Life-course exposure to stressful life events and incident incontinence in middle-aged and older women: a prospective nationally representative longitudinal study

Despite established links between stressful life events (SLEs) and adverse health outcomes, their association with incontinence (urinary or fecal), particularly in middle-aged and older women, remains underexplored. This study aims to investigate the association between life-course exposure to SLEs and incident incontinence among middle-aged and older women based on a nationwide longitudinal survey. This prospective cohort study included 6,337 women aged ≥ 45 years without baseline incontinence from China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). SLEs were assessed at baseline and categorized as no-SLEs (0 events), moderate-SLEs (1–2 events), and high-SLEs (≥ 3 events) groups. The primary outcome was time to incident any incontinence (urinary or fecal). Weighted Cox models were established to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with mediation analysis evaluating the potential mediation effect. In sensitivity analysis, SLEs were alternatively modeled as a continuous variable. All models were adjusted for demographic characteristics, health behaviors, and comorbidities. Over a median follow-up of nine years, 12.66% (802/6,337) developed incontinence. Compared to no-SLEs group, moderate-SLEs exposure was associated with a 31% increased risk of incontinence (HR = 1.31, 95% CI: 1.00–1.71, P = 0.047), and high-SLEs exposure elevated risk by 88% (HR = 1.88, 95% CI: 1.41–2.49, P < 0.001). Depressive symptoms mediated 14.88% of the association in high-SLEs group, with statistically significant natural indirect effect (HR = 1.08, 95% CI: 1.03–1.12, P < 0.001). Life-course exposure to SLEs independently predicts incident incontinence (urinary or fecal) among women aged ≥ 45 years, partially mediated by depressive symptoms. These findings support the development of healthy aging strategies incorporating adversity screening, enhanced psychological assessment and incontinence screening for high-risk women, and integration of psychological care into urogynecological practice.