Urinary incontinence in pulmonary rehabilitation: A common but insufficiently addressed comorbidity

To the editor,

We read with great interest the recent multicenter prospective cohort study by Gravier et al. investigating the prevalence of urinary incontinence (UI) among individuals attending pulmonary rehabilitation (PR) and the effects of PR on urinary symptoms. The authors are to be commended for addressing an often overlooked but clinically relevant comorbidity in chronic respiratory disease (CRD) populations.

The reported prevalence of UI (38%) in individuals attending PR highlights the substantial burden of this condition and aligns with earlier observations suggesting that UI is highly prevalent yet under-recognised in people with CRDs.^{Citation1,Citation2} Importantly, the study demonstrates that while PR leads to statistically significant improvements in urinary symptoms, these changes do not reach the minimum clinically important difference, indicating limited clinical relevance. This finding reinforces the notion that conventional PR programs, as currently delivered, may be insufficient to meaningfully address UI.

A notable strength of the study is its large sample size and multicenter design, which enhances the external validity of the findings.^Citation3 However, several methodological considerations warrant discussion. First, UI assessment relied exclusively on self-reported questionnaires, which may likely underestimate true prevalence because of social stigma and reporting bias. The absence of objective measures, such as bladder diaries or pad tests, may have further limited the precision of symptom evaluation. Second, heterogeneity in exercise testing modalities and missing post-intervention data among non-completers may have contributed to the wide confidence intervals observed in analyses related to PR completion and response.

The modest effect of PR on urinary symptoms observed in this study is likely attributable to the absence of UI-specific interventions within the rehabilitation program. Evidence supports the effectiveness of targeted strategies such as pelvic floor muscle training, bladder training, and behavioural interventions in improving UI outcomes.^Citation4 Their integration into PR programs could potentially enhance both urinary and respiratory-related outcomes, as well as patient engagement and adherence.

In conclusion, this study provides valuable insight into the high prevalence of UI and its limited responsiveness to standard PR. Routine screening for UI at PR entry, together with the integration of targeted continence management strategies, may represent an important step towards more comprehensive, patient-centred rehabilitation. Future randomised trials are warranted to determine whether embedding UI-specific interventions within PR can lead to clinically meaningful improvements in urinary symptoms and overall rehabilitation outcomes.

Pandey, S., Thakur, A., & Kanika. (2026). Letter to editor: Urinary incontinence in pulmonary rehabilitation: A common but insufficiently addressed comorbidity. Pulmonology, 32(1). https://doi.org/10.1080/25310429.2026.2631201