Received: 26 December 2022 | Accepted: 30 January 2023
DOI: 10.1002/nau.25146
CLINICAL ARTICLE
Which type of female urinary incontinence has more
impact on pelvic floor and sexual function in addition to
anxiety and depression symptoms: A questionnaire‐based
study
Aykut Demirci MD, FEBU1
Hayriye Dilek Hamurcu MD2
1
Department of Urology, Dr.
Abdurrahman Yurtaslan Ankara
Oncology Training and Research
Hospital, Ankara, Turkey
2
Department of Psychiatry, Dr.
Abdurrahman Yurtaslan Ankara
Oncology Training and Research
Hospital, Ankara, Turkey
Correspondence
Aykut Demirci, MD, FEBU, Department
of Urology, Dr. Abdurrahman Yurtaslan
Ankara Oncology Training and Research
Hospital, Ankara, Turkey.
Email: draykutdemirci@hotmail.com and
aykut.demirci@saglik.gov.tr
814 | © 2023 Wiley Periodicals LLC.
| Fatih Hızlı MD1 |
| Halil Başar MD1
Abstract
Purpose: To evaluate pelvic floor and sexual dysfunction, and anxiety and
depression symptoms in females with different urinary incontinence (UI) types.
Materials and Methods: A cross sectional evaluation was made of 73
patients diagnosed with UI in the Urology Clinic between December 2021 and
November 2022. In addition to demographic data, the points were recorded
from the International Consultation on Incontinence Questionnaire Female
Lower Urinary Tract Symptoms (ICIQ‐FLUTS), Hospital Anxiety and
Depression Scale (HADS), Female Sexual Function Index (FSFI), and the
Pelvic Floor Distress Inventory‐20 (PFDI‐20).
Results: The mean age of the patients was 38.3 ± 3.7 years. Incontinence types
of the patients were determined as 42% urgency urinary incontinence (UUI),
30.1% stress urgency incontinence (SUI), and 27.4% mixed type urinary
incontinence (MUI). Anxiety symptoms were determined in 20.5% and
depression symptoms in 41.1% of all the patients. The median ICIQ‐FLUTS
score was determined to be significantly higher in the MUI patients than in
the other types [25.5 (MUI) vs. 17 (SUI), p = 0.007; 16 (UUI), p = 0.001]. The
median FSFI and HADS scores were seen to be similar in all the UI types
(p = 0.1). The median PFDI‐20 score was found to be higher in the MUI group
than in the UUI group (126.5 vs. 88.5, p = 0.02).
Conclusion: The sexual dysfunction and psychological symptoms were found
to be similar in the patients according to UI type. The MUI patients were seen
to have more incontinence symptoms compared to the other types and
experienced more pelvic floor dysfunction than patients with UUI.
KEYWORDS
anxiety, depression, pelvic floor distress, sexual dysfunction, urinary incontinence
wileyonlinelibrary.com/journal/nau Neurourol Urodyn. 2023;42:814–821.

DEMIRCI ET AL.
1 | INTRODUCTION
Urinary incontinence (UI) is defined by the International
Continence Society as involuntary urine leakage and it may
be seen in one of every two females at some time during
life.1,2 According to the most troublesome symptoms, UI
can be further defined into three subtypes: Stress urinary
incontinence (SUI), urgency urinary incontinence (UUI)
and mixed type urinary incontinence (MUI). SUI is defined
as urine leakage during physical effort, coughing or
sneezing, UUI as frequent day and/or night urination
without any urinary tract infection together with sudden
urgency to urinate which may be accompanied by urine
leakage, and MUI as the combination of these two types
together.1 The most frequently seen type is SUI (50%)
followed by MUI (40%) and UUI (20%).3
It has been stated by the World Health Organisation that
for the emotional and mental well‐being of an individual, a
healthy sexual life is necessary in addition to good physical
health.4 Females with UI avoid sexual relations because of
the fear of urine leakage during sexual intercourse, and in
addition to decreased levels of sexual desire and satisfaction,
it has been observed that 60% of these patients could
develop sexual dysfunction.5 There is also known to be a
close relationship between impaired pelvic floor integrity
together with ageing, weight gain, hormonal dysfunctions,
and birth‐related trauma, and both UI (67%–71%) and
sexual dysfunction (50%–83%).6,7 Females with complaints
of UI have been determined to avoid socialising more than
those with no such complaints, causing symptoms of
anxiety and depression (25.8% vs. 17.6%; 11.8% vs. 7.2%,
respectively).8
However, it is also thought that some UI patients accept
these complaints as a natural process, and the number of
patients presenting at the clinic remains low. The reasons
for this include a lack of knowledge of the doctor initially
consulted about the factors that can cause incontinence
symptoms and other associated health problems, and the
societal taboo of speaking about sexual problems.9 There-
fore, it is difficult to determine the real situation of pelvic
floor and sexual dysfunction in UI patients and especially of
subtypes.
