Stress urinary incontinence (SUI) is a urinary system disorder characterized by involuntary urine leakage during activities like coughing, sneezing, physical exertion, or other situations that elevate intra-abdominal pressure, resulting in temporary urinary incontinence (UI) [1]. Among females, especially in the elderly demographic, SUI stands as a prevalent urologic condition. Studies have reported prevalence rates ranging from 18.9% to 40%, with a notably higher prevalence of up to 28.2% in females aged over 60 years [2, 3, 4, 5]. A study has revealed that 60.6% of patients experiencing UI perceive it as significantly more embarrassing than depression and cancer [6]. This embarrassment often leads to a delay in seeking medical treatment due to the presence of qualitative shame. Consequently, patients find it challenging to access timely and effective therapeutic measures, which worsens disease symptoms and adds to their psychological stress. The intensifying symptoms and negative emotions further contribute to an increased sense of shame among patients, subsequently diminishing their social participation and reducing their inclination to seek medical treatment [7, 8, 9, 10]. This creates a vicious circle that adversely impacts the overall quality of life of these patients. Additionally, it is important to acknowledge that several factors, including a lack of awareness and education, cultural norms, gender roles, and age, contribute to the stigma surrounding incontinence [8, 9, 10]. Currently, research concerning the experienced stigma among elderly females with SUI [9, 10, 11, 12] predominantly focuses on evaluating clinical outcomes using composite scores, often without considering the heterogeneity among the items in these scales. However, latent profile analysis (LPA) is a clustering method based on a latent variable model, offering the capability to identify different groups within the data and describe the unique characteristics of each group [13]. Hence, this study aims to use LPA as a tool for exploring and analyzing the various subgroups of stigma characteristics present among elderly females with SUI. The results of this study provide evidence to furnish valuable insights for the development of targeted nursing interventions. These interventions are designed to reduce stigma, minimize its impact on patients’ health-related behavior, and ultimately improve their overall quality of life.

This study aimed to investigate the prevailing levels of stigma among elderly females experiencing SUI. Additionally, the study also employed the LPA technique to categorize participants according to their stigma experiences, leading to the identification of three distinctive profiles: low-self-low-perceived, high-self-medium-perceived, and high-self-high-perceived. The findings indicated that the most substantial proportion of participants fell into the “high-self-medium-perceived” group.

In this study, it was observed that elderly female patients experiencing SUI exhibited elevated levels of stigma. Furthermore, the patients’ level of self-stigma was found to surpass their levels of perceived stigma. These findings can be attributed to several factors. Firstly, SUI can exert a significant impact on patients’ social activities and overall quality of life. Consequently, patients may harbor increased concerns about their own physical well-being, leading to an increased sense of self-morbid shame [23, 24, 25]. Moreover, older adults often have limited social circles and may place less emphasis on external evaluations. Consequently, their perceived morbid shame scores tend to be relatively low [26, 27]. A study involving 506 female patients experiencing UI, Guan et al. [27] also found that patients had the highest scores for intrinsic shame, which is consistent with the findings of this current study.

The study revealed that educational attainment (level of literacy), marital status, and water intake emerged as significant factors influencing the sense of shame among elderly female patients with SUI. Patients with varying levels of literacy may harbor different attitudes toward themselves and their illness, thereby impacting the degree of shame they experience [28]. Those with higher levels of literacy might place greater importance on etiquette and cultural refinement in social interactions, potentially leading to a greater mental and psychological burden when experiencing incontinence. This, in turn, may increase the likelihood of falling into the “high-self-medium-perceived” group. Conversely, patients with low levels of literacy may tend to belong to the “low-self-low-perceived” group. These findings align with those of Wang et al. [28], which is a study investigating the relationship between stigma and healthcare-seeking behaviors in elderly females. The study found that marital status independently influenced the intention of patients to seek healthcare. However, that study did not identify a direct impact of marital status on the stigma of patients. Conversely, our study demonstrated that patients with a spouse were more inclined to belong to the “high-self-high-perceived” group, while patients without a spouse were more likely to fall into the “low-self-low-perceived” group. This difference could be attributed to patients with spouses being more concerned about their image and privacy, which may lead to an intensified sense of stigma. However, these findings should be further explored with larger sample sizes. The daily water intake exhibited a positive correlation with the stigma, with higher water intake associated with a higher likelihood of falling into the “low-self-low-perceived”, “high-self-medium-perceived”, and “high-self-high-perceived” groups. This might be because excessive water intake can burden the digestive system, exacerbating UI symptoms and intensifying feelings of shame and embarrassment. The findings from Andersen et al. [29] also suggest that a well-managed water intake regimen can help alleviate the UI symptoms, consequently reducing the stigma of the patient [30, 31].

