There is an established relationship between urinary incontinence (UI) and increased falls risk among older adults (1)​. Urinary urgency and urgency urinary incontinence is associated with a doubling in fall risk (2). Urinary urgency has been associated with changes in gait which are associated with an increased risk of falling (3). A common management option for individuals with UI is the use of continence containment products (pads). Up to 77% of women use pads for daily management, regardless of other treatments used. Pads may present an additional mechanical factor which may have an influence on gait and fall risk; as a wet pad, an often bulky item which rests between the legs may influence how people walk. This study assessed gait patterns when wearing dry versus saturated pads, to examine whether there were any changes in gait which might influence fall risk.

This exploratory cross-over study recruited women over 60 years of age with or without UI. Participants wore a validated Kinesis Gait analysis apparatus whilst wearing wet and dry pull-ups or briefs.The briefs and pull-ups were TenaCare products. All wet products were soaked with water to 70% capacity. The standardized protocol involved filling the pads in 100 ml increments every 10 minutes to ensure saturation. At 70% capacity the total volume of water in the wet briefs was 1575 mL and in the wet pull-ups it was 1000mL, calculated according to manufacturer’s published absorbencies.
The validated wearable Kinesis Gait analysis apparatus used wireless inertial sensors to capture limb movement during performance of a timed up and go test and gait analysis. Participants were fitted with two measurement units attached to the midpoint of the left and right anterior shin using Velcro straps. Gait variables included individual stride analysis, bilateral gait, spatial gait parameters, temporal gait parameters, gait variability, and gait symmetry. Data was sent wirelessly to analytical software for storage and comparative analysis. The underlying algorithms for analysis have been validated against force plate and optical motion capture. For each gait cycle women performed a timed up and go test (TUG), standing up from a chair,and walking a distance of 3 metres, turning around, and walking back 3 metres to be seated on the chair. Women were then asked to complete the TUG test over a 10 metre distance. This procedure was repeated in each wet/dry condition and when walking normally. After a baseline TUG over both distances, in which the participants wore no pads, women were randomly allocated to either the brief or the pull-up and then randomly allocated once again to either the wet or dry state. This randomization process was repeated until the participant underwent testing whilst wearing each type of containment product (Figure 1).

Ten women participated (mean (SD) age 75.1 (7.1) years; range 65-87 years. Consistent trends in gait variability (GV), stride velocity variability (SVV), stride time variability (STV), and cadence between the “wet” and “dry” state were observed (Table 1). Wet briefs were associated with the highest mean GV, SVV and STV. Mean cadence had lower scores in “wet” pads, reaching the lowest score in the wet brief condition. Women tended to “speed up, reduce their stride length, increase their gait variability and decrease their cadence in the “wet” state. Using the effect size for GV in wet compared to dry briefs, 95 women would be needed for an adequately powered study to compare the influence of a wet versus dry brief on gait variables.

Consistent changes in gait patterns suggest that walking in wet pads could act as a mechanical risk factor for falls, providing a novel and empirically supported association between falls risk and walking in wet pads. Walking in a soaked brief with tapes, rather than pull up style brief, appeared to have the greatest impact on gait, illustrating the differential influence of the type of continence product on gait. This experimental study used pad saturations which are well above those dictating pad change in real life use, and should be interpreted accordingly.

This exploratory study provided novel empirical evidence that walking in wet pads may result in gait changes associated with increased falls risk.These findings add a novel dimension to the understanding of contained UI's effect on mobility.

PLOS ONE, 16(10). https://doi.org/10.1371/journal.pone.0257506
PLOS ONE, 16(5). https://doi.org/10.1371/journal.pone.0251711
Advances in Therapy, 35(11), 1831–1841. https://doi.org/10.1007/s12325-018-0796-8

Continence 12S (2024) 101631
DOI: 10.1016/j.cont.2024.101631