Introduction and Hypothesis <p>Urinary incontinence (UI) is a common chronic condition in middle-aged and older women, linked to various physical and psychological health issues. High psychological need frustration (PNF) may compromise UI patients’ autonomy and motivation in pursuing health goals, preventing effective self-management. This study aimed to explore the determinants of PNF among UI patients amid global aging.</p> Methods <p>A convenience sample of 170 middle-aged and older women was recruited from a tertiary hospital in Shenzhen between January and April 2025. Participants completed standardized questionnaires, including a general information questionnaire, psychological need frustration scale for physical activity (PNFS-PA), the International Consultation on Incontinence Questionnaire—Short Form (ICI-Q-SF), the International Physical Activity Questionnaire—Short Form (IPAQ-SF) and the Satisfaction with Life Scale (SWLS). Data were analyzed using<i> t</i>-tests, analysis of variance (ANOVA), Pearson correlation coefficients, and multiple linear regression.</p> Results <p>Findings revealed that most patients exhibited mild-to-moderate UI severity and moderate levels of PNF. PNF demonstrated a positive association with UI severity and negative correlations with physical activity and life satisfaction; however, the effect sizes&#xa0;associated with physical activity was relatively small. Multiple linear regression analysis identified educational level, family residence, UI severity, physical activity levels, and life satisfaction as statistically significant predictors of PNF.</p> Conclusions <p>The PNF of middle-aged and older women with UI is at a moderate level. Educational level, family residence, UI severity, physical activity levels, and life satisfaction are the factors influencing the PNF of UI patients.</p>