The aim of this study was to investigate which type
of urinary incontinence has more impact on pelvic floor
function, sexual dysfunction, and anxiety/depression
symptoms.
2 | MATERIALS A ND METHODS
2.1 | Patient selection
Approval for this cross‐sectional cohort study was granted
by the local ethics committee (decision no: 2022‐01/1511).
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| 815
All the patients included in the study provided informed
consent. The study included 73 patients diagnosed with
urinary incontinence in the Urology Clinic between
December 2021 and November 2022.
2.2 | Inclusion criteria
1. Females aged 18–45 years in the premenopausal
period.
2. A diagnosis of urinary incontinence.
3. Sexually active within the last 6 months.
2.3 | Exclusion criteria
1. A history of antidepressant, or antipsychotic drugs.
2. The presence of active urinary tract infection.
3. A history of urogynaecological cancer.
4. The presence of advanced grade (POP‐Q Grades 3–4)
pelvic organ prolapse.10
5. Pregnancy.
2.4 | Procedure
The urinary incontinence type of the patients was
determined based on the clinical symptoms and genito-
urinary examination. A record was then made for each
patient of age, body mass index (BMI), smoking status,
alcohol consumption, occupation, income level and
comorbid diseases. All the patients completed the
following questionnaires, which have all been validated
in Turkish: International Consultation on Incontinence
Questionnaire Female Lower Urinary Tract Symptoms
(ICIQ‐FLUTS), Hospital Anxiety and Depression Scale
(HADS), Female Sexual Function Index (FSFI), and
Pelvic Floor Distress Inventory‐20 (PFDI‐20).
2.5 | Measurement tools
The ICIQ‐FLUTS questionnaire was used to evaluate
incontinence symptoms. This questionnaire comprises 12
items, each scored from 0 to 4 points. The first 4 items are
related to bladder filling, the next 3 to urination, and the
final 5 to incontinence symptoms and associated com-
plaints. Higher scores are evaluated as increased symp-
tom severity.11,12
The HADS scale was used to determine anxiety and
depression symptoms. This scale consists of 14 items
in two subscales measuring anxiety (HADS‐A) and
depression (HADS‐D) symptoms. Each subscale includes
7 items, each scored from 0 to 3 points. A score of

816 | DEMIRCI
≥11 points on HADS‐A is evaluated as “anxiety symptoms
present” and a score of ≥8 points on HADS‐D as
“depression symptoms present”.13,14
The FSFI is used to evaluate female sexual
functions. The form consists of a total of 19 items
evaluating sexual desire scored from 1.2 to 6 points,
arousal scored from 0 to 6 points, lubrication scored
from 0 to 6 points, orgasm scored from 0 to 6 points,
sexual satisfaction scored from 0 to 6 points, and pain
symptoms scored from 0 to 6 points. Lower points in
each section are interpreted as a greater severity of
symptoms, with a total score of <26.55 evaluated as the
presence of sexual dysfunction.15,16
The PFDI‐20 questionnaire comprises 6 items in
the Pelvic Organ Prolapse Distress Inventory‐6
(POPDI‐6), 6 items in the Urinary Distress Inventory‐
6 (UDI‐6), and 8 items in the Colorectal Distress
Inventory‐8 (CRADI‐8). Each item is scored from 0 to 4
points and the total points from each section are
calculated from 100, giving a total maximum score of
300 points. Higher points indicate a higher severity of
symptoms.17,18
2.6 | Statistical analysis
For determination of the sample size, G*Power (vn. 3.1.9.4)
software was used. In the F test analysis of variance
(ANOVA): fixed effects, omnibus, one‐way (Post hoc:Com-
pute achieved power) comparison in three different groups
with a total number of 73 patients, the power of this study
was determined as 0.86 (effect size: 0.4, error margin: 0.05).
