The worldwide prevalence of urinary incontinence (UI) is estimated to be 8.7%. Numerically, it represents 421 million people affected by urinary symptoms, which is larger than the population of the United States of America. The presence of UI is significantly associated with an increased in depression, social isolation, quality of life, and mortality rate.
Several factors have been associated with urinary incontinency such as aging, obstetric and gynecological history, lifestyle habits, among others.[1,2] Some of these factors can be modifiable which can be treated either by a health professional or can be addressed by the own patient. Therefore, it is important that these factors are identifiable early to improve the management of UI. Besides that, by identifying variables associated with UI, health professionals can encourage the active participation of women in daily clinical practice to make them autonomous in relation to the management of their own health.  Thus, patients could adapt their behaviors to eliminate or decrease the factors associated with an increase in severity of UI and/or to prevent the onset of its symptoms.
However, it is still inconclusive how modifiable and non-modifiable factors may influence the severity of UI.  In addition, as far as the authors knowledge, no previous systematic review has been published that has summarized this information. This preliminary study aims to identify, compile, and present the available evidence  regarding modifiable lifestyle habits that may exacerbate UI.

This systematic review was conducted according to PRISMA guidelines. The study protocol was registered in the PROSPERO database (CRD42022349773). A systematic search was performed using Ovid Medline, Embase, Web of Science, and Scopus on October 2021. No limits were applied on the databases for the date, language or publication range. Studies that have investigated lifestyle habits and their influence on UI  (of any type) were included. The primary outcome was UI severity.
Two independent researchers conducted the screening of the selected studies in Covidence: first by title and abstract; and after that, by reading the full-text. After including the studies, the researchers performed the data extraction of all studies, and a consensus among researchers was established after finishing the extraction. Besides qualitative, the quantitative data extraction was performed. Estimates of association between modifiable factors and UI were extracted from included studies and and analyzed for this preliminary and narrative synthesis. To identify the contribution of each factor and its relationship with UI, we used the reference factors chosen by the authors from the primary studies as the comparators.

The initial electronic search resulted in a total of 3,511. After removing duplicates (n=40), 347 were screened, and at the end of the selection stages, four studies that reported modifiable prognostic factors of UI classified as lifestyle habits were included in this preliminary report. The longitudinal studies were conducted in the United States of America and included participants with any type of UI (n= 75,749). The severity of UI was measured by self-reported frequency (n=3) and severity (n=1) of urinary symptoms.The recruitment of participants range was from 2000 until 2010. 
Alcohol intake, caffeine intake, caffeine change intake, physical activity and smoking were modifiable lifestyle factors related to UI identified in the literature. Regression analyses were reported in order to identify the frequency of weekly and monthy urinary lost, and the progression of UI in all the studies included in the present systematic review. Table 1 provides a summary of the results from our narrative and preliminary analysis.

Although previous systematic reviews have synthetized and reported the risk factors associated with urinary symptoms, this is the first study to analyze modifiable factors related to lifestyle that could interfere and worsen the severity of any type of UI. The intake of substances (i.e., caffeine and alcohol) and smoking seems to increase the odds ratio for worsening the UI symptoms. The habit of practicing physical activities seems to present the lower odds ratio range in order to worse UI severity, when compared to other factors found in the literature.
According to our preliminary results, researchers and clinicians may be encourage to incorporate the assessment of factors associated with UI and lifestyle habits into their routine care, considering that those factors may interfere and increase the severity of the UI in women with incontinence. Moreover, the physiotherapist can encourage the active participation of women by health education strategies, in order to make them autonomous in relation to the management of their own health, considering that lifestyle habits may be associated with worsening of UI symptoms.

Five different lifestyle habits were identified in the literature as factors associated with the worsening of urinary leakage symptoms. The largest odds ratio for worsening UI symptoms was identified for alcohol intake. Different comparators were used by authors in order to analyze the magnitude of the associations (ORs) for each of the prognostic factors identified by the present review.
The results of the present project may help health professionals of clinical and research practice to understand the progression of UI, which can also reflect in new practices to reduce the rate of urinary symptoms that can be considered severe. This type of result can contribute to the decision-making process of health professionals during the management of patients with UI.

Lamerton TJ, Torquati L, Brown WJ. Overweight and obesity as major, modifiable risk factors for urinary incontinence in young to mid-aged women: a systematic review and meta-analysis: Obesity and urinary incontinence in women. Obesity Reviews. 2018;19(12):1735-1745. doi:10.1111/obr.12756
Almousa S, Bandin van Loon A. The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: A systematic review. Maturitas. 2018;107:78-83. doi:10.1016/j.maturitas.2017.10.003

Continence 12S (2024) 101419
DOI: 10.1016/j.cont.2024.101419