knowledge of the female respondents ranged from 14.29% to 100% (Fig. 1). The average score in the study group was 66.67% (64.48 $\pm$ 24.63%). The study demonstrated that women under 35 years of age (U = 772.5; p = 0.005) and those with higher education (U = 615.5; p 0.001) had significantly higher levels of knowledge. In the study, there was no correlation between the place of residence, marital status, body weight assessment, chronic diseases, the prevalence of use of incontinence prevention in daily life, and the level of knowledge (Table 8).

Fig. 1.

Comparison of assessment and self-evaluation of knowledge.

Table 8. Knowledge assessment.

		Mean $\pm$ SD	Min–Max	Me [Q1–Q3]	U	p
Age
	35 years	73.49 $\pm$ 21.84	19.05–100	76.19 [61.90–90.48]	772.5	0.005
	$>$36 years	59.18 $\pm$ 24.8	14.29–100	57.14 [38.10–80.95]
Education
	Higher	74.6 $\pm$ 23.03	19.05–100	80.95 [61.90–95.24]	615.5	0.001
	Other	53.94 $\pm$ 21.83	14.29–100	52.38 [38.10–76.19]
Place of residence
	Rural or city 50 thousands	60.22 $\pm$ 25.3	14.29–100	61.9 [38.10–83.33]	1021.5	0.120
	city $>$50 thousands	68.41 $\pm$ 23.56	23.81–100	76.19 [50.00–88.10]
Marital status
	Single	69.74 $\pm$ 23.83	14.29–100	76.19 [52.38–90.48]	796.5	0.320
	Marries	64.57 $\pm$ 24.38	19.05–100	66.67 [38.10–85.71]
Body weight
	Normal	68.99 $\pm$ 25.27	19.05–100	76.19 [52.38–85.71]	965.0	0.100
	Excessive	61.1 $\pm$ 24.06	14.29–95.24	57.14 [38.10–80.95]
Chronic diseases
	Yes	62.22 $\pm$ 24.95	19.05–100	61.9 [40.48–85.71]	1041.0	0.260
	No	67.86 $\pm$ 24.06	14.29–100	76.19 [45.24–85.71]
Prevention
	Yes	70.63 $\pm$ 21.77	23.81–100	73.81 [57.14–90.48]	837.5	0.110
	No	61.84 $\pm$ 25.45	14.29–100	61.9 [38.10–80.95]

SD, standard deviation.

UI is indeed becoming increasingly common in today’s medical landscape, particularly within urogynecology. It stems, in part, from a decline in female sex hormones, causing changes in the bladder and vagina, and the extinction of ovarian function [12, 13, 14]. Besides age, several factors contribute to the predisposition to UI, including overweight (obesity), smoking, multiple pregnancies, lack of exercise, carrying heavy objects, prior gynecological procedures, menopause, dynamic natural childbirth, delivering newborns with high birth weight, and genetic conditions [9, 10, 11, 12, 13, 14, 15].

The incidence of LUTS in women rises with age and the number of deliveries, increasing from 19% in those under 45 years to 29% in women aged 80 years and older [16]. The literature provides limited coverage of incontinence prevention. The results of this study allow us to assess women’s knowledge levels and their practical application in everyday life regarding incontinence prevention. In our study, 15% of women between the ages of 18 and 25 have already experienced UI. A sedentary lifestyle and inactivity weakens the pelvic floor muscles. Inadequate and excessively strenuous training may also overload it. Athletic women often experience heightened strain on pelvic floor muscles, leading to SUI, although the exact mechanisms behind these relationships are not yet fully understood [17]. The largest group in the study comprised respondents aged 46–60, accounting for 26% of the respondents. Interestingly, the study shows that place of residence and education indeed influence a higher percentage of women with the disease in question. This is likely due to better access to doctors and higher detection rates compared to women in smaller cities or rural areas. Among the mentioned methods of pregnancy termination, women most commonly underwent natural childbirth with protection (protection of the perineum by the midwife) or a perineal incision. Unfortunately, poorly conducted deliveries and lack of postpartum prophylaxis, including consultation with at least a urogynecological physiotherapist, as observed, have a significant impact on the appearance of LUTS later on. Urogynecological physiotherapy has proven effectiveness in treating SUI [18]. In surgical treatment of SUI, suburethral taping confirms the safety and efficacy of the method, both in short-term and long-term follow-ups, with a success rate exceeding 80% [19]. Ultrasound is feasible, reliable, and minimally invasive to explore the pathophysiology of UI [20]. The choice of the method between “retropubic” vs. “transobturator” surgeries depended on a preoperative ultrasound examination of the pelvic floor and by taking into account the mobility of the urethra and the height of the periurethral furrow-vaginal vaults. The role of ultrasonographic measurement of bladder and detrusor wall thickness could be an important step in diagnosis of UI [21].

