Urinary incontinence (UI) and fecal incontinence (FI) are multifactorial disorders with potential genetic and familial components. Understanding familial aggregation may inform risk stratification and early intervention strategies. We aimed to investigate the association between family history (specifically sibling/maternal history) and the presence of UI and FI in the general population of northwest Iran.

This cross-sectional study included 1,865 participants (936 women, 929 men) from urban and rural areas of three northwestern provinces. Data were collected using validated Persian questionnaires (ICIQ-OAB, ICIQ-FLUTS, ICIQ-MLUTS, PFDI). Participants were asked about family history of urinary problems or pelvic organ prolapse in sisters or mothers. Associations were analyzed using chi-square tests (p < 0.05 considered significant).

Among female participants, 3.6% (67/1865) reported a history of urinary problems or prolapse in a sister or mother. Among male participants, 0.7% (13/1865) reported a similar history in a father or brother. The presence of a positive family history was significantly associated with UI prevalence in women. Women with a family history had higher rates of UI (18.7% overall) compared to those without, with the association being strongest for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Additionally, co-occurrence of UI and FI was more frequently observed in women with positive family history.

The findings of this study support the presence of familial clustering in pelvic floor disorders, particularly among women, suggesting that genetic predisposition and/or shared environmental factors may contribute to the development of urinary and fecal incontinence. The stronger association observed for stress and mixed urinary incontinence aligns with known heritable components related to connective tissue integrity, pelvic floor support, and neuromuscular function. The higher rate of double incontinence in women with a positive family history further indicates that familial susceptibility may extend across multiple pelvic floor compartments rather than isolated conditions. The markedly lower reporting of family history in men and the absence of a strong association may reflect both true sex-related biological differences and underreporting due to sociocultural factors. Overall, these results highlight the clinical importance of incorporating family history into risk assessment and support targeted early screening and preventive strategies in high-risk populations.

A positive family history of urinary problems in sisters or mothers is associated with increased prevalence of UI and double incontinence in women. These findings suggest potential familial aggregation of pelvic floor disorders, supporting consideration of family history in clinical risk assessment and early screening strategies.