Data obtained in the study were analyzed statistically using
IBM® SPSS® vn. 20 software. Continuous variables were
stated as mean ± standard deviation or median (interquartile
range) values and categorical data as number (n) and
percentage (%). Conformity of the data to normal distribu-
tion was assessed with the Shapiro–Wilk test. Comparisons
of more than two groups were made using one‐way ANOVA
when parametric assumptions were met, and the
Kruskal–Wallis test when not met. The Bonferroni test was
used in post hoc analyses. Correlation analyses were
performed using the Spearman test. A value of p < 0.05
was accepted as statistically significant.
3 | RESUL TS
The sociodemographic characteristics of the patients are
summarised in Table 1. The mean age of the patients was
38.3 ± 3.7 years. The distribution of incontinence types of
the patients was determined as 42% UUI, 30.1% SUI, and
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ET AL.
27.4% MUI. Anxiety symptoms were determined in 20.5%
of the patients, depression symptoms in 41.1%, and
sexual dysfunction in 83.6%. Comparisons of the UI types
ae shown in Table 1. The three UI groups were
determined to be similar in respect of mean age, median
BMI, comorbid diseases, smoking, alcohol consumption,
median parity, the median duration of symptoms,
occupation, education level, mean monthly income,
and anxiety/depression symptoms (p = 0.1, p = 0.51,
p = 0.1, p = 0.68, p = 0.95, p = 0.92, p = 0.09, p = 0.07,
p = 0.61, p = 0.81, p = 0.46, p = 0.29, respectively). Sexual
dysfunction was determined to be more prevalent among
the MUI patients than the other types (MUI 100% vs. SUI
77.3%, UUI 77.4%, p = 0.04).
When the questionnaire scores were examined
according to the UI types, it was seen that the median
FSFI total score was similar in all the groups (p = 0.1). No
significant difference was found in respect of the FSFI
sub‐sections of sexual desire, arousal, satisfaction, and
pain scores (p = 0.22, p = 0.66, p = 0.34, p = 0.45, respec-
tively). The median lubrication and orgasm scores were
determined to be lower in the MUI patient group than in
the SUI group [3 (2.2) vs. 4.3 (1.3), p = 0.02; 2.6 (3.7) vs.
4.4 (2), p = 0.04, respectively]. In the PFDI‐20 question-
naire, the median POPDI‐6 and CRADI‐8 points were
seen to be similar in the 3 UI type groups (p = 0.21,
p = 0.13, respectively). The median UDI‐6 and total
PFDI‐20 scores were found to be higher in the MUI type
group than in the UUI group [75 (31.2) vs. 33.3 (33.3)
p < 0.001; 126.5 (82.8) vs. 88.5 (85.4) p = 0.02, respec-
tively). No significant difference was seen between the UI
types in respect of the HADS‐A and HADS‐D scores
(p = 0.54, p = 0.25, respectively). The median ICIQ‐
FLUTS total score was determined to be significantly
higher in the MUI patients than in the SUI and UUI
groups [25.5 (12) vs. 17 (11) p = 0.007; 16 (12) p = 0.001,
respectively]. When the sub‐section scores were exam-
ined, the median score of filling symptoms was similar in
the three groups (p = 0.05). The voiding and
incontinence symptom scores were determined to be
higher in the MUI patients compared to those with UUI
[4.5 (4.75) vs. 2 (4) p = 0.004; 13 (5.75) vs. 6.5 (9.75)
p = 0.01, respectively) (Table 2).
