In the obese, weight loss reduces incontinence

Add incontinence relief to the list of benefits obese patients gain from losing weight.

The NIH-funded Program to Reduce Incontinence by Diet and Exercise recruited 338 obese and overweight women (BMI 25-50), who reported at least 10 episodes of stress or urge incontinence weekly. Participants received basic information on managing leaks and strengthening the pelvic floor and were divided into two groups.

After six months, those enrolled in an intensive weight-loss regimen lost an average of 8% of their body weight (about 17 lb). Their weekly incontinence episodes declined by 47%. The control group attended general education sessions about healthy eating and physical activity. While they lost only 1.6% of their body weight on average (about 3 lb), they still had 28% fewer episodes (N Engl J Med. 2009;360:481-490).

Obese women frequently experience overactive bladder (OAB) and urine leakage, but you may not be aware of it in specific cases. A survey of 311 patients found these conditions are “underdiagnosed in the primary-care setting” (BMC Fam Pract. 2009;10:8) (accessed April 17, 2009).

Patients were asked to rate how much they were bothered by OAB or incontinence symptoms, if any. OAB was significantly associated with obese women (BMI >30), especially those who were premenopausal (younger than 55 years). Incontinence accompanied the majority of cases.

Overall, OAB prevalence was 48.3% in women and 60.5% in men. That's higher than was found in a telephone survey six years ago, which pegged the overall prevalence of OAB at 16.9% in women and 16.0% in men (World J Urol. 2003;20:327-336).

The discrepancy is attributed to reluctance to admit embarrassing symptoms. “A user-friendly screening questionnaire may allow patients to comfortably report their bladder complaints and increase the ability of providers to recognize, evaluate, and treat OAB,” researchers conclude.
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