Pelvic Power, Steady Steps: Association Between Pelvic Floor Muscle Function, Urinary Incontinence and Balance in Community-Dwelling Older Women: Cross-Sectional Study

<p style="text-align:justify;"> Background: Urinary incontinence (UI) is highly prevalent in older women and is closely associated with pelvic floor muscle (PFM) dysfunction. Impaired pelvic–trunk control may affect postural stability and increase fall risk. However, evidence directly relating PFM strength to balance in this population remains limited. The purpose of this study was to determine the association among PFM strength, UI severity and balance in community–dwelling older women. <p style="text-align:justify;"> Methods: A cross–sectional study was conducted including 92 older women aged ≥ 60 years. Data were collected prospectively between January and February 2025 at a single time point. The strength and function of PFM were assessed using the modified Oxford scale and the PERFECT scheme. UI severity and impact were measured with the International Consultation on Incontinence Questionnaire–Short Form (ICIQ–SF). Balance and mobility were evaluated using the Romberg test, One–Leg Standing, Functional Reach and Timed Up and Go (TUG) tests. Gait speed and fear of falling were assessed with 4–Meters Walk Test and the Short Falls Efficacy Scale (Short FES). Descriptive and correlation analyses (Pearson or Spearman) were performed. <p style="text-align:justify;"> Results: Women (mean age 70.23 ± 5.75 years) with high maximal PFM strength exhibited significantly reduced UI severity and impact across all ICIQ–SF domains (p < 0.05). Within the PERFECT scheme, endurance strength was related to low UI severity (frequency: ρ = –0.339; p = 0.001; quantity: ρ = –0.271; p = 0.010; impact on daily life), whereas fast contractions showed no association. In addition, increased PFM strength and endurance were correlated with improved balance, with more consistent links for dynamic tests (notably TUG: ρ = –0.254, p = 0.008; ρ = –0.229, p = 0.028, respectively) than for static outcomes. No association was observed between strength and gait speed, but increased endurance strength was linked to reduced fear of falling (ρ = –0.506, p=0.016). <div style="text-align:justify;"> Conclusions: In community–dwelling older women with mild UI, enhanced PFM function, especially endurance, is associated with diminished UI severity, improved dynamic balance and reduced fear of falling. Clinically, this supports routine PFM assessment alongside ICIQ–SF and simple balance tests, as well as combining integrated PFM strength training interventions with lower–limb and balance exercises. Incorporating continence assessment into fall–risk evaluations may reduce leakage and falls, but prospective trials should test causality of the present study. </div> <div style="text-align:justify;"> <br /> </div>