Prevent Urinary Incontinence by Losing Weight

Up to 84 percent of women (and 30 percent of men) have to deal with urinary incontinence at some point in their lives. The inability to "hold it in" can be caused by:

• Urge incontinence: Involuntary leakage of urine as soon as the urge to urinate is felt, not being able to get to the bathroom fast enough.
• Stress incontinence: Involuntary leakage urine caused by physical stress, such as climbing stairs, laughing, coughing, sneezing, orgasm, or doing abs exercises. Any physical stress on the abdominal cavity conveys pressure to the bladder.
• Mixed incontinence: A combination of urge incontinence and stress incontinence, a combination of leakage when you feel there is a "need to go" and when physical activities like those listed above stress the bladder.
• Overflow incontinence: Production of urine greater than the capacity of the bladder.
• Functional incontinence: The inability to hold urine due to reasons other than lower urinary tract dysfunction or stress, such as delirium, psychiatric disorders, urinary tract infections, or confinement to a bed or wheelchair.
• Overactive bladder: A nerve condition that causes the bladder to overreact to common stimuli.

Incontinence may be triggered by the sound of running water. Many people lose bladder control as soon as they walk in the front doors of their homes but before they can get to the toilet; their parasympathetic nervous systems stop sending signals to the muscles around the bladder to retain urine on sight of but before physically reaching the bathroom. Smoking as well as abuse of either caffeine or alcohol increases the frequency of incontinence, as do a history of urinary tract infections, pelvic surgery, multiparity (having lots of babies, for instance, the author knows a woman who became incontinent after she delivered her seventeenth child), fecal incontinence, pelvic organ prolapse (organs that turn inside out), and previous surgeries to stop incontinence.

Urinary incontinence can be caused or exacerbated by:

• Diabetes,
• Obesity,
• Any condition that causes chronic cough,
• Spinal cord injuries,
• Congestive heart failure, and,
• In women, low estrogen levels after menopause (or in women of any age, surgical removal of the ovaries and/or uterus),
• In men, prostate enlargement or prostate cancer.

A variety of medications can cause urinary incontinence, including alpha-blockers, angiotensin-converting enzyme inhibitors, muscle relaxants, sedatives, diuretics, over the counter allergy medications, and estrogen replacement therapy.

Treatments for incontinence range from:

• Pelvic floor exercises and Kegel exercises, anti-incontinence devices, and surgery for stress incontinence.
• Changes in diet, new medications, pelvic floor exercises, and surgical intervention for urge incontinence.
• Pelvic floor exercises, drugs that regulate the parasympathetic nervous system, and surgery for mixed incontinence.
• Placement of a catheter and a collection bag for overflow incontinence, and
• Treatment of the underlying health problem in functional incontinence.

While you and your doctor are sorting out your options, or while you are waiting for your treatment to work you may need to use incontinence products. You aren't supposed to need to use incontinence supplies like adult diapers indefinitely, however. It's never an acceptable result of treatment not to have bladder control. Women who have bladder control issues can often make faster progress when they lose weight.

Losing Weight for Better Bladder Control

A team of researchers recruited 1,475 women in Pittsburgh, Pennsylvania, and Memphis, Tennessee in the United States for a study of general health and fitness and successful bladder control. The researchers measured body mass index (a measurement of weight adjusted for height), grip strength, quadriceps (thigh muscle) strength, walking speed, fat mass, and lean body mass at the beginning of the study and over the next three years. All of the women were between 70 and 80 years old.

Some of the women already had issues with urinary incontinence when they were recruited for the study. At the beginning of the study, 212 (14 percent) reported at least one episode of stress incontinence, the kind of incontinence that occurs when walking up steps or laughing or having sex, and so on, at least once a month. Also, 233 of the women (16 percent) reported at least one episode of urge incontinence per month. This is the kind of incontinence that occurs when you just can't get to the bathroom fast enough. 

The researchers found tell-tale signs that incontinence would get worse in these women over the age of 70. Women who lost 5 percent or more of their grip strength were 60 percent more likely than average to develop incontinence or to have more frequent episodes of incontinence. On the other hand:

• Women who lost 5 percent or more of their BMI were 53 percent less likely to have episodes of stress incontinence.
• Women who lost 5 percent of more of their fat mass were 47 percent less likely to have episodes of stress incontinence.
• Women who gained 5 percent or more muscle mass were 83 percent less likely to have episodes of stress incontinence.

In other words, losing weight helps control those embarrassing runs to the bathroom. Gaining muscle almost eliminates them.

Losing fat and gaining muscle did not turn out to be a magical cure for every kind of incontinence. The benefits of exercise and weight control were limited to stress incