Weight loss improves incontinence in women
Losing weight significantly reduces episodes of stress incontinence, a study in the New England Journal of Medicine has confirmed.
Urinary incontinence and obesity commonly co-exist, and observational studies have suggested that weight loss may have a beneficial effect on the severity of incontinence in overweight patients.
This study randomised women to either a 6-month intensive behavioural weight loss programme, that included diet, exercise and behaviour modification, or a structured 4-session education programme (the control group).
Women were eligible if they were aged over 30, had a BMI of 25-50 and at baseline reported 10 or more urinary incontinence episodes in a 7-day diary of voiding. Patients with stress, urge and mixed incontinence were included in the study. A total of 338 patients were enrolled, randomised on a 2:1 basis giving 226 patients in the weight loss programme and 112 in the control group.
Participant groups at baseline were well matched for age (mean 53 years), BMI (mean 36) and number of episodes of incontinence per week (mean 24).
The women in the intervention group had a greater mean weight loss from baseline than those in the control group - 8% (7.8kg) versus 1.6% (1.5kg). After 6 months the mean number of incontinence episodes had decreased by 47% in the intervention group compared with 28% in the control group (P=0.01). Improvement in stress incontinence was statistically significant (58% versus 33%, P=0.02), but not for urge incontinence (42% versus 26%, P=0.14).
A higher proportion of patients in the intervention group had a clinically relevant reduction of 70% or more in the frequency of all incontinence episodes (P<0.001), episodes of stress incontinence (P=0.009) and episodes of urge incontinence (P=0.04).
Three-quarters (76%) of women in the intervention group were 'moderately or very satisfied with the change in incontinence' compared with less than half (47%) in the control group.
The study findings back up standard clinical practice. Clearly however, an appreciable weight loss is required to achieve clinically significant improvement in symptoms. Simple advice for overweight women with incontinence to lose weight may not be sufficient. Referral of obese patients to formal weight management programmes or overweight patients to slimming programmes may be more helpful.
Given the overall health benefits of weight loss, addressing weight issues should be considered standard management for all overweight patients with urinary incontinence.
Subak LL, Wing R, Smith West D. et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009; 360: 481-90Author
Dr Jonathan Rees
GPwSO Urology, Bristol