Modest weight loss may curb urine leakage
NEW YORK (Reuters Health) - Overweight women with bladder-control problems can often improve those symptoms if they lose even a modest amount of weight, a new study suggests.
Excess weight, particularly in the abdomen, is one risk factor for urinary incontinence, and studies have found that shedding those extra pounds can help prevent the problem or reduce symptoms. However, it has not been known exactly how much weight women need to lose in order to see a significant improvement in symptoms.
The new study, published in the journal Obstetrics & Gynecology, suggests that overweight and obese women can reap benefits by losing 5 percent to 10 percent of their initial weight.
That range is considered a modest weight loss for people who are substantially overweight. For a woman who is 200 pounds, for example, it would mean shedding as few as 10 pounds.
For the study, researchers followed 338 overweight and obese women with urinary incontinence who were randomly assigned to either a weight-loss program focused on diet, exercise and behavior change, or to a "control" group that received only education on healthy lifestyle and weight loss.
Over 18 months, the women kept diaries tracking their weekly urinary incontinence symptoms.
Overall, the researchers found, women who shed between 5 and 10 percent of their initial weight were two to four times more likely than women who gained weight to report a significant reduction in their incontinence symptoms.
A significant reduction was defined as a decline of at least 70 percent in the number of incontinence episodes a woman had each week.
Of study participants who lost 5 to 10 percent of their starting weight, 54 percent reported that much of a decline in symptoms at the 18-month mark. That compared with 37 percent of women who gained weight.
The results should be "encouraging" to women, because a weight loss of that magnitude is achievable for many overweight people, according to the researchers, led by Dr. Rena R. Wing of Miriam Hospital and Brown University in Providence, Rhode Island.
The findings come from a clinical trial designed to test whether diet and exercise can help ease urinary incontinence symptoms. At the outset, the women were, on average, 53 years old and severely obese.
Women randomly assigned to the intervention group were prescribed a reduced-calorie diet of 1,200 to 1,800 calories per day, and worked their way up to exercising for about 3 hours per week -- with activities like brisk walking. They also attended weekly group meetings focused on lifestyle change.
The program lasted six months; women who lost weight then went into a "maintenance" program that focused on motivating them to keep up their lifestyle changes, with group meetings every other week.
Women in the control group were offered classes that gave general advice on diet, exercise and weight loss, with a total of seven classes over 18 months.
By the end of the study, most women had maintained some amount of weight loss; 21 percent were in the range of 5 to 10 percent, while 25 percent had lost more. One-quarter had gained weight.
When the researchers considered other factors that affect urinary incontinence risk -- like older age, smoking and having had multiple pregnancies -- they found that women who shed 5 to 10 percent of their initial weight were anywhere from two to four times more likely to report a significant reduction in incontinence episodes during the study period, versus women who gained weight.
Greater weight loss, however, did not seem to bring additional benefits. Wing and her colleagues note, though, that they "cannot strongly rule out such effects."
The researchers point out that other treatments for urinary incontinence, including medication, target only the condition itself. Weight loss, on the other hand, "has a wide spectrum of benefits" for overweight people, they write.
A number of studies have found that a 5 to 10 percent weight loss may, for example, help lower blood pressure or curb the risk of developing type 2 diabetes.
"A sustained decrease in urinary incontinence can now be added to the extensive list of health improvements associated with modest weight loss," the researchers write.
SOURCE: link.reuters.com/fuc69m Obstetrics & Gynecology, August 2010.
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