Associations between urinary incontinence and physical activity in women: a cross-sectional survey in the UK

To examine the link between urinary incontinence (UI) and physical activity participation in women. Little research has explored this relationship, despite the long-term effects of reduced physical activity on women's health and well-being.

A cross-sectional survey was conducted using self-reported data collected through social media and university channels.

Adults aged 18 years or older identifying as women, including transgender women who had undergone gender-affirming vaginoplasty and people assigned female at birth. In total, 413 individuals completed the survey, of whom 3 were excluded for not meeting inclusion criteria. Most respondents (n=403; 98%) identified as female, with the largest age group being 25-44 years (n=176; 46%).

Severity of urinary incontinence (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)), physical activity quantity and intensity (International Physical Activity Questionnaire-Short Form (IPAQ-SF)) and self-reported impact of UI on participation in physical activity. Analysis of IPAQ-SF and ICIQ-UI SF scores evaluated associations between UI and activity quantity and intensity. Free-text responses were categorised and their frequencies were recorded.

UI was reported by 76.8% (n=315) of participants, with a median ICIQ-UI SF score of 6.0 (IQR 6.0, range 1.0-21.0) in those reporting UI. One-third (32.5%; n=133) agreed or strongly agreed that UI influenced their decision to start physical activity, and 37.3% (n=153) agreed that UI during activity affected whether they continued; free-text responses indicated this was a negative influence. Those with lower UI scores reported a higher quantity of physical activity, although this was not statistically significant (Kruskal-Wallis H=5.093, p=0.165). Significant reductions were observed in vigorous (H=10.733, p=0.013) activity time among those with more severe UI. Ordinal regression analysis showed a positive relationship between low intensity of physical activity and high levels of UI (OR 2.26, 95% CI 1.38 to 3.71, p=0.001). Age was not found to be a confounding variable. Analysis of free-text responses revealed themes of UI and its links to physical activity, strategies to prevent or cope with UI and the physical and emotional impacts of UI.

In this sample, a high prevalence of UI was associated with lower intensity of physical activity. Most strategies employed by participants addressed leaks when they occurred, with few mentioning preventive approaches, such as pelvic floor exercises. Public health campaigns should reframe UI, shifting the narrative towards prevention and treatment through early intervention.