Research report
A research report is the sourced material a domain
dossier is synthesized from — generated on a plan and a cadence, one topic per file.
A report carries no confidence tags. Its bracketed markers say who might have
an incentive to shade a line; none of them says anyone checked it. To reach a score, a line has
to be drafted onto a candidate as unverified and pass the Verifier or the
Corroborator, like everything else.
Section epidemiology · Version 2026-09-01 · Cadence annual · Evidence class 2 published · Sources 9 · Supersedes none
Domain: stress-urinary-incontinence · Scope: public primary sources reachable by this repo's connectors, WebSearch and WebFetch. Excludes CPT-coded utilization data (AMA-licensed), non-US findings, and state-level CDC BRFSS geographic data (no connector; a WebSearch surfaced only secondary summaries, no primary CDC page independently fetched this pass).
Sourcing: nine peer-reviewed/guideline sources, dominated by four independent NHANES-cycle analyses (2015-2023) that use four different case definitions and therefore do not corroborate one another's specific quantities; no single figure here rests on two independent teams measuring the same thing.
The domain dossier's epidemiology section anchors on one NHANES cycle (2015-March 2020) and flags incidence, demographic concentration, and a population-level SUI-only prevalence figure as unsearched. This pass adds four more independent NHANES-cycle analyses spanning 2015-2023, a large longitudinal incidence-onset cohort, one race-specific cohort, and one surgical-demand projection. Across every cycle-comparison source located this pass, reported urinary incontinence (UI) prevalence in US women is rising or holding at a historically elevated plateau, never falling [1][2][3][4]. The size of any reported figure is driven at least as much by case definition — a validated moderate-or-worse severity instrument versus any self-reported leakage of any frequency — as by the underlying survey cycle, a pattern the treating guideline itself acknowledges [9]. Stress-type symptoms are consistently among the most common UI subtypes reported, whether measured as a share of prevalent cases or of new-onset cases [1][2][4][6]. A true incidence rate (new cases per person-time) for SUI specifically was not found in the general US population; the closest available figure is a large cohort's report of the subtype distribution among women newly identified with incident UI [6]. Demographic concentration by race is addressed by exactly one source, and it reports overall UI, not the SUI subtype specifically [7]; geographic concentration was searched for and not found.
_Baseline (v1). No prior version; this establishes the starting point for future diffs._
The AUA/SUFU guideline that governs this domain's standard of care defines SUI as "the symptom of urinary leakage due to increased abdominal pressure, which can be caused by activities such as sneezing, coughing, exercise, lifting, and position change" [9] [single-source]. The same guideline states plainly that "the prevalence of SUI has been reported to be as high as 49%, depending on population and definition" [9] [single-source] — the guideline's own authors treat case-definition sensitivity as expected, not as an artifact of any one study below.
Four NHANES-based analyses, from four separate research teams, report four different national prevalence figures because they use four different case definitions and cover four different (overlapping but non-identical) survey windows:
None of these four quantities is a like-for-like re-measurement of any other; each is single-source for its own specific number, even though the directional pattern — prevalence at or above pre-2015 baselines in every cycle examined — recurs across all four.
A fifth source projects SUI/pelvic organ prolapse (POP) surgical volume rather than condition prevalence directly: applying previously published age-specific surgery rates to 2017 US Census Bureau population projections, the combined projected count of SUI-or-POP surgeries rises from 469,460 in 2025 to 553,858 in 2060, an 18% increase, tracking a projected 17% growth in the female population aged 18-89 [8] [single-source]. Read narrowly: this projects surgical utilization assuming constant age-specific surgery rates against a growing and aging population — it is a demand proxy driven by demographics, not evidence that underlying SUI prevalence itself is rising, and it reports a combined SUI-or-POP count rather than an SUI-only figure.
No source located this pass reports a true SUI incidence rate (new cases per person-time) in a general US population; a targeted search for "stress urinary incontinence incidence per 1000 women-years cohort" returned zero PubMed records in a 15-year window. The closest available figure comes from the Nurses' Health Study and Nurses' Health Study II: 10,349 women aged 41-83 were identified with incident UI via repeated mailed questionnaires beginning in 2004-2005 and followed for 8 years. At the point of onset, 56% reported stress-type symptoms, 23% urgency, and 21% mixed [6] [single-source]. This is a subtype distribution among an already-ascertained incident cohort, not a population incidence rate with a defined at-risk denominator, and it is flagged here as the nearest primary evidence to an incidence figure rather than as one.
The Black Women's Health Study's 2011 biennial follow-up (n=38,100 self-identified Black women) found "approximately one in two participants reported having UI at least once a year (50.6%)," extrapolating via 2020 Census weighting to an estimated 5.6 million (95% CI 5.42-5.80 million) Black women aged 35+ in the US with UI [7] [single-source]. Read narrowly: this is overall UI, not the SUI subtype specifically — no source located this pass reports an SUI-subtype prevalence broken out by race. A geographic-distribution query ("urinary incontinence prevalence geographic variation rural urban region United States") returned zero PubMed records this pass; geographic concentration remains unaddressed by any primary source found.
