Beliefs and strategies about urinary incontinence: a possible moderation role between symptoms and sexual function, and quality of life.

Background: Urinary Incontinence (UI) has numerous repercussions in women's lives, and it is underreported/underdiagnosed.

Objective: The present study aimed to understand: (1) the differences between women with and without urine loss regarding Quality of Life (QoL) and Sexual Function (SF); (2) the possible moderation role of UI-related beliefs and strategies on the relationship between UI-symptom severity and SF and QoL, in women with UI.

Methods: Cross-sectional Design. Participants: Primary aim: Overall, 2,578 women aged 40-65 ( = 49.94,  = 6.76) were collected online. Secondary aim: 1,538 women who self-reported having urine loss occasionally/frequently ( = 50.19,  = 6.58). All data analyses were done with IBM SPSS Statistics and R statistical system 4.0 through RStudio. Statistical Path analysis was performed with the lavaan package to study the hypothetical association and moderating effects between the variables.

Results: Primary aim: women without UI had a better SF [(2576) = 3.13,  = 0.002; 95% C.I., 0.18 to 0.80] and QoL [(2576) = 7.71,  < 0.001; 95% C.I., 3.14 to 5.28] than their counterparts with UI. Secondary aim: UI-related coping strategies attenuated the impact of UI-symptom severity on SF( = -0.07;  = 0.041); the more dysfunctional the UI-related beliefs were, the poorer QoL was ( = -0.06;  = 0.031); the more frequent the UI-related hiding/defensive strategies were, the poorer QoL was ( = -0.26;  < 0.001).

Discussion: Limitations: online data collection, which thwarted the clarification of participants, if needed; absence of a UI medical diagnosis (only self-reported measures were used). Strengths and practical implications: (i) the crucial role of UI-related beliefs and strategies in the QoL of women with UI; (ii) the impact that UI-concealing/defensive strategies have in attenuating the impact of UI-symptom severity on SF, which might be perceived as a short-term benefit and hence contribute to maintaining the UI condition and constitute a barrier to help-seeking, (iii) impact of UI-symptom severity on QoL and SF (including a comparison group entailing women without UI, which is scarcely used); and (iv) the use of gold-standard and psychometrically robust instruments.

Conclusion: Changing dysfunctional UI-related beliefs and strategies in clinical settings may improve the QoL; UI-concealing strategies may reinforce themselves by immediate effects on SF, but are not functional in the long term.