In the journals
Weight loss reduces urinary incontinence in heavy women
Losing weight reduces the risk factors for many diseases,
especially cardiovascular disease and type 2 diabetes. Shedding
just 10 pounds, for example, can lower blood pressure. Weight
loss also lowers blood sugar and improves cholesterol levels.
Now, a new benefit can be added to the list: reduced urinary
incontinence in women who are overweight or obese. In a
randomized trial funded by the National Institutes of Health,
moderate weight loss in a group of heavy women who undertook a
six-month diet and exercise program cut the frequency of urinary
incontinence episodes by nearly a half. Results were published in
The New England Journal of Medicine (Jan. 29, 2009).
Urinary incontinence affects more than 13 million women in the
United States. It not only causes inconvenience and emotional
stress, it also raises the risk of falls, fractures, and nursing
home admissions. Obesity has long been associated with urinary
leakage in women, but until now, there's been little research to
confirm that losing weight would help reverse the problem — or to
suggest how much weight loss would be needed.
In the New England Journal of Medicine study,
investigators with the Program to Reduce Incontinence by Diet and
Exercise (PRIDE) at the University of California at San Francisco
worked with 338 overweight or obese women (average age 53) who
leaked urine at least 10 times per week. Participants were
randomly assigned to either an intensive program of diet,
exercise, and behavioral modification or to a control group that
was instructed in the benefits of weight loss, exercise, and
healthy eating but received no training to help them modify their
habits. At the start of the study, subjects were given self-help
bladder-control booklets and completed seven-day voiding diaries
in which they identified incontinence episodes as stress
incontinence (urine leakage with coughing, sneezing, straining,
or exercise), urge incontinence (urine leakage after feeling a
sudden need to urinate), or other.
The weight loss group met weekly for six months in one-hour
sessions led by experts in exercise, nutrition, and behavior
change. They were given a low-calorie (1,200–1,500 calories per
day), low-fat diet and told to gradually increase
moderate-intensity physical activity up to at least 200 minutes
per week. The control group participants met four times in
one-hour group sessions. After six months, women in the first
group had lost an average of 17 pounds and had 47% fewer urinary
incontinence episodes; the control group participants lost an
average of 3 pounds and reported 28% fewer episodes. A higher
proportion of the women in the weight loss group (41%) than in
the control group (22%) experienced a 70% or greater drop in the
frequency of incontinence episodes. Perhaps not surprisingly,
weight-loss participants reported feeling happier about the
change in their incontinence, compared with the control group.
The PRIDE investigators acknowledge that their findings may not
apply to all women. They selected participants partly because
they lacked certain medical conditions and were willing to stick
with the behavioral program. Also, it was impossible to "blind"
the experiment so that neither participants nor researchers would
know which group was receiving the treatment. Nonetheless, the
study strongly suggests that weight loss reduces incontinence
episodes, possibly by reducing pressure on the bladder and pelvic
floor. Understanding this may help women concerned about urinary
leakage during exercise to stick with their workouts, knowing
that doing so could improve urinary incontinence down the road.
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