Association between physical activity and urinary incontinence according to menopausal stages

Abstract

Pelvic floor dysfunction (PFD) is a common and multifactorial condition affecting women across the lifespan. Urinary incontinence (UI), its most prevalent symptom, may be influenced by hormonal status and physical activity (PA), although evidence examining menopausal status as a moderator remains limited. This cross-sectional study examined the association between PA level, menopausal status, and UI in 1,294 physically active adult women. Participants completed the IPAQ-SF, the Pelvic Floor Impact Questionnaire–Short Form (PFIQ-7), and screening questions on urinary symptoms and menopausal status. Overall, 56.6% reported UI despite moderate-to-high PA levels. Perimenopausal, menopausal, and postmenopausal women showed a higher prevalence (63.5%) than non-menopausal women (51.5%) (p < 0.001). Globally, UI prevalence was 59.5% in women reporting moderate PA, 56.1% in low PA, and 53.7% in high PA (p = 0.002). Stratified analyses indicated that PA level was associated with UI only in non-menopausal women (p < 0.001), whereas prevalence remained consistently elevated across PA levels in menopausal stages. These findings suggest that general PA alone may not be sufficient to offset menopause-related vulnerability to UI and underscore the need to differentiate between overall PA and targeted pelvic floor interventions. Menopausal status should be considered when designing prevention strategies across the female lifespan.