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Menopause Live - IMS Updates
InFocus

Date of release: 23 February, 2009

Weight loss and urinary incontinence


Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence is lacking. In a recently published study by Subak and colleagues [1], 338 overweight and obese women, with a mean age of 53 ± 11 years, and with at least ten urinary incontinence episodes per week, were randomly assigned to an intensive 6-month weight-loss program, including diet, exercise, and behavior modification (n = 226) or to a structured education program (n = 112). The body mass index and the weekly number of incontinence episodes were similar in the intervention group and the control group at baseline. The women in the intervention group had a mean weight loss of 8.0% (7.8 kg), as compared with 1.6% (1.5 kg) in the control group (p < 0.001). After 6 months, the mean weekly number of incontinence episodes decreased by 47% in the intervention group, compared with 28% in the control group (p = 0.01). The intervention group had a greater decrease in the frequency of stress incontinence episodes (p = 0.02), but not of urge incontinence episodes (p = 0.14) compared with the control group. A higher proportion of the intervention group than of the control group had a clinically relevant reduction of 70% or more in the frequency of all incontinence episodes (p < 0.001), stress incontinence episodes (p = 0.009), and urge incontinence episodes (p = 0.04). Thus the behavioral intervention targeting weight loss reduced the frequency of self-reported urinary incontinence episodes among overweight and obese women as compared with the control group. A decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction.

Comment

Impaired control of micturition and indeed true urinary incontinence are common and cumbersome conditions in many elderly women. Population surveys report a prevalence in women between 20% and 50% depending on the criteria used. The recent study by Subak and colleagues is one of the better studies reconfirming the beneficial effects of weight loss on, in particular, stress but also urge and mixed incontinence. Age, parity and body mass index are the three classical risk factors for urinary incontinence. Obesity is more or less the only modifiable risk factor and should hence be utilized in the clinical approach. However, compliance to lifestyle modification programs is notoriously poor. As a consequence, results from this study are particularly important as we can now motivate patients not only in qualitative but also in quantitative terms. In addition, it is important as we now have also more data on potential beneficial effects and not only on stress incontinence. The mechanisms responsible for these effects are not known with certainty. Reduced mechanical pressure on pelvic floor tissues is ostensible but hypotheses awaiting further exploration are leptin-dependent processes and reduced hyperinsulinemia/insulin resistance which may influence afferent and/or efferent nervous function. Interestingly, weight reduction may also improve central nervous system capabilities. It should also be emphasized that weight loss is important but should not be the only remedy. Pelvic floor exercise must continue to be promoted as well as sound micturition habits. Furthermore, urinary incontinence impairs quality of life, not only by its frequency but also by its severity and intensity [2]. In other words, we need to consider, for example, the amount of fluid in stress incontinence as well as the intensity of urgency in mixed and urge incontinence. These aspects still await detailed studies. Perhaps, the positive results of the aforementioned study could encourage this.

Comentario

Göran Samsioe
Lund, Sweden

    References

  1. Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009;360:481-90. Published January 29, 2009.
    http://www.ncbi.nlm.nih.gov/pubmed/19179316

  2. Monz B, Chartier-Kastler E, Hampel C, et al. Patient characteristics associated with quality of life in European women seeking treatment for urinary incontinence: results from PURE. Eur Urol 2007;51:1073-81.
    http://www.ncbi.nlm.nih.gov/pubmed/17081676