Urinary incontinence increases with age. The prevalence of incontinence is higher in younger women than men, but both increase with age. The type of incontinence in women also varies markedly with age, with stress urinary incontinence more common below 50 years and urgency and mixed urinary incontinence more common in older women (Hannested et al. 2000). Figure 1.2 summarizes the incontinence trends with increasing age. Nursing home residents have a much higher level of incontinence, estimated to be as high as 50–80 %. Incontinence in these patients significantly increases the burden on carers. Cognitive impairment, frailty, and reduced mobility all contribute to exacerbating the severity of incontinence in the elderly.

Incontinence in females is most commonly stress incontinence, followed by mixed and urgency incontinence (Fig. 1.3). Stress incontinence is more common in women under 50 years of age, with mixed incontinence most commonly occurring in women over 50 years. Although less common than stress incontinence, urgency incontinence is often more bothersome and more often requires treatment. Urgency incontinence often occurs in the constellation of symptoms known as overactive bladder (frequency and urgency, with or without incontinence). Overactive bladder with incontinence (OAB_wet) is more prevalent in women than men.

Risk factors for incontinence in women are many and varied. They include age, parity, mode of delivery (vaginal vs. caesarian), parturition events (instrumentation), obesity, estrogen status, and genetics. Less convincing is the evidence for the role of menopause, hysterectomy, and cognitive impairment as primary causes for incontinence. It should also be noted that in developing countries, vesicovaginal fistulae remain the leading cause of female incontinence.