[1] Prevalence of Urinary Incontinence in the United States 2015-2020 — Urogynecology (Philadelphia, Pa.) (published 2026-08-17; accessed 2026-09-01). PMID 42606983 — https://pubmed.ncbi.nlm.nih.gov/42606983/ [peer-reviewed] [2] Updated Prevalence of Urinary Incontinence in Women: 2015-2018 National Population-Based Survey Data — Female Pelvic Medicine & Reconstructive Surgery (published 2022-04-01; accessed 2026-09-01). PMID 35030139 — https://pubmed.ncbi.nlm.nih.gov/35030139/ [peer-reviewed] [3] Rising Prevalence of Urinary Incontinence and Nocturia Amid the COVID-19 Pandemic — Neurourology and Urodynamics (published 2025-06, day not given in the PubMed record; accessed 2026-09-01). PMID 40313157 — https://pubmed.ncbi.nlm.nih.gov/40313157/ [peer-reviewed] [4] Post-Pandemic Prevalence of Urinary Incontinence Among Women in the United States and Associated Risk Factors — International Urogynecology Journal (published 2026-03, day not given in the PubMed record; accessed 2026-09-01). PMID 41081813 — https://pubmed.ncbi.nlm.nih.gov/41081813/ [peer-reviewed] [5] Post-Pandemic Prevalence of Urinary Incontinence Among Women in the United States (companion conference abstract to PMID 41081813) — International Continence Society, ICS-EUS 2025 Abstract 581 (published 2025, exact date not given on the page; accessed 2026-09-01). PMID 41081813 — https://www.ics.org/2025/abstract/581 [other] [6] The natural history of urinary incontinence subtypes in the Nurses' Health Studies — American Journal of Obstetrics and Gynecology (published 2020-02; accessed 2026-09-01). PMID 31449803 — https://pubmed.ncbi.nlm.nih.gov/31449803/ [peer-reviewed] [7] Prevalence of Incontinence in the Black Women's Health Study — International Urogynecology Journal (published 2026-07, day not given in the PubMed record; accessed 2026-09-01). PMID 41575521 — https://pubmed.ncbi.nlm.nih.gov/41575521/ [peer-reviewed] [8] Projections for Urogynecologic Surgeries in the United States, 2025-2060 — Southern Medical Journal (published 2026-08-03; accessed 2026-09-01). PMID 42550940 — https://pubmed.ncbi.nlm.nih.gov/42550940/ [peer-reviewed] [9] American Urological Association / SUFU, Stress Urinary Incontinence (SUI) Guideline (originally published 2017, amended 2023; corresponding journal amendment PMID 37096580) — AUA/SUFU (published 2023, day not given on the page; accessed 2026-09-01). PMID 37096580 — https://www.auanet.org/guidelines-and-quality/guidelines/stress-urinary-incontinence-(sui)-guideline [guideline]
Well established: nothing in this report rests on two independent, non-affiliated primary sources agreeing on the same specific quantity — every quantity below is [single-source]. The only thing repeated across independent sources is the qualitative direction (prevalence at or above pre-2015 baselines in every cycle-comparison study examined) rather than any one number.
Thin: every prevalence, incidence, and demographic figure in section 3 carries [single-source]. [4] and [5] describe the same underlying study read through two documents (a PubMed abstract and a companion conference-abstract page), not two independent sources — the full peer-reviewed text of [4]/[5] was paywalled and not reached this pass, so the subtype breakdown (mixed 29.2%, stress 23%, urgency 10.8%) rests entirely on the conference-abstract mirror [5]. [3]'s headline SUI figures (24.89% to 29.65%) carry an unresolved ambiguity about whether they are female-only or mixed-sex, disclosed rather than assumed away.
Rescoped from class 3: none. Every question this report addresses is a published quantity (prevalence, incidence-adjacent, or projected surgical volume), not a question about what a person would do.
Out of scope: non-US findings (a UK Biobank prospective cohort on new-onset SUI surfaced in search results and was not used, per the scope line above); CDC BRFSS state-level geographic data (a WebSearch surfaced only secondary summaries; no primary CDC dataset page was independently fetched this pass); CPT-coded incontinence-visit utilization data (AMA-licensed, out of reach by design, consistent with the domain dossier).
Not searched vs. not found:
[inference] The section 1 summary's characterization of prevalence as "rising or holding at a historically elevated plateau" is this report's own synthesis across four case-definition-mismatched NHANES analyses from four different research teams — no single source in this report tracks one consistent case definition across the full 2015-2023 window, so the directional read is a pattern this report is drawing across non-identical measurements, not a finding any one paper states in that form.
| Proposition | Evidence class | Resolvable identifier | Dossier section |
|---|---|---|---|
| In NHANES 2015-March 2020 (n=6,446 nonpregnant women aged 20+), weighted UI prevalence was 22.3% (95% CI 20.8-23.8), of whom 16.2% reported stress-predominant symptoms | 2 published | PMID 42606983 | 1 |
| In NHANES 2015-2018 (n=5,006 women), 61.8% reported any UI, an estimated 78,297,094 US women, of whom 37.5% reported stress-type symptoms | 2 published | PMID 35030139 | 1 |
| In NHANES 2021-2023 (n=2,834 women aged 20+), crude UI prevalence was 63% (age-adjusted 47.6%), an estimated 79.6 million US women | 2 published | PMID 41081813 | 1 |
| Comparing NHANES 2017-2020 to 2021-2023, SUI prevalence rose from 24.89% to 29.65% (p<0.0001) | 2 published | PMID 40313157 | 1 |
| Among 10,349 women aged 41-83 in the Nurses' Health Study/Nurses' Health Study II with incident UI ascertained in 2004-2005, 56% reported stress-type symptoms at onset | 2 published | PMID 31449803 | 1 |
| In the Black Women's Health Study 2011 follow-up (n=38,100), 50.6% of self-identified Black women reported UI at least once yearly, extrapolating to an estimated 5.6 million (95% CI 5.42-5.80 million) US Black women aged 35+ | 2 published | PMID 41575521 | 1 |
| Using 2017 Census projections and previously published age-specific surgery rates, projected SUI-or-POP surgical volume rises from 469,460 (2025) to 553,858 (2060), an 18% increase | 2 published | PMID 42550940 | 1 |