The  Urinary Incontinence in Women in Pakistan: Prevalence, Awareness, Current Management, and the Case for Establishing Female Continence Clinics: A Comprehensive Review

Naseha Begum; Muhammad Ishfaq; Ahmad Omar; Rubina Qadeer; Tehniyat Ishaq

doi:10.69885/pju.v4i1.111

Authors

Naseha Begum Bin Ahmed Gynae Hospital, Batkhela, Malakand, Pakistan https://orcid.org/0009-0007-5857-7346
Muhammad Ishfaq Department of Urology Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, Liverpool, UK https://orcid.org/0000-0001-8425-0725
Ahmad Omar FRCS(Urol), Consultant Urologist, Functional Urologist, and Lead https://orcid.org/0000-0002-1117-1150
Rubina Qadeer Bin Ahmed Gynae Hospital, Batkhela, Malakand, Pakistan https://orcid.org/0009-0003-0435-9723
Tehniyat Ishaq Department of Obstetrics and Gynecology, Peshawar Medical College, Pakistan. https://orcid.org/0000-0002-9962-7801

DOI:

https://doi.org/10.69885/pju.v4i1.111

Keywords:

urinary incontinence; women’s health; Pakistan; urogynecology; functional urology; continence clinic; Bulkamid; botulinum toxin; neuromodulation; policy; training.

Abstract

Background: Urinary incontinence (UI) is a common yet underdiagnosed condition in women, particularly in low- and middle-income countries (LMICs) like Pakistan. The lack of awareness, social stigma, and fragmented healthcare services contribute to limited access to appropriate diagnosis and management.

Purpose of the Review: This review aims to evaluate the prevalence, risk factors, awareness, and current management strategies for UI among women in Pakistan. It also seeks to propose a comprehensive framework for the establishment of specialized continence clinics, integrating community-based screening, district-level care, and tertiary urogynecology-functional urology centers.

Results: The prevalence of UI in Pakistan ranges from 11% to 45%, with postpartum women and those of higher parity be-ing most affected. Awareness of UI as a treatable medical condition is very low, with fewer than 10% seeking care. Conserva-tive treatments such as pelvic floor muscle training (PFMT) are inconsistently delivered, while pharmacologic and minimal-ly invasive treatments are rarely accessible outside tertiary centers. Advanced treatments, such as polyacrylamide hydrogel (Bulkamid®) and botulinum toxin, are unavailable to most patients.

Conclusion: Establishing a tiered, cost-effective model for continence care, starting with community screening and educa-tion, followed by district-level continence clinics and tertiary care centers, can improve access to UI services in Pakistan. Pol-icy reforms, training, and international partnerships are essential to expanding and sustaining these services.