The study also found that the presence of diabetes mellitus, the frequency of urine leakage, and the number of chronic diseases can impact the perception of stigma in elderly females with SUI [32]. Patients with comorbid diabetes were more inclined to belong to the “high-self-high-perceived” group, whereas patients without diabetes were more likely to fall into the “high-self-medium-perceived” group. This phenomenon may be attributed to the fact that diabetes not only affects incontinence symptoms but can also lead to other health issues like retinopathy and neuropathy. These additional health concerns increase the susceptibility of patients to external influences, thereby amplifying their perception of stigma [33, 34, 35, 36, 37]. This finding is consistent with the findings of Akyirem et al. [33]. Furthermore, patients with less frequent urine leakage were more likely to fall into the “low-self-low-perceived” group, while those with more frequent leakage tended to belong to the “high-self-high-perceived” group. This observation can be attributed to the fact that urinary leakage not only impacts the social activities of the patients but also increases the burden and discomfort experienced by others. Consequently, patients become more acutely aware of their incontinence [7, 8, 38, 39]. This aligns with the results reported by Cai [38], which indicated that patients with UI often have their social interactions and comfort affected by urine leakage. It is important to note that while some studies have shown that chronic diseases can lead to patients developing a sense of shame [40, 41, 42], the present study found that patients with $\ge$5 chronic diseases reported a lower sense of shame compared to those with 2 chronic diseases. This could be attributed to patients gradually accepting their condition and adapting to the impact of their illnesses on their lives when dealing with multiple chronic diseases. However, it is worth acknowledging that the study’s conclusion may be limited by its small sample size and underrepresentation, highlighting the need for further investigation with a larger sample size.

In conclusion, this study highlights the significant impact of stigma on elderly females experiencing SUI. The comprehension of factors influencing these emotional responses, such as level of literacy, marital status, water intake, the presence of diabetes mellitus, the frequency of urinary leakage, and the number of chronic diseases, can help healthcare professionals design customized interventions and support systems aimed at enhancing the psychosocial well-being of these patients. Through the reduction of stigma and the promotion of acceptance, there is the potential to improve the overall quality of life for elderly females living with SUI.

In summary, this study used the potential profile analysis method alongside the SSCI scale to investigate the stigma among elderly female patients with SUI. The findings identified three distinct subgroups, with the majority falling into the “high-self-medium-perceived” group. Particular attention should be directed toward patients with high levels of literacy, elevated water intake, a spouse, serious urine leakage, and coexisting diabetes. Tailored nursing interventions should be implemented to enhance their mental well-being and diminish the burden of stigma they experience.

The raw data supporting the findings of this study are available from the authors, without undue reservation.

HH, BY, YL, and XY participated in the concept and design of the study. HH, YL and XH collected data and controlled quality. HH, BY, and QZ drafted and edited the manuscript. HH, QZ, and LO performed the statistical analyses. XY will be responsible for the paper’s pre-publication. All authors made substantial contributions to interpret data and revised the manuscript for important intellectual content. All authors contributed to the article and approved the final version.

The Ethics Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University (2022-87) approved the study. Before we distributed the questionnaires, we assured the medical staff that the questionnaire will be used for academic research, their personal information will remain confidential, and they could withdraw at any stage. Moreover, the participants signed informed consent forms.

The authors would like to acknowledge the cooperation of the elderly population who participated in this study and express their gratitude for the valuable contributions of the research assistants.

This study received support from the Medical and Health Science and Technology Project funded by the Special Funds for Economic and Scientific Development of Longgang District, Shenzhen, China (LGWJ2021-042).

The authors declare no conflict of interest.