A positive correlation was determined between the
ICIQ‐FLUTS and the PFDI‐20 scores (r = 0.59,
p < 0.001), and a negative correlation between the
ICIQ‐FLUTS and the FSFI scores (r = −0.29, p = 0.02).
A negative correlation was determined between the
HADS‐D score and the FSFI (r = −0.29, p = 0.01). A
positive correlation was determined betwen the HADS‐
A score and the PDFI‐20 score (r = 0.27, p = 0.02)
(Table 3).
 15206777, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25146 by Universidad Nacional Autonoma De Mexico, Wiley Online Library on [29/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
DEMIRCI ET AL. | 817

TABLE 1 Comparison of the socio‐demographic characteristics of the patients.

All patients (n = 73) SUI (n = 22) UUI (n = 31) MUI (n = 20) p Value
a
Age 38.3 ± 3.7 39.3 ± 1.98 37.06 ± 5.0 39.4 ± 1.95 0.1
2 b
BMI (kg/m ) 29.2 (7.6) 28.4 (10.8) 29.2 (7.5) 30.8 (4.1) 0.51
Comorbidities, n (%)
HT 19 (23.7) 2 (8.6) 8 (24.2) 9 (37.5) 0.1
DM 11 (13.7) 1 (4.3) 7 (21.2) 3 (12.5)
COPD 2 (2.5) 0 (0) 1 (3.0) 1 (4.1)
None 48 (65.8) 20 (86.9) 17 (51.5) 11 (45.8)
Smoking, n (%)
Yes 21 (28.8) 5 (22.7) 9 (29.0) 7 (35.0) 0.68
No 52 (71.2) 17 (77.3) 22 (71.0) 13 (65.0)
Alcohol, n (%) 0.95
Yes 4 (5.5) 1 (4.5) 2 (6.5) 1 (5.0)
No 69 (94.5) 21 (95.5) 29 (93.5) 19 (95.0)
b
Parity 1 (1) 1 (1) 1 (2) 0.5 (1) 0.92
b
Duration (months) 24 (36) 24 (18) 24 (28) 48 (165) 0.09
Education, n (%)
Elementary 29 (39.7) 9 (40.9) 10 (32.3) 10 (50.0) 0.61
Secondary 17 (23.3) 5 (22.7) 9 (29.0) 3 (15.0)
High school 13 (17.8) 4 (18.2) 4 (12.9) 5 (25.0)
University 14 (19.2) 4 (18.2) 8 (25.8) 2 (10.0)
Occupation, n (%)
Yes 16 (21.9) 4 (18.2) 6 (19.3) 6 (30.0) 0.07
No 57 (78.08) 18 (81.8) 25 (80.7) 14 (70.0)
a
Income level (monthly,□) 2217.8 ± 3280.5 1663.6 ± 2309.1 2754.8 ± 3931.3 1995.0 ± 3099.2 0.81
Anxiety symptoms, n (%)
Yes 15 (20.5) 3 (13.6) 6 (19.4) 6 (30.0) 0.46
No 58 (79.5) 19 (86.4) 25 (80.6) 14 (70.0)
Depressive symptoms, n (%)
Yes 30 (41.1) 7 (31.8) 12 (38.7) 11 (55.0) 0.29
No 43 (58.9) 15 (68.2) 19 (61.3) 9 (45.0)
Sexual dysfunction, n (%)
Yes 61 (83.6) 17 (77.3) 24 (77.4) 20 (100.0) 0.04
No 12 (16.4) 5 (22.7) 7 (22.6) 0 (0)
Note: □ = Currency symbol of Turkish Republic. Significant values were shown with bold (p < 0.05).
Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; HT, hypertension; MUI, mixed type urinary
incontinence; SUI, stress urinary incontinence; UUI, urgency urinary incontinence.
a
Mean ± SD.
b
Median (IQR).
