Physical Activity and Incident Urinary Incontinence in Middle-Aged Women
Abstract
Purpose:
While strenuous, high impact activity may provoke urinary incontinence, little is known about relations with moderate physical activity. We examined recreational activity and incident urinary incontinence in middle-aged women.
Materials and Methods:
This is a prospective study of women 37 to 54 years old in the Nurses’ Health Study II. Repeated physical activity reports from 1989 to 2001 were averaged to estimate long-term activity levels. From 2001 to 2003 we identified 4,081 incident cases with at least monthly urinary incontinence. Incontinence type was further determined among cases with at least weekly urinary incontinence. Multivariable logistic regression models were used to estimate adjusted relative risks of urinary incontinence across quantiles of physical activity. To determine whether relations were mediated by body mass index, separate models were constructed that excluded and included body mass index as a covariate.
Results:
The risk of at least monthly urinary incontinence decreased with increasing quintiles of moderate physical activity (RR 0.80, 95% CI 0.72–0.89 comparing extreme quintiles). For stress and urge urinary incontinence, women with the most physical activity had lower rates of incontinence than those with less activity. RRs were 0.75 (95% CI 0.59–0.96 for top vs bottom quartile) for stress urinary incontinence and 0.53 (95% CI 0.31–0.90) for urge urinary incontinence. After adjustment for body mass index, the overall association with at least monthly incontinence attenuated, but remained significant (RR 0.89, 95% CI 0.80–0.99 comparing extreme quintiles).
Conclusions:
Long-term, moderate physical activity was inversely associated with urinary incontinence. The role of exercise in weight maintenance may partly explain this association.
References
- 1 : Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct2000; 11: 301. Google Scholar
- 2 : Psychosocial impact of urinary incontinence in the community-dwelling population. J Am Geriatr Soc1990; 38: 282. Google Scholar
- 3 : Urinary incontinence: medical and psychosocial aspects. Annu Rev Gerontol Geriatr1989; 9: 74. Google Scholar
- 4 : The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct1997; 8: 323. Google Scholar
- 5 : Proceedings of the National Institute of Diabetes and Digestive and Kidney Diseases International Symposium on Epidemiologic Issues in Urinary Incontinence in Women. Am J Obstet Gynecol2003; 188: S77. Google Scholar
- 6 : Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med2004; 34: 451. Google Scholar
- 7 : Patient-reported impact of urinary incontinence–results from treatment seeking women in 14 European countries. Maturitas2005; 52: S24. Google Scholar
- 8 : Is urinary incontinence a barrier to exercise in women?. Obstet Gynecol2005; 106: 307. Google Scholar
- 9 : Physical activity and urinary incontinence among healthy, older women. Obstet Gynecol2007; 109: 721. Google Scholar
- 10 : Association of age, race, and obstetric history with urinary symptoms among women in the Nurses’ Health Study. Am J Obstet Gynecol2003; 189: 428. Google Scholar
- 11 : Preference, compliance and initial outcome of therapeutic options chosen by female patients with urinary incontinence. J Urol1995; 154: 1727. Link, Google Scholar
- 12 : How the principles of exercise physiology influence pelvic floor muscle training. J Wound Ostomy Continence Nurs2001; 28: 150. Google Scholar
- 13 : Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol1994; 23: 991. Google Scholar
- 14 : Body mass index, weight gain, and incident urinary incontinence in middle-aged women. Obstet Gynecol2007; 110: 346. Google Scholar
- 15 : Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand2007; 86: 870. Google Scholar
- 16 : Are smoking and other lifestyle factors associated with female urinary incontinence?. The Norwegian EPINCONT Study. BJOG2003; 110: 247. Google Scholar
- 17 : The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int2003; 92: 69. Google Scholar
- 18 : Clinical and cystometric characteristics of continent and incontinent noninstitutionalized elderly. J Urol1988; 140: 567. Link, Google Scholar
- 19 : Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiol1995; 48: 339. Crossref, Medline, Google Scholar
- 20 : Modern Epidemiology. Philadelphia: Lippincott Williams & Wilkins1998. Google Scholar
