Core Stability Differs in Women with and without Lower Urinary Tract Symptoms (LUTS)

Objectives: To compare core stability, aerobic physical activity (aPA), and resistance PA (rPA) in women with lower urinary tract symptoms (LUTS) versus women without LUTS.

Methods: Women aged 18-70 years with and without LUTS were recruited prospectively from tertiary medical center clinics and were excluded for pregnancy, neurological disease, spinal pathology/surgery, current shoulder or lower extremity injury, abdominal/pelvic surgery in the past 6 months, and chronic pelvic pain. Women completed demographics, Urinary Distress Short Form (UDI-6), Godin Shepherd Leisure Time Physical Activity Questionnaire (“Godin”), a novel Resistance Activity Questionnaire (RAQ), and underwent core stability testing using the “Core Score,” a composite score of 4 core stability tests: a single-leg squat, a side bridge, a prone bridge, and a supine bridge. Each individual test was graded from 0-3, and the “Core Scores” ranged from 0-12, with higher numbers indicating higher core stability. Summary statistics are provided overall and by LUTS diagnosis. Chi-square tests, Fisher’s exact tests, and independent two-sample t-tests compared demographics by LUTS diagnosis. Wilcoxon rank sum tests compared median core stability, aPA, rPA, and UDI-6 scores between women with and without LUTS. Linear regression models estimated the effects of UDI-6 scores and of a LUTS diagnosis on “Core Scores” in separate analyses.

Results: 48 women with LUTS and 49 women without LUTS participated with a mean age of 46 years, BMI of 32, and parity of 2. Women with LUTS were older (p < 0.01), had higher parity (p < 0.01), and had higher rates of constipation (p = 0.03), dyspareunia (p < 0.01), and current formal core exercise instruction (p = 0.03) (Table 1). Women with LUTS reported a median score of 39 (IQR: 21-58, p < 0.01) on the UDI-6 indicative of symptomatic LUTS, whereas women without LUTS were confirmed to be asymptomatic. Women with LUTS had significantly lower single-leg squat (p < 0.01), side bridge (p < 0.01), and prone bridge (p = 0.02) scores compared to women without LUTS. Their “Core Score” was significantly lower (p < 0.01), but Godin and RAQ scores did not differ between groups (p = 0.58 and p = 0.12, respectively) (Table 2). For every 10-unit increase in the UDI-6, there was a 0.32-point decrease in the "Core Score” (p < 0.01).

Conclusions: Women with LUTS had significantly worse core stability than women without LUTS but their aPA and rPA levels did not differ. Increasing LUTS severity correlated with worsening core stability. Future directions include a larger prospective cohort study to further assess core stability, aPA, rPA, and musculoskeletal health in relation to bladder health with consideration for more objective measures of PA, followed by randomized controlled trials targeting core stability to improve bladder health.