By Dr Cary Presant MDUrinary incontinence, or the uncontrollable leakage of urine, is one of the most embarrassing symptoms from which a patient can suffer. This is common in women who are overweight or obese. With urinary incontinence, quality of life decreases dramatically. But few people realize that once urinary incontinence develops, there is an increased incidence of falls, a higher rate of fractures, and an increased likelihood of nursing home admission. An estimated 13 million women in the United States suffer from urinary incontinence. The overall annual health care costs of taking care of these women are $20 billion.
Being overweight is a significant factor in the occurrence of urinary incontinence. Because of this, weight loss has been recommended for assistance in helping to control urinary incontinence.
An article by Dr. L. Subak of the University of California San Francisco and her coworkers (New England Journal of Medicine, Volume 360, page 481, 2009) has identified the impact of weight loss, and has identified a method for optimally achieving improvement in urinary incontinence with control of weight. In this excellent study of 338 women who were overweight or obese, the authors evaluated women who had at least 10 urinary incontinence episodes per week. In these women, 22% had stress incontinence (incontinence associated with straining, exercise, coughing, or sneezing) and 44% had predominantly urge incontinence (a loss of urine associated with an urge to void). One-third of patients had a mixed typed of incontinence.
Women were randomized to receive either four general information sessions about the helpfulness of weight loss, physical activity, and helpful eating, or were randomized to a more aggressive weight loss program that consisted of weekly weight loss discussions for 6 months, reduced calorie diets from 1,200 to 1,500 calories per day (and less than 30% of calories from fat) and vouchers for a meal replacement product (they used Slim-Fast) for 2 meals per day for 4 months and one meal a day thereafter. All patients were advised to exercise at least 200 minutes each week, and were given information on behavioral skills such as stimulus control and problem solving.
After 6 months of this program, the difference in results was impressive. Women who were in the aggressive weight loss group with weekly support programs had a 47% reduction in urinary incontinence episodes, and this was about 20% greater improvement than those patients who were given only 4 sessions without intensive weight loss programming. The improvement in incontinence was greater with stress incontinence (a 58% reduction in stress incontinence in the aggressive weight loss group), but was less in the urge incontinence group (with only a 42% reduction in urge related incontinence).
Importantly, women who participated in these programs generally were very satisfied with the change in incontinence. Even in the minimal intervention group (only 4 sessions of training), 47% of women were very satisfied. 76% of women in the high intensity intervention group showed improvement.
Because urinary incontinence is such a difficult problem not only for the patient but also for the patient’s family and friends, the results of this study are very important. Men and women with urinary incontinence should be advised to lose weight. Discussion with the urologist about supportive interventions such as training and behavioral skills and counseling, together with an active exercise program, are useful in improving symptoms in these individuals. Because of a high likelihood of other health problems (falling, fractures, and even nursing home admissions), prompt attention to these symptoms of the patient by the primary care physician and by a consulting urologist are important in improving overall health outcomes, and improving the quality of life of individuals with a serious medical symptom. Because incontinence is not just embarrassing, it’s really dangerous.
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