 15206777, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25146 by Universidad Nacional Autonoma De Mexico, Wiley Online Library on [29/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
818 | DEMIRCI ET AL.

TABLE 2 Median scores of questionnaire domains according to the urinary incontinence types.
All patients
(n = 73) SUI (n = 22) UUI (n = 31) MUI (n = 20) p Value
FSFI
Desirea 3 (2.4) 3.3 (2.5) 3 (1.8) 2.4 (2.4) 0.22
a
Arousal 2.7 (2.4) 3.3 (2.4) 2.4 (3) 2.1 (2.8) 0.66
a b
Lubrication 3.3 (2.7) 4.3 (1.3) 3.3 (4.2) 3 (3.2) 0.03
Orgasma 3.2 (3.2) 4.4 (2) 2.8 (4.4) 2.6 (3.7)c 0.04
a
Satisfaction 3.6 (1.2) 3.8 (0.8) 4 (1.2) 3.2 (2) 0.34
a
Pain 3.6 (5.6) 4.4 (4.7) 2.8 (5.2) 2.8 (5) 0.45
a
Total score 18.2 (15.9) 23.85 (14.08) 18.2 (19.8) 16.85 (13.8) 0.1

PFDI‐20
POPDI‐6a 29.1 (24.9) 25 (30.2) 29.1 (23.6) 33.3 (29.1) 0.21
a
CRADI‐8 18.7 (31.3) 23.4 (32.03) 12.5 (34.3) 14.06 (40.6) 0.13
d e
UDI‐6 103.1 (73.9) 41.6 (45.8) 33.3 (33.3) 75 (31.2) <0.001
a f
Total score 104.1 (75) 96.3 (139.6) 88.5 (85.4) 126.5 (82.8) 0.02

HADS
HADS‐Ad 8 (6) 8 (5) 8 (7) 8 (8) 0.54
a
HADS‐D 7 (7) 5.5 (9) 7 (6) 8 (7) 0.25

ICIQ‐FLUTS
Fillingd 8 (4) 6 (5.25) 8 (3.25) 8.5 (5) 0.05
Voidinga 3 (4) 4 (4) 2 (4) 4.5 (4.75)g 0.01
Incontinencea 9 (8.75) 9 (6.75) 6.5 (9.75) 13 (5.75)h 0.006
d i
Total score 18 (13) 17 (11) 16 (12) 25.5 (12) <0.001
Note: All scores were shown as median (IQR). Significant “p values” were shown with bold (p < 0.05).
Abbreviations: ANOVA, analysis of variance; CRADI‐8, Colorectal‐Anal Distress Inventory‐8; FSFI, Female Sexual Function Index; HADS, Hospital Anxiety
and Depression Scale; ICIQ‐FLUTS, International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms; MUI, mixed type
urinary incontinence; PFDI‐20, Pelvic Floor Distress Inventory‐20; POPDI‐6, Pelvic Organ Prolapse Distress Inventory‐6; SUI, stress urinary incontinence;
UDI‐6, Urinary Distress Inventory‐6; UUI, urgency urinary incontinence.
a
Kruskall–Wallis test.
b
MUI vs. SUI, p = 0.02.
c
MUI vs. SUI, p = 0.04.
d
One way ANOVA Test (Bonferroni correction was used for post hoc analysis).
e
MUI vs. UUI, p < 0.001.
f
MUI vs. UUI, p = 0.02.
g
UUI vs. MUI, p = 0.004.
h
UUI vs. MUI, p = 0.01.
i
MUI vs. SUI, p = 0.007; MUI vs. UUI, p = 0.001.

4 | DISCUS SION symptoms of UI patients, the psychological problems that

could develop in these patients were also evaluated. The
In this study, the relationships were investigated of results of the study demonstrated that incontinence
incontinence symptoms according to urinary symptoms were seen more in MUI patients than in those
incontinence types with pelvic floor and sexual functions. with other types. Although no difference was seen
In addition, by evaluating the anxiety and depression between the UI types, there was determined to be an

DEMIRCI ET AL.
