We note some limitations to this study. Estimates of prevalence in the published epidemiologic data on urinary incontinence often vary widely. These large variations are derived mainly from the wide range in definitions used, differences in survey setting, and methodology used. The overall prevalence rate of 51% reported in our survey is high. Further, the prevalence of incontinence among our respondents appeared to decrease slightly with age. One possible explanation and limitation of our study is that respondents self-selected to participate. The other limitation is that older, incontinent women likely were underrepresented in our sample due to institutionalization and survivor bias. The end result is that the prevalence of incontinence might have been overestimated for younger respondents (incontinent younger women more likely to respond) and underestimated for the older respondents (incontinent older women less likely to dwell in communities). The choice of our sampling frame and thus our ability to generalize the findings to other settings also might be viewed as problematic. This was not intended to be a community sample. We were interested in the impact of urinary incontinence on women attending family medicine clinics because these women are our patients and we have the opportunity to intervene to improve their quality of life.
Another limitation was that our questionnaire was available only in English. This might have affected our response rate and generalizability of these findings.
Despite these limitations, we believe the I-QOL is a useful instrument for the investigation of incontinence-related quality of life in the community and the clinical trial setting. We have begun to use the I-QOL among patients attending an incontinence clinic. We have found it to be well received and plan to report on its performance in this setting in the near future.