Arthritis Significantly Increases Urinary Incontinence Risk

US adults aged 20 and older with arthritis have a significantly higher likelihood of experiencing urinary incontinence (UI), according to a study published in Medicine.1

US adults with arthritis have higher odds of stress, urge, and mixed urinary incontinence (UI), highlighting the need for routine screening and integrated care. | Image Credit: eddows - stock.adobe.com

Exploring the Unclear Link Between Arthritis, UI

The researchers noted that although musculoskeletal disorders have been linked to UI, evidence specifically connecting arthritis, a common musculoskeletal disorder, to impaired bladder control remains limited.

To clarify this association, they conducted a cross-sectional, nationally representative analysis using data from the National Health and Nutrition Examination Survey (NHANES), evaluating whether arthritis predicts UI among adults aged 20 and older. NHANES is a nationally representative, cross-sectional survey that assessed the nutrition and health status of the US population.2

“Clarifying this connection could inform integrated strategies that simultaneously alleviate joint and urinary burden,” the authors wrote.1

The analysis pooled data from 5 consecutive NHANES cycles (2011-2012, 2013-2014, 2015-2016, 2017-2020, and 2021-2023). Of the 34,089 adults aged 20 and older who completed the examination, 24,528 were eligible for the study, as they had complete information on arthritis status, UI, and covariates.

UI was determined using 2 standardized items administered by certified technicians. A response of “yes” to leakage during activities such as coughing, lifting, or exercising indicated stress UI, while responding “yes” to leakage related to urgency indicated urge UI. Mixed UI was recorded when patients endorsed both items.

Additionally, arthritis was identified through self-reporting of a physician diagnosis, after which respondents specified whether they had osteoarthritis (OA), rheumatoid arthritis (RA), or another form.

Covariates were grouped into 3 domains: demographics, lifestyle factors, and clinical measures. The researchers used logistic regression to model UI as the outcome and self-reported arthritis as the exposure, adjusting progressively for covariates and applying survey weights for population-level estimates.

Arthritis Significantly Elevates Stress, Urge, and Mixed UI

Among the eligible sample, 27.03% (95% CI, 25.9%-28.2%) reported having arthritis. On average, those with arthritis were older, had a higher body mass index, were more often female and non-Hispanic White, and more frequently had hypertension, diabetes, or UI. UI frequencies were estimated as 25.01% (95% CI, 24.20%-25.84%) for stress, 22.49% (95% CI, 21.56%-23.44%) for urge, and 11.0% (95% CI, 10.44%-11.68%) for mixed.

After full adjustment, arthritis was associated with 31% higher odds of stress UI (OR, 1.31; 95% CI, 1.16-1.47), 44% higher odds of urge UI (OR, 1.44; 95% CI, 1.30-1.60), and 49% higher odds of mixed UI (OR, 1.49; 95% CI, 1.31-1.70). Both OA and RA were independently associated with each UI subtype (P < .05).

OA demonstrated a stronger association with urge UI (OR, 1.48; 95% CI, 1.30-1.67) than stress UI (OR, 1.25; 95% CI, 1.09-1.44). RA exhibited the reverse pattern, with a stronger association with stress UI (OR, 1.45; 95% CI, 1.22-1.72) than urge UI (OR, 1.21; 95% CI, 1.02-1.44). For mixed UI, RA had a slightly higher estimated effect (OR, 1.56; 95% CI, 1.25-1.95) than OA (OR, 1.44; 95% CI, 1.25-1.65).

“These findings imply that urologists should routinely probe joint health in incontinent patients, whereas orthopedists and rheumatologists ought to screen for, and proactively manage, concurrent lower urinary tract symptoms,” the authors wrote.

Implications for Clinical Practice and Future Care

The researchers acknowledged several limitations, including reliance on self-reported diagnoses, which may introduce recall or misclassification bias. Still, they emphasized the clinical implications of their findings.

“Clinicians should routinely screen arthritic patients for lower-urinary-tract symptoms; integrating this assessment into arthritis care could yield immediate public-health and quality-of-life gains,” the authors wrote.

References

1. Yan C, Wu HH, Liu TT, Zhang H, Li FL, Zhang XG. Association between arthritis and urinary incontinence in US adults: A cross-sectional study based on NHANES 2011-2023. Medicine (Baltimore). 2025;104(46):e45934. doi:10.1097/MD.0000000000045934
2. About NHANES. CDC. December 18, 2024. Accessed November 24, 2025. https://www.cdc.gov/nchs/nhanes/about/index.html