TABLE 3 Correlation among ICIQ‐FLUTS, HADS‐A, HADS‐D, FSFI, and PFDI‐20 scores.
ICIQ‐FLUTS HADS‐A
r p Value r p Value
ICIQ‐FLUTS – – 0.04 0.69
HADS‐A 0.04 0.69 – –
HADS‐D 0.17 0.14 0.53 <0.001
FSFI −0.29 0.02 −0.08 0.5
PFDI‐20 0.59 <0.001 0.27 0.02
Note: Spearman correlation test. Significant values were shown with bold (p < 0.05).
Abbreviations: FSFI, Female Sexual Function Index; HADS, Hospital Anxiety and Depression Scale; ICIQ‐FLUTS, International Consultation on Incontinence
Questionnaire Female Lower Urinary Tract Symptoms; PFDI‐20, Pelvic Floor Distress Inventory‐20.
increased risk of sexual dysfunction together with an
increase in incontinence symptoms. Both continence and
sexual functions were found to be negatively affected by a
deterioration in pelvic floor functions. No difference was
seen between the UI types in respect of anxiety and
depression symptoms.
Although there are many reasons for female sexual
dysfunction, incontinence is accepted as one of these
reasons. In a study of 1217 female patients from 20
different regions in Turkey, there was seen to be sexual
dysfunction in 59.6% of UI patients according to the FSFI
scores.5 In another study, the frequency of sexual
dysfunction in UI patients was found to be 71.6%, and
the FSFI score was determined to decrease with an
increase in incontinence symptoms.19 However, although
the frequency of sexual dysfunction has been clearly
shown to be high in UI patients, there are differences
between studies which have researched the frequency of
this in UI types. While Gomes et al.,19 found that the
scores obtained on FSFI questionnaires according to UI
types were similar, in another study it was reported that
more sexual dysfunction was experienced by MUI
patients and especially orgasm functions and sexual
desire levels were determined to be lower than those of
SUI and UUI patients, respectively.19,20 In the current
study, although the frequency of sexual dysfunction seen
in incontinence patients was high, no difference was
determined between the types in respect of FSFI total
score, which was similar to the findings of Gomes et al.19
In the subscale scores, similar to the literature, the
deterioration in orgasm functions during sexual inter-
course in MUI patients was found to be worse in SUI
patients and there was also a deterioration in lubrication.
These differences in the subscale scores can be attributed
to the fact that MUI patients experience more leakage in
different circumstances or they experience more severe
incontinence symptoms than patients with other UI
types and this makes them avoid sexual intercourse.
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| 819
HADS‐D FSFI PFDI‐20
r p Value r p Value r p Value
0.17 0.14 −0.29 0.02 0.59 <0.001
0.53 <0.001 −0.08 0.5 0.27 0.02
– – −0.29 0.01 0.11 0.35
−0.29 0.01 – – −0.17 0.18
0.11 0.35 ‐0.17 0.18 – –
Deteriorations that can develop in the pelvic floor
muscles and ligaments for reasons such as advanced age,
smoking and births, cause pelvic floor dysfunction
(PFD).17 There are problems related to sexuality in
almost 80% of women who experience PFD, and it is
thought that SUI patients experience PFD more.6,21
However, PFD may also be seen in healthy women
who do not have any risk factors, and the importance of
improvement in pelvic floor functions in the treatment
not only of SUI patients, but also in UUI patients, has
been emphasised.22,23 However, patients with other
components of PFD such as pelvic organ prolapse and
anal incontinence may not report these complaints as
they may not be aware of the relationship of these with
UI. Therefore, the real incidence of PFD may be much
higher than has been reported in literature.24 Moreover,
there are very few studies that have examined the effect
of psychological factors independently of treatment in
patients with PFD.25 In a study by Reis et al.,26 anxiety
symptoms were seen at the high rate of 59.5% in patients
with myofascial dysfunction in pelvic floor muscles.
