Background:
Urinary incontinence (UI) and pelvic floor distress are common among women and may be influenced by physical activity, body mass index (BMI), education, and knowledge. This study examined these factors among Iranian women.

Material and methods:
This cross-sectional study included 150 Iranian women aged 30-85 years. Data were collected using demographic questionnaires, the International Physical Activity Questionnaire-Long Form (IPAQ-LF), the Pelvic Floor Distress Inventory-20 (PFDI-20), the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), and a self-reported knowledge scale. Analyses included descriptive statistics, Kruskal-Wallis tests, ANOVA, and Spearman correlations, with significance set at p<0.05.

Results:
Most participants had moderate physical activity (90.7%), were overweight (70%), and reported medium to high knowledge levels (68.7%). BMI was significantly associated with pelvic floor distress (p=0.010) and UI (p<0.001), with overweight women showing the highest PFDI-20 and ICIQ-UI scores. Physical activity was not significantly associated with symptoms (p>0.05). Education was associated only with the Urinary Distress Inventory subscale (p=0.034). Knowledge level showed significant differences in the PFDI-20 subscales and total scores, with medium knowledge linked to the lowest symptoms, while differences in UI severity were statistically significant (p=0.024).

Conclusions:
BMI was the strongest factor associated with pelvic floor distress and UI, while physical activity and education showed limited associations, highlighting the importance of weight management and targeted educational interventions.