Lower urinary tract symptoms (LUTS) are primarily considered a problem for older women; however, young, nulliparous women can experience problems with stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and symptoms of overactive bladder syndrome (1). Alterations of gait patterns have been identified in college-aged women with SUI (2). This is the first study looking at specific gait parameters nulliparous college-aged women with urgency or UUI to age-matched women without any urinary symptoms.

This descriptive study is part of a larger data set that was collected to review gait biomechanics with nulliparous young women in graduate school. Women were recruited through emails from June 2019 to March 2021. A total of 58 participants completed the data collection. Ten of the 58 participants had complaints of urgency or UUI. An additional 10 participants without any complaints or significant medical history were age-matched to the participants with urge-related complaints. An a priori power analysis was conducted using G*Power (version 3.1.9.6) and recommended a sample size of 16 with an effect size index of 0.75, alpha of 0.05 and power of 80%.
The inclusion criteria were as follows: nulliparous and female. The exclusion criteria were the following: male, ambulation with an assistive device, younger than 18 years of age, and a history of pelvic, lower extremity, back, or abdominal surgery in the last 6 months.
Participants were screened for eligibility and consented by a research team member. They then completed a brief questionnaire related to their medical history regarding urinary, gastrointestinal, menstrual, and orthopedic problems. Height, weight, leg length, knee joint width, and ankle joint width were measured. Reflective markers were placed on each participant according to the Plug-in Gait Model for lower body reconstruction by a member of the research team. Participants were allowed to keep socks on if they preferred this. 
Spatiotemporal, kinetic, and kinematic data were collected on the Vicon Vero 2.2 Motion Analysis System (Vicon, Oxford, UK) sampling at 100 Hz integrated with two force plates (Advanced Medical Technology, Inc., Watertown, MA, USA) (45.7 cm x 50.8 cm) sampling at 2 kHz.  The Vicon System was calibrated, and a static trial was completed. Participants completed a minimum number of 16 walking trials to ensure good force plate contact for at least three trials. Trials were collected by a physical therapist with experience in motion analysis (DWF).
Selected spatiotemporal, kinetic, and kinematic values were processed using the Plug-in Gait Model within the Nexus processing system (Vicon, Oxford, UK). For missing markers in model reconstruction, cyclic filling, rigid body filling, and pattern filling were used to fill any gaps before processing the Plug-in Gait Model. 
	There was attrition with two participants, one in the group with urgency and one in the control group. These were both excluded from any analysis. 
Means and standard deviations for gait speed, cadence, and step width were reported for both groups and then were analyzed with an Independent sample t-test. Means were calculated for hip abduction moment at weight acceptance and hip external rotation angle at weight acceptance. Independent sample t-tests were utilized for comparisons of both kinetic and kinematic values. The paired t-test was used for between-limb comparisons between the right and left lower extremities for step width in the urinary urgency group. Data were analyzed with IBM SPSS Statistics Version 27 (IBM Corp, Armonk, New York).

Eighteen female participants completed gait analysis with nine of these being participants with symptoms of urgency or urge incontinence and nine without. Table 1 provides descriptive data. Notable differences in the urgency group include a greater percentage of constipation, urge incontinence, stress incontinence, irregular menses, irritable bowel syndrome, and recurrent urinary tract infections. Notable differences for the group without complaints were a higher percentage of scoliosis. Both groups had the same percentage reporting abdominal cramping and also had sought physician care for lower extremity orthopedic injuries, although those with urgency were slightly higher. Although not included in Table 1, the urgency participated in exercise varying times through the week: 1-2 times (33.3%), 3-4 (33.3%), > 4 (33.3%), while those without were as follows: 1-2 (22.2%), 3-4 (22.2%), >4 (55.5%). Table 2 includes the mean with the standard deviations and confidence intervals.
	There were no significant differences for the comparisons between groups for cadence (p = 0.981), step width (p = 0.211), gait speed (p = 0.470), mean hip abduction moment at weight acceptance (p = 0.101), and hip external rotation angle at weight acceptance (p = 0.072). There was no significant difference in the between limb comparison for step width (p = 0.150) for those with urgency.

This is the first study to observe gait in nulliparous women with urgency and UUI. Though there were no significant findings between the two groups, this was a small sample size and the parameters were not exhaustive. Both groups are very closely matched with BMI and age. The selected measures were based on previous literature looking at a similar population of college-aged women comparing those with SUI and without (2). Hartigan’s significant findings were at weight acceptance and also focused on differences between dominant and non-dominant limbs of those with SUI, and this served as guidance in the selection of parameters for this study. Limb dominance was not asked for the participants in this study and could potentially impact the results.  An additional limitation of this study was marker drop out during the gait cycle, requiring gap filling through the Vicon system for reconstruction of the 3-D gait model, which may have affected the final analysis.

Although there were no significant findings between the urgency group and the age-matched comparisons for these specific measures, other kinematic and kinetic aspects of the gait cycle should be the focus of future research (e.g., mid-stance and toe-off)  in those with urgency. Based on the literature review, there have been descriptive studies of young college-aged women with LUTS, but there have been limited studies regarding on how these symptoms impact the biomechanics of gait, which requires further study.

Ural, Ü. M., Gücük, S., Ekici, A., & Topçuoglu, A. (2021). Urinary incontinence in female university students. International Urogynecology Journal, 32(2), 367-373. https://doi.org/10.1007/s00192-020-04360-y
Hartigan, E., McAuley, J. A., Lawrence, M., Brucker, W., King, A., Tryon, B., & DeSilva, M. (2020). Hip Angles, Joint Moments, and Muscle Activity During Gait in Women With and Without Self-reported Stress Urinary Incontinence. Journal of Women’s Health Physical Therapy, 44(3), 107-116. https://doi.org/10.1097/JWH.0000000000000166