Reply to: Beyond BMI : A Practical Phenotype Lens for Urinary Incontinence in Older Women

We thank the authors for their thoughtful letter regarding our recent study on sarcopenic obesity (SO) and urinary incontinence (UI) in older women [1, 2]. We appreciate their recognition of the clinical relevance of our findings and their practical insights for translating these results into geriatric practice. In response to their suggestion to provide clinically oriented summaries, we conducted additional analyses estimating predicted probabilities of UI across combinations of SO and selected clinical factors included in our models. Predicted probabilities were derived from the fully adjusted logistic regression model, with all other covariates held at their mean values. The analyses indicate that the presence of SO alongside constipation is associated with the highest predicted probability of UI (approximately 0.64), compared with women without SO and without constipation (approximately 0.43). Similarly, stratifying by fecal incontinence and IADL impairment shows a clear gradient in predicted UI risk: higher risk is observed when both SO and fecal incontinence are present (approximately 0.82) compared with when neither SO nor fecal incontinence is present (approximately 0.45). Likewise, higher risk is observed when both SO and impaired IADL are present (approximately 0.62) compared with when neither SO nor impaired IADL is present (approximately 0.43). Beyond illustrating statistical associations, these estimates may help clinicians identify higher-risk phenotypes during routine geriatric assessment. The coexistence of sarcopenia, adiposity, and functional or bowel-related conditions may therefore facilitate earlier risk stratification and more targeted preventive strategies for UI in older adults. Notably, the combination of SO and fecal incontinence was associated with the highest predicted probability of UI. Clinically, this highlights the importance of a comprehensive assessment that includes muscle health, bowel function, and functional status. Management strategies may therefore benefit from a multidimensional approach incorporating resistance and pelvic floor exercises, nutritional optimization targeting sarcopenia, bowel management, and interventions aimed at maintaining functional independence, rather than focusing solely on urinary symptoms. In response to the points raised in the letter, we additionally examined the association between body phenotypes and specific UI subtypes. In this additional analysis, SO was differentially associated with UI subtypes in older women. SO was associated with urgency UI (OR: 1.73, 95% CI: 1.01–2.95, p = 0.045) and mixed UI (OR: 2.23, 95% CI: 1.12–4.44, p = 0.022), while no significant association was observed with stress UI (OR: 0.56, 95% CI: 0.26–1.23, p = 0.151) (Table 1). This pattern may reflect the multifactorial pathophysiology of UI in older adults. Urge and mixed UI are influenced not only by pelvic floor dysfunction but also by age-related changes in bladder function, neuromuscular control, and overall functional status. Aging-related changes—including atrophy of type II muscle fibers, hormonal alterations such as decreased estrogen levels, and peripheral neuropathy—may contribute to weakened pelvic floor musculature and delayed reflex responses, thereby increasing susceptibility to urinary incontinence [3]. In addition, bowel dysfunction and impaired daily functioning may further exacerbate lower urinary tract symptoms through shared pelvic floor mechanisms, increased intra-abdominal pressure, and reduced ability to maintain continence. The observed association between SO and mixed UI may therefore reflect the combined effects of reduced muscle mass and increased adiposity on physical performance and pelvic floor support. In contrast, stress UI is more commonly linked to isolated pelvic floor weakness, which may explain the absence of significant associations with the studied factors in our sample. At the same time, fecal incontinence, constipation, and impaired IADL were associated with specific UI subtypes, highlighting the need to consider body composition phenotypes alongside functional status and bowel-related conditions when assessing UI risk (Table 1). These findings support a more nuanced, subtype-oriented clinical evaluation. Taken together, these findings highlight the complex and multifactorial mechanisms underlying UI in geriatric populations. Neslihan Hazel Önür drafted the response to the Letter to the Editor. Tuğba Erdoğan and Gülistan Bahat critically reviewed the manuscript and contributed to the interpretation and refinement of the responses. All authors approved the final version submitted for publication. The authors have nothing to report. The authors received no specific funding, and no sponsor was involved in this study. The authors declare no conflicts of interest. This publication is linked to a reply article by Chen et al. To view this article, visit https://doi.org/10.1111/jgs.70498.