Similarly in the current study, the anxiety symptom
scores were seen to be higher in patients with a high
PFDI‐20 score. There was also seen to be a close
relationship between UI and PFD, at similar rates in
MUI patients and SUI patients, with more PFD
symptoms experienced than by UUI patients. However,
these results for the total PFDI scores are driven more by
the UDI‐6 scores because women with pelvic organ
prolapse and fecal incotinence, which could have a
crucial impact on pelvic floor function, were excluded
from this study. Therefore, the exact situtation for
advanced patient groups could not be evaluated and this
is a limitation of the study.
Depression is known to be more related to the
presence of UI than the presence of other chronic
diseases, and the prevalence of depression in UI patients
has been reported to be in the wide range of 6%–38%.27 In

820 | DEMIRCI
a study of 5321 women in Norway, it was determined
that those with UI were at a 1.64‐fold higher risk of
having depression symptoms.8 In addition, when exam-
ined according to UI types, the association with
depression has been shown to develop 4.2‐fold more in
MUI and UUI patients than in those with SUI.28 In the
current study, a positive correlation was determined
between depression symptoms and an increase in
incontinence symptoms in UI patients. However, in
contrast to the literature, no difference was seen between
UI types. This was thought to be due to the inclusion of
patients who presented at the clinic for treatment rather
than screening the population.
There were some limitations to this study. Rather
than the evaluation of UI patients in a single centre,
there is a need for multicentre studies to reflect the
general situation in society. As the primary aim of this
study was to examine the differences between UI types in
respect of sexual and pelvic floor functions, no control
group was formed. In addition, the relationship between
a healthy sex life and partners is of great importance, but
the sexual attitudes of the partners of the patients were
not evaluated. As the evaluations of this study were
questionnaire based, special techniques such as electro-
myography were not used to evaluate the pelvic floor
muscles of the patients. In addition, the basic pathophy-
siological pathways of the relationship between UI and
psychiatric symptoms and sexual dysfunction were not
investigated and therefore the results obtained remain as
observational findings.
5 | CONCLUSION
Urinary incontinence is not only a problem of urine
leakage, but is a complex disease together with comor-
bidities. Both sexual and pelvic floor functions are
negatively affected by an increase in UI symptoms, and
depressive symptoms increase. The predominant group
with UI complaints is patients with MUI. Although there
was no difference between the types in respect of sexual
function, the urinary distress symptoms of MUI patients
were seen to be greater than those of UUI patients.
AUTHOR CONTRIBUTIONS
Concept and study design: Aykut Demirci, Fatih Hızlı,
Hayriye Dilek Hamurcu. Data collection: Aykut Demirci,
Fatih Hızlı. Analysis and writing: Aykut Demirci.
Supervision and critical review: Aykut Demirci, Halil
Başar, Hayriye Dilek Hamurcu, Fatih Hızlı.
CONFLI CT OF I NTER EST STATEMENT
The authors declare no conflicts of interest.
15206777, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nau.25146 by Universidad Nacional Autonoma De Mexico, Wiley Online Library on [29/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ET AL.
DATA AVAILABILITY STATEMENT
The participants of this study did not give written
consent for their data to be shared publicly, so due to
the sensitive nature of the research supporting data is not
available.
ETHICS STATEMENT
Approval for this cross‐sectional cohort study was granted
by the Ethics Committee of Dr. Abdurrahman Yurtaslan
Ankara Oncology Training and Research Hospital (Decision
No.: 2022‐01/1511). Informed consent was obtained from all
individual participants included in the study.
ORC ID
Aykut Demirci http://orcid.org/0000-0001-8921-4571
Fatih Hızlı http://orcid.org/0000-0002-8416-3231
Hayriye Dilek Hamurcu http://orcid.org/0000-0002-
1456-2499
Halil Başar http://orcid.org/0000-0003-1770-5165
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How to cite this article: Demirci A, Hızlı F,
Hamurcu HD, Başar H. Which type of female
urinary incontinence has more impact on pelvic
floor and sexual function in addition to anxiety and
depression symptoms: a questionnaire‐based study.
Neurourol Urodyn. 2023;42:814‐821.
doi:10.1002/nau.25146