In addition, the study demonstrated that women with chronic diseases were significantly more likely to declare the occurrence of uncontrolled urine leakage during exercise, coughing, or sneezing. The symptoms reported by female respondents included painful intercourse in 10% of respondents, lower abdominal and low back pain in 17%, while 44% of women reported no additional symptoms. The study observed a significant correlation among women living in rural areas and small urban areas. In contrast, a previous survey distinguished the three most important etiological factors for SUI occurrence in premenopausal and postmenopausal women in Poland. The analysis results clearly indicated that patient age (p = 0.0001), body mass index (BMI) (p = 0.0001), and surgical removal of the uterus by laparotomy (p = 0.0001) had the greatest influence on SUI incidence. The impact of other etiological factors remained quite controversial [22]. In Japan women, stress incontinence was prevalent at all ages and the incidence of UI increased over 70 years of age. Urinary incontinence was more likely as activities of daily living limitations and cystitis increased. Women with a history of hysterectomy or diabetes mellitus were at increased risk for UI [23]. The most common risk factors UI, among Turkish women, were age, number of births, body mass index $>$25 kg/m², recurrent urinary infection, diabetes mellitus and vaginal delivery [24].

Assessing women’s knowledge levels, the study observed that women using UI prophylaxis were significantly more likely to indicate up to 6 max allowable micturitions/day, whereas women not using prophylaxis were significantly more likely to indicate more than 8 micturitions/day. Similarly, regarding the allowable number of micturitions per night, it was observed that women living in cities with more than 50,000 residents were significantly more likely to indicate up to 2 allowable micturitions/night. The knowledge of the female respondents ranged from 14.29% to 100%. Thus, the study certainly shows that women who use preventive measures are significantly more informed and aware compared to those who do not, as indicated by their self-evaluation on this matter. Additionally, a significantly higher level of knowledge is evident among women aged up to 35 with higher education, with no significant impact observed based on place of residence or marital status. In the study by Aramowicz et al. [25], most of the respondents considered their level of knowledge to be average (27%), sufficient (23.7%) and weak (15.1%). In contrast, 24.3% of the respondents consider their scope of information on SUI as good and very good (7.9%). Therefore, the state of knowledge of women in the field of SUI is still insufficient [25]. Derewiecki et al. [26] in their study of women’s knowledge about incontinence obtained the following data: in I group — women reporting an UI problem, 73.68% declared knowledge at a sufficient level, while in II group — women without UI symptoms, it was only 22.5%. In a similar study conducted by Bakalczuk et al. [27], 36.5% of the respondents evaluated their state of knowledge as good, about 34.9% as sufficient and 18.7% of the women possessed insufficient knowledge. Despite general awareness that the problem of UI exists, still remains at too low a level to decrease the percentage of people affected by this affliction [27].

To implement incontinence prevention, it is essential to eliminate risk factors. Avoiding constipation (by consuming a diet rich in fiber and ensuring adequate hydration of the body), engaging in regular physical activity, maintaining normal body weight, quitting smoking, and adopting proper toilet habits (such as avoiding urine retention and refraining from pushing during micturition) are necessary for preventing UI. Additionally, UI prophylaxis users were significantly more likely to indicate that pelvic floor muscle exercises were the least invasive form of UI treatment ($\chi$² = 9.17; p = 0.03). Although risk factors cannot be eliminated from our lives, the sooner healthy habits are consistently implemented, the greater the chance that incontinence complaints can be prevented [28]. It is also important to consider menopausal urogenital syndrome, where estrogen deficiency contributes to urogenital atrophy. Patients experiencing reduced elasticity and resilience of the vaginal and urethral mucosa may have increased symptoms of incontinence [29]. In such cases, topical therapy using vaginal estrogens or prasterone can significantly reduce discomfort, alleviate vaginal atrophy, and decrease the frequency of incontinence episodes [30].

Women’s age and education affect knowledge of incontinence prevention. Taking into account their commonness in society, lower urinary tract symptoms have the characteristics of a disease requiring the development of a system of preventive, educational, and therapeutic activities. That is why multi-level cooperation is so important to increase the effectiveness of therapy.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

MWiś and KC-W designed the research study. MWiś, KC-W, KT, AM, KW, MWil performed the research. KC-W, KT, AM, KW, MWil analyzed the data. KC-W, KT, AM, MWil, KW wrote the manuscript. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

Ethical review and approval were waived for this study due to the survey-based, anonymous nature of the study. As the survey is anonymous, no informed consent is required.

We would like to express our gratitude to all those who helped us while writing this manuscript. Thanks to all the peer reviewers for their opinions and suggestions.

This research received no external funding.

The authors declare no conflict of interest. Karolina Chmaj-Wierzchowska, Maciej Wilczak and Katarzyna Wszołek are serving as Guest editors of this journal. We declare that Karolina Chmaj-Wierzchowska, Maciej Wilczak and Katarzyna Wszołek had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Ugo Indraccolo.