In this secondary analysis of a cross-sectional study conducted on a large representative sample from Turkiye, our investigation focused on identifying the determinants of UI in men and women separately. UI is often considered a problem that primarily affects women, which leads most studies to focus on female populations. Our study found that the overall prevalence of UI in Turkiye is approximately 9%, with a significantly higher prevalence in women (11%) than in men (5.5%). A consistent theme runs through our results, highlighting the significant influence of gender on the prevalence of UI. This underscores the importance of gender-sensitive healthcare strategies and interventions when addressing UI.

Our study discloses that UI is also a pertinent health issue for men, with its prevalence approaching a similar frequency in both genders as age advances. Notably, the widest gap in UI prevalence was observed within the age group of 34–44 years, while the smallest gap was apparent in the age bracket of 65–74 years. Prevalence started increasing after 45 years among men and after 35 years among women. This finding harmonizes with prior studies, including Unlu et al.‘s [5] research, which associated an age over 35 with an 89.6% rise in UI prevalence. Age consistently emerges as a contributing factor in the likelihood of UI across numerous studies [4, 6, 7]. In a recent study of hospitalized patients in Turkiye, the prevalence of UI in 1176 hospitalized patients was 29.4%, whereas this rate increased to 41.6% in patients over 65 years of age [7].

Another noteworthy determinant unveiled by our study was educational level. A lower educational attainment increased the risk for UI in both sexes. Interestingly, the risk associated with lower educational levels was more pronounced in women, with a 1.98-fold increase, compared to a 1.74-fold increase in men. The impact of education on UI is complex, as evidenced by Grzybowska et al.‘s finding that higher education levels correlated with a decreased likelihood of using incontinence pads constantly [8]. Similarly, a study on Estonian postmenopausal women indicated that secondary education correlated with an 87% increase in UI odds [9].

The present study’s employment status findings highlight significant differences in UI prevalence among men and women in various employment categories. Men demonstrated lower UI prevalence when employed, whereas women exhibited a higher prevalence. Conversely, UI prevalence increased among both genders when unemployed or retired. These results emphasize the importance of considering employment status as a contributing factor in UI prevalence and highlight the need for tailored interventions to address UI within different employment categories.

Smoking’s influence on UI is multi-faceted and persistent coughing, often associated with smoking, can exert pressure on pelvic muscles, potentially weakening them and increasing the risk of stress incontinence [10]. Furthermore, smoking’s bladder-irritating effects can lead to more frequent bathroom visits [11]. Additionally, smoking has been linked to bladder cancer [12, 13]. In our study, male smoking didn’t show a significant association with UI, yet female current and former smokers exhibited higher UI prevalence than non-smokers. These findings align with research suggesting that current and former smoking heightens stress and motor incontinence in women [14]. However, our results diverge from studies that established a strong smoking-related association with lower urinary tract symptoms in men [15, 16].

In our study, a relationship was found between self-perceived health and the prevalence of UI. Those who reported fair or poor/very poor health were significantly more likely to suffer from UI. These findings highlight the association between perceived health status and UI, implying that improving overall well-being could be related to UI. This highlights the potential of comprehensive health strategies to mitigate UI risk by addressing individual health perceptions. Of note, women tend to rate their health as poor and very poor and also have a higher UI prevalence.

Evidence points towards a connection between COPD and increased UI prevalence [17, 18]. Coughing spells in COPD can elevate abdominal pressure, potentially causing stress incontinence. Additionally, certain COPD medications can impact continence [19]. Consistent with existing literature, our study found an increased UI risk among individuals with COPD, with a higher risk among men. This finding underscores COPD’s potential contribution to susceptibility to UI.

Hypertension’s effects on women, including heightened nocturnal voiding and stress urinary incontinence, have been explored, but its broader influence on UI remains less understood [17, 20]. In our study, we identified significant differences in UI prevalence between hypertensive and non-hypertensive individuals, highlighting a potential connection between blood pressure regulation and UI. This underscores the relevance of managing hypertension not just for cardiovascular well-being but also concerning UI prevention and management.

Diabetes emerges as an independent UI risk factor, unexplained by obesity [21, 22]. Our study substantiated this finding, identifying diabetes as a risk factor for UI in both genders, whereas obesity increased UI risk solely in women. The elevated UI prevalence among individuals with diabetes underscores the potential impact of blood sugar regulation on UI occurrence. Diabetic neuropathy, a common diabetes complication, can damage nerves that control bladder muscles [23]. Over time, high blood sugar levels can weaken bladder muscles, affecting storage capacity. Managing diabetes could potentially play a role in mitigating UI risk.

The relationship between obesity and UI has been well-studied [24,25,26]. Our findings align with prior research indicating that maintaining a healthy BMI could benefit UI prevention or treatment. BMI was identified as a significant risk factor for UI in women, with obese women exhibiting a twofold UI risk increase. The complex interplay between obesity and UI mechanisms is not entirely comprehended, but Swenson et al.‘s [26] study suggest that increased intravesical pressure in obese women could elevate UI risk due to heightened demands on continence mechanisms.

Our results also highlight the relevance of an active lifestyle. Sedentary behavior was associated with higher UI risk, while physical activity correlated with lower risk. Numerous studies emphasize the positive impact of physical activity on UI risk reduction among women of varying age groups [27,28,29]. Our findings, however, indicate no such association between physical activity, sedentary behavior, obesity, and UI in men. Nonetheless, other studies suggest that physical activity and obesity could influence postprostatectomy UI [30].

The present study provides valuable insights into the prevalence and associated factors of urinary incontinence in Turkiye. We utilized data from the 2019 Turkish Health Survey (THS), which included a nationally representative sample of 9,740 households. This extensive sample size enhances the generalizability of findings to the broader Turkish population.

However, this study has some limitations that should be considered when interpreting the results. The cross-sectional design restricts the establishment of causal relationships and long-term trends. Reliance on self-reported data introduces potential recall and social desirability biases, impacting the accuracy of variables such as UI prevalence, chronic conditions, and health-related behaviors. The study’s limited temporal scope, focusing on the past 12 months, may not capture broader trends. On the other hand, questioning the past 12 months prevent recall bias.

The use of secondary data also imposes certain limitations to the study’s scope, constrained by available variables and their predefined definitions. This limitation hinders the examination of additional factors and refinement of measurements. For instance, the Yes/No format of the urinary incontinence (UI) question may not fully capture the nuanced nature of UI experiences, lacking specificity on types like urge and stress incontinence. Translation concerns, particularly regarding the phrase “problems controlling bladder,” may lead to an overestimation of UI incidence.

Furthermore, a fundamental limitation is the lack of detailed information on various etiological factors related to urinary incontinence (UI) for both men and women in the available dataset. The absence of specific data on gender-specific etiologies, such as the impact of prostate interventions on male UI, is recognized as a constraint, impeding a comprehensive exploration of the diverse factors contributing to UI in both male and female populations.