Hypothesis / aims of study
Urinary incontinence (UI) occurs when the structures surrounding the urethra and bladder, also known as the pelvic floor (PF), do not work effectively and result in urine leaking (National Institute for Health and Care Excellence, NICE, 2021). The pelvic floor complex has a synergistic role with respiratory functions, indicating that activities increasing intra-abdominal pressure (IAP) could potentially trigger UI if the PFM are weak (3). This is particularly noted during activities that require forceful breathing, such as singing, which actively engages respiratory and accessory muscles, including the PFM (1).
Singing involves controlled breathing and PFM engagement, which might make it a suitable recreational form of PFMT, particularly if taught as part of singing training. While professional singers often receive training that includes PFM engagement, recreational singers may not, possibly putting them at a higher risk of UI (2, 4, 5). With proper training and awareness, singing could serve not only as a cultural and recreational activity but may be an effective method for managing and potentially improving UI symptoms (1).
The aim of the study is to investigate how group singing affects individuals with UI, with a focus on examining the influence of demographic factors such as sex, age, and singing experience on the severity of UI symptoms and overall quality of life. The study intends to gather data through a survey, analysing the potential benefits of singing as a non-clinical intervention for UI.
Study design, materials and methods
The methodology of the study involved conducting a retrospective online survey across the UK. The survey targeted participants aged 18 or above who had been actively engaged in singing for at least one month. To determine the necessary sample size for statistically meaningful results, a power analysis was conducted using G*Power, which indicated that a sample of 138 participants was required.
Recruitment was facilitated through communication with gatekeepers of singing groups throughout the UK. A total of 172 gatekeepers granted permission, and they, in turn, reached out to their respective singing groups to encourage participation in the survey. The research advert, designed to recruit participants, included a QR code and a link to access the survey. It clearly outlined the study aims and provided detailed information, ensuring that participants were fully informed about the nature of the study and their rights, including the ability to withdraw from the study at any time. This transparency was aimed at ensuring informed consent and ethical participation throughout the research process.
Data collection focused on the impact of urinary incontinence (UI) symptoms on participants' daily lives and their singing activities. The survey was divided into sections, covering consent, demographic information, the ICIQ LUTS QoL, and a final thank-you section. Due to a Shapiro-Wilk test indicating non-normal distribution of the data (p < .001), non-parametric tests i.e. Mann-Whitney U and Kruskal-Wallis were utilised for analysis.
Results
A total of 163 participants were recruited, with 137 eligible after applying exclusion criteria. Findings revealed that individuals who obtained a higher LUTS Qol score were more likely to experience urinary urgency during singing (p = 0.006), urinary urgency interrupting singing (p = 0.002), urinary leaking during singing (p < .001) and urinary leaking interrupting singing (p < .001).
Singers who reported participating more than three times per week reported greater UI symptom severity impacting their quality of life (p = 0.020).
No significant differences were observed in UI symptoms based on sex, age, or singing experience over time. Descriptive statistics highlighted that 76.5% of participants were female, and 65% were aged 65 or older, with 83.2% currently experiencing UI.
Interpretation of results
The results suggest that increased singing frequency is positively linked with and increased impact of LUTS QoL and symptoms. It isn’t known if people with a higher impact of LUTS attend singing as it is an accessible activity or if singing may exacerbate symptoms when completed over 3 times per week. Further research should be explored within this population to understand any causal factors of singing with pelvic floor function, and to understand if pelvic floor exercise training alongside singing activities may support people suffering with LUTS. This underscores the potential of structured singing interventions as a novel form of pelvic floor muscle training (PFMT), offering a therapeutic approach to managing UI symptoms.