Double incontinence among women globally: A systematic review and meta-analysis

BACKGROUND Double incontinence (DI), defined as the co-occurrence of urinary and anal incontinence, is a major cause of morbidity. AIM To estimate the pooled prevalence of DI among women globally. METHODS A systematic review and meta-analysis was conducted following PRISMA guidelines, searching PubMed, Scopus, Web of Science, and Lens.org for observational studies from January 2010 to May 2025. Eligible studies reported DI prevalence in women. Titles and abstracts were screened using Rayyan, and data were pooled using a random-effects model in Jamovi v2.6.44. Heterogeneity was assessed via I 2 and Q statistics, and publication bias was evaluated using Egger’s regression and funnel plots. RESULTS Ten studies (n = 76009 women) from seven countries spanning four World Health Organization regions were included. The pooled prevalence of DI was 8.66% [95% confidence interval (CI): 7.14%-10.63%], with moderate heterogeneity (I 2 = 32.7%, 95%CI: 0.0%-62.8%; Q = 13.396, P = 0.145; Tau2 = 0.0374, 95%CI: 0.000-0.152). Sensitivity analyses confirmed robustness, with leave-one-out estimates ranging from 8.31% to 9.25%. Meta-regression explained only 23.8% of heterogeneity, indicating measurement variability as the primary source. No significant publication bias was detected across multiple methods (Egger’s P = 0.721; Begg’s P = 1.000; trim-and-fill: Zero imputed studies; Fail-Safe n = 2554). Cumulative meta-analysis showed temporal stability (2009-2020). CONCLUSION DI affects approximately 8.7% of women in studied populations (predominantly middle- and high-income countries), representing a significant public health priority. This pooled international estimate is most applicable to urban/peri-urban women in settings with healthcare access. Critical geographic gaps (Sub-Saharan Africa, South-East Asia) and absence of low-income country representation limit global generalizability. Standardized DI definitions and targeted research in underrepresented regions are essential to achieve truly comprehensive global estimation and inform equitable, evidence-based interventions.