Evaluating the correlation between high heels use and urinary incontinence in healthy women: cross sectional study

Background: Pelvic floor dysfunction (PFD), including urinary incontinence (UI), is a prevalent concern among women and has significant effects on quality of life. Urinary incontinence, defined as the involuntary leakage of urine, can result from weakened pelvic floor muscles (PFMs). PFMs play a critical role in supporting pelvic organs and maintaining continence. Multiple factors can contribute to PFM dysfunction, including age, childbirth, obesity, and lifestyle habits. Among lifestyle factors, prolonged use of high-heeled shoes has been speculated to influence pelvic alignment and muscle function, potentially increasing the risk of urinary incontinence. However, this relationship remains understudied, especially in young, healthy women. Objective: The aim of this study was to evaluate the correlation between heel height in regularly worn footwear and urinary incontinence symptoms among healthy women aged 18–35 years in the Surat district. Methodology: This cross-sectional study was conducted among 429 healthy female participants selected through non-probability sampling. Participants were categorized into three groups based on the regular heel height worn: <3 cm, 3–5 cm, and 5–7 cm. The Urogenital Distress Inventory – Short Form (UDI-6) was used to assess lower urinary tract symptoms. Data were analyzed using one-way ANOVA and regression models to explore the association between heel height and various symptoms of urinary incontinence. Results: Statistical analysis revealed that women who wore heels in the 5–7 cm range reported significantly higher incidences of frequent urination, urgency-related leakage, physical activity-related leakage, difficulty urinating, and pelvic pain compared to the other groups (p < 0.001). The 3–5 cm heel group demonstrated the lowest symptom scores, suggesting a potential protective range. There was no significant difference in symptom scores between those wearing <3 cm heels and the 3–5 cm group. Conclusion: The study establishes a statistically significant correlation between higher heel heights (5–7 cm) and increased urinary incontinence symptoms. Moderate heel heights (3–5 cm) may not adversely affect pelvic floor function and could be considered safer for long-term use. These findings highlight the need for awareness among women about the musculoskeletal and urogenital consequences of prolonged high-heel usage. Further longitudinal studies are recommended to explore causality and long-term effects.