Stressful Life Events Linked to Higher Incontinence Risk in Older Women

Women who experience more stressful life events face a substantially higher risk of developing incontinence later in life, according to a prospective longitudinal study of more than 6,300 middle-aged and older women in China. The research, published in BMC Public Health, found that those reporting three or more stressful events had an 88 percent greater risk of incident urinary or fecal incontinence compared with women reporting none, and that depressive symptoms appeared to explain part of that association. The study drew on the China Health and Retirement Longitudinal Study, a nationally representative survey, and followed 6,337 women aged 45 and older who were free of incontinence at baseline between 2011 and 2020.

Stressful life events were assessed at the start of the study and grouped into three categories: no events, one to two events, and three or more events. The researchers tracked how long participants remained free of any incontinence, defined as urinary or fecal, over a median follow-up of nine years. During that period, 12.66 percent of the women, or 802 of the 6,337 participants, developed incontinence.

Using weighted Cox proportional hazards models, the team estimated hazard ratios for incontinence associated with each level of stress exposure, adjusting for demographic characteristics, health behaviors, and comorbidities. Compared with women reporting no stressful life events, those with one or two events had a 31 percent higher risk of developing incontinence, a result that reached statistical significance with a hazard ratio of 1.31 and a 95 percent confidence interval of 1.00 to 1.71. The gradient was steeper at the highest exposure level.

Women reporting three or more stressful life events had an 88 percent elevated risk, with a hazard ratio of 1.88 and a 95 percent confidence interval of 1.41 to 2.49, a finding that was strongly statistically significant. In sensitivity analyses, the researchers alternatively modeled stressful life events as a continuous variable rather than in categories, testing the robustness of the exposure measure. Beyond the direct association, the study examined whether depressive symptoms might lie on the pathway between stress and incontinence.

Mediation analysis indicated that depressive symptoms accounted for 14.88 percent of the association in the high-exposure group. The natural indirect effect was statistically significant, with a hazard ratio of 1.08 and a 95 percent confidence interval of 1.03 to 1.12, suggesting a modest but measurable mediating role. The authors note that although stressful life events have established links with a range of adverse health outcomes, their association with incontinence in middle-aged and older women had remained underexplored.

By using a nationwide longitudinal survey rather than a cross-sectional design, the study could establish that stress exposure preceded the onset of incontinence among women who were continent at baseline, strengthening the case for a prospective association. The findings carry several caveats inherent to the design. Stressful life events were self-reported at a single baseline assessment, and the exposure categories group together different types of adversity without distinguishing their timing, severity, or nature.

As with any observational cohort, residual confounding cannot be excluded, and the mediation analysis identifies a statistical pathway rather than a proven causal mechanism. The results apply to women aged 45 and older in China and may not generalize directly to other populations. Nevertheless, the authors argue that the results support building adversity screening into healthy aging strategies, pairing enhanced psychological assessment with incontinence screening for women at high risk, and integrating psychological care into urogynecological practice.

Subject of Research: Association between life-course stressful life events and incident urinary or fecal incontinence in middle-aged and older women

Article Title: Life-course exposure to stressful life events and incident incontinence in middle-aged and older women: a prospective nationally representative longitudinal study

Article References: Wang, X., Tian, Z., Fu, L., Du, Z., Wang, X., Xu, T., & Sun, Z. (2026). Life-course exposure to stressful life events and incident incontinence in middle-aged and older women: a prospective nationally representative longitudinal study. BMC Public Health. https://doi.org/10.1186/s12889-026-30021-8

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30021-8

Keywords: incontinence, stressful life events, women's health, longitudinal study, depressive symptoms, CHARLS, aging, epidemiology, Cox proportional hazards, mediation analysis, urinary incontinence, fecal incontinence