Dissertation
Associations of urinary incontinence and postpartum physical activity: a mixed methods investigation
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2025
DOI: 10.25820/etd.007943
Abstract
Introduction: Physical activity (PA) is essential for the promotion of health and prevention of disease in the postpartum period (birth through 12 months after delivery) and across the lifespan. Yet, PA decreases during pregnancy and does not fully recover after birth, suggesting that interventions are needed to promote PA postpartum. Urinary incontinence (UI) is common postpartum and is associated with low PA outside of the perinatal period. UI has a variable presentation with four main characteristics: presence, severity (slight, moderate, severe, or very severe), type (stress, urge, mixed, or undefined), and level of bother. However, little is known about the association of each UI characteristic with postpartum PA, and so, our knowledge is inadequate for determining the needs of postpartum women with UI.
Aims/Hypotheses: Study 1 aimed to determine the association of UI characteristics (presence, severity, type, and level of bother) with aerobic moderate-to-vigorous PA and muscle-strengthening activity (postpartum PA) in postpartum women. It was hypothesized that those with UI, greater severity, stress or mixed UI, and high symptom bother would have lower postpartum PA than those without UI, low severity, urge UI, or low symptom bother. Study 2 aimed to thematically analyze the potential mechanisms for the association of UI with postpartum PA to identify subsequent intervention components.
Methods: This dissertation employed a mixed-methods study design. Study 1 was a cross-sectional, online survey including 244 women between 3 and 12 months postpartum. Validated surveys assessed UI characteristics (Sandvik Severity Index and Urinary Distress Inventory), postpartum PA (Global Physical Activity Questionnaire, a single item from the Behavioral Risk Factor Surveillance Screen, and Muscle Strengthening Exercise Questionnaire), demographics, and obstetric history. Multiple linear regression, multiple logistic regression, and Tukey tests analyzed associations of UI characteristics and postpartum PA, after adjustment for BMI, smoking status, delivery mode, and complementary activity (muscle strengthening or moderate-to-vigorous intensity physical activity). Study 2 employed one-on-one semi-structured interviews in 30 postpartum women with UI recruited from study 1. Interview questions asked about experiences with UI and postpartum PA as well as preferences for a postpartum PA intervention. All interviews were transcribed using AI transcription software. Thematic analysis using interpretive phenomenology was used to interpret qualitative data from semi-structured interviews.
Results: UI presence was not associated with postpartum PA. Those with severe UI, mixed UI, and high symptom bother were found to have less weekly moderate-to-vigorous aerobic postpartum PA and muscle-strengthening exercise compared to those with slight UI, stress UI, low symptom bother. Thematic analysis uncovered six themes regarding UI and postpartum physical activity: 1) physical activity decreases and physical activity preferences change during the postpartum period, 2) there are many factors which influence postpartum activity participation and preferences, 3) UI causes postpartum women to stop activity, decrease activity intensity, and use compensatory strategies when being active, 4) UI is a threat to postpartum women’s identity, mental health, and social health, 5) current standards of postpartum healthcare are insufficient in addressing the needs of postpartum women with UI, and 6) postpartum women with UI desire a combined pelvic floor and physical activity intervention.
Discussion: Strengths of these studies are the comprehensive assessment of UI characteristics, and the rich and detailed information gathered from semi-structured interviews. Limitations of these studies include the cross-sectional study design, self-report measurement of physical activity, and a homogeneous study sample which may not be representative of all postpartum women. These findings demonstrate the need for further investigations into the association of UI and postpartum physical activity. First, longitudinal studies using device-based measurement of physical activity are needed to better establish temporality and address limitations of self-reported physical activity. Future studies should also investigate whether UI treatment improves postpartum physical activity. Clinically, these findings suggest the need for improved UI screening practices to ensure appropriate referrals to healthcare professionals with expertise in UI treatment, exercise prescription, and mental health. These professionals should be considered standard members of the healthcare team for postpartum women with UI. Finally, an intervention should be designed and pilot-tested based on participants’ desire for an individualized and remotely-delivered intervention targeting the pelvic floor and general fitness.
Details
- Title: Subtitle
- Associations of urinary incontinence and postpartum physical activity: a mixed methods investigation
- Creators
- Lisa VanWiel
- Contributors
- Kara M. Whitaker (Advisor)Lucas J. Carr (Committee Member)Jessica Gorzelitz (Committee Member)William Story (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Health and Human Physiology
- Date degree season
- Spring 2025
- DOI
- 10.25820/etd.007943
- Publisher
- University of Iowa
- Number of pages
- xiii, 110 pages
- Copyright
- Copyright 2025 Lisa VanWiel
- Language
- English
- Date submitted
- 04/15/2025
- Description illustrations
- Tables
- Description bibliographic
- Includes bibliographical references (pages 80-106).
- Public Abstract (ETD)
Many women in the postpartum period (birth through 12 months after delivery) have low physical activity and are at risk for negative health conditions. These women may benefit from interventions designed to increase physical activity and improve health. Urine leakage is common in the postpartum period and may contribute to low physical activity. Yet, few studies have examined the influence of urine leakage on postpartum physical activity. This dissertation aimed to understand how and why urine leakage influences postpartum physical activity. First, 244 postpartum women completed online surveys to provide information on their physical activity and urine leakage. Next, 30 of those women who reported urine leakage in the online surveys were interviewed and asked about their experiences with urine leakage and physical activity. The results of the first study indicate that the severity of leakage, pattern of leakage, and level of bother due to leakage were related to postpartum physical activity. The second study showed that urine leakage was a barrier to postpartum physical activity leading women to stop activity, decrease intensity, or use compensatory strategies. Women want more guidance on managing leakage and returning to physical activity and would like an individualized, app-based intervention from a pelvic floor physical therapist which targets the pelvic floor and provides general exercise recommendations. Birth providers should screen women for leakage and refer them to pelvic floor physical therapists for more information on managing leakage and returning to physical activity. Further, postpartum physical activity interventions should be developed for women with leakage.
- Academic Unit
- Health, Sport, and Human Physiology
- Record Identifier
- 9984830729002771
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