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Obese And suffering From Incontinence? Here's Why That Happens And What You Can Do To Treat It

by — Last updated: 2020-04-23 in Urinary Tract Issues

Obesity increases the risk of incontinence. Losing weight — even just a small percentage of your initial body weight — is the best option, but other treatments can also be of help. Here's what you need to know.

A 2017 UK health survey estimated that almost one-third of the adult population was obese and another third was overweight, yet not obese. Doctors use an index called the body mass index (BMI) to classify body weights. You can calculate your BMI by dividing your weight over your height squared. A BMI over 30 is considered obese, and one over 25 is considered overweight.

Obesity is associated with a number of adverse health consequences such as heart disease, diabetes, and hypertension. One of the less-discussed problems that many obese people have to deal with is urinary incontinence, a term used to describe the involuntary passage of urine. Millions of people across the globe suffer from this condition, which can be very frustrating and can cause social embarrassment in many instances.  

Many studies have found strong links between obesity and urinary incontinence. One study published in the Journal Of Urology in 2009 found that obesity is an independent risk factor for incontinence and that the more obese a person is, the more likely they would be to develop urinary incontinence. The authors of this study found that each 5-unit increase in BMI was associated with a 30 to 70 percent increased risk of urinary incontinence. The risk was even higher when the patients were followed up at five and 10 years. 

Another study done on women specifically found a similar link between obesity and urinary incontinence. The researches compared 100 obese women to 100 women with healthy weights in terms of stress urinary incontinence. It was found that 70 percent of the obese women had stress urinary incontinence, while only 17 percent of the women with normal weight reported this problem. 

Why does obesity increase the risk of incontinence?

To understand how obesity might cause incontinence, you’d need to know a little more about how the body holds urine in, and why incontinence happens.

Urine is formed in the kidneys and then collected in the urinary bladder, which is in turn closed by the urethral sphincter — a muscular tube that contracts on the bladder neck and holds urine in. The bladder and the sphincter are supported by the pelvic floor muscles, which form a muscular diaphragm allowing the sphincter to function normally. Damage to the bladder muscle, the urethral sphincter, the pelvic floor muscles, or the nerves supplying them can cause urinary incontinence. 

It is not fully understood how obesity fits into the picture, but there are some well-supported theories.

Obese women are more likely to have other risk factors for urinary incontinence —such as multiple pregnancies, estrogen deficiency, and previous operations, which put them at risk of having a disrupted urethral sphincter or a weak pelvic floor. Both of these are essential for normal continence.

Other researches believe that obesity itself is the cause, regardless of the other risk factors. The increased pressure inside the abdomen, occurring due to the large amounts of abdominal fat in obese people, chronically pushes down on the bladder, possibly damaging and weakening the urethral sphincter, pelvic floor muscles, and adjacent nerves, and eventually causing stress incontinence.  

What can you do if you are obese and suffering from incontinence? 

Research has shown that weight loss successfully reduces the occurrence of urinary incontinence. Losing even five to 10 percent of your body weight can go a long way, and might lead to significant improvement — with results similar to what would be achieved with other non-surgical incontinence treatments.

Moreover, a healthy weight is key to a healthy lifestyle and losing weight would reduce many of the other health risks associated with obesity. For this reason, weight reduction is considered te first-line treatment for incontinence in obese individuals.

Other lifestyle changes, such as cutting down on smoking, alcohol, and spicy foods, doing more exercise, bladder training, Kegel exercises, and controlling the amount of daily fluid intake can also speed up the treatment process. Kegel exercises, specifically, have been shown to help in reducing stress urinary incontinence. These exercises strengthen the pelvic floor muscles, allowing the urethral sphincter to work more efficiently. Absorptive incontinence pads can also be used to avoid wetting your underwear until a definite resolution is achieved. 

In cases where the problem persists despite all these measures, your doctor might recommend drugs that reduce bladder contractions or strengthen the urethral sphincter.

Some women might benefit from using vaginal pessaries, which mechanically support the urethral sphincter, and help it close more competently.

Surgical options are also offered to those who fail medical and conservative therapy. ​

Transurethral slings and artificial urinary sphincters have been historically considered as an excellent surgical option in such cases, but they are not free from complications. The transurethral sling procedure is very simple and is considered the first-line surgical therapy in women with stress urinary incontinence. 

There’s a strong link between obesity and urinary incontinence, as many studies have shown. Weight loss is the first step in treating this condition and it holds many additional health benefits. For those who still have incontinence despite losing weight, many more advanced treatments are available and should be discussed with the treating physician. 

  • Photo courtesy of SteadyHealth

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