Urinary incontinence (UI) is associated with increased falls risk, particularly in older adults (1). Urgency urinary incontinence has been linked to a twofold increase in falls risk, and urinary urgency itself may induce gait changes associated with falling (2). In a prior exploratory study of ten older women, trends toward increased gait variability and reduced cadence were observed when walking in wet versus dry pads (3). Power calculation from that study indicated that 95 participants would be required for adequate power. We therefore undertook a study to determine whether walking in either dry or wet continence containment products was associated with measurable gait changes in younger women.

This crossover study recruited community-dwelling women aged ≥18 years, with or without UI. Based on an effect size of 0.6 in gait variability between the soaked and dry condition using briefs with tapes (3), 95 participants were required to achieve 80% power at a two-sided alpha of 0.05. Gait was assessed using the Kinesis inertial sensor system with bilateral sensors positioned on the anterior shins. Briefs were tested under three conditions: dry, wet at 300 mL, and soaked at 900 mL, corresponding to 25% and 75% of the manufacturer’s stated 1200 mL maximum absorbency. After baseline testing without a brief, participants were randomly assigned to the wet and soaked condition. Participants completed a Timed Up and Go (TUG) test over 3 metres and a 10-metre walk test. Outcomes included gait variability, stride velocity variability, stride time variability, cadence, and stride velocity asymmetry. Repeated-measures ANOVA with Bonferroni-corrected post-hoc testing was used.

Ninety-five women participated (mean age 27.3 ± 7.8 years, range 18–57; mean weight 65.0 ± 13.4 kg). No statistically significant differences were observed for gait variability, stride velocity variability, stride time variability, or stride velocity asymmetry at either distance. Cadence differed statistically significantly across conditions at both distances (Table 1). All pad-wearing conditions were associated with a higher cadence than baseline. There were no statistically significant differences between conditions at 3 metres. At 10 metres, dry brief cadence was statistically significantly lower than in the soaked brief (Table 2).  Stride time variability showed a borderline overall effect (F=2.92, p=0.034), but no pairwise comparison remained statistically significant after correction. There was no statistically significant difference across conditions in stride velocity, stride length, and stride length variability. Average stride length at 10 metres showed a borderline overall effect (F=2.88, p=0.037), with no significant post-hoc pairwise differences.

This study failed to reach its primary outcome. There was no statistically significant effect of either wet or soaked briefs on gait variability.  The gait effect of continence containment products was only observed in relation to cadence, suggesting that pad bulk rather than wetness may be the principal driver of gait adaptation. In the absence of significant change in stride velocity, this observed pattern is consistent with a compensatory strategy characterized by shorter, more frequent steps, and perhaps women simply sped up to get the test over. The younger age range of this cohort and greater physiological reserve may partly explain why variability changes seen previously were not replicated. Although this gait pattern has been associated with fall risk in older adults, its clinical significance in a younger population remains uncertain. A fully powered trial in older women is planned.

Wearing continence containment products was associated with increased cadence, independent of pad wetness, suggesting that pad bulk may induce a subtle compensatory gait adaptation which may have potential implications for falls risk in those at risk.

PLoS One. 2021;16(5):e0251711.
JAMA. 2017;318(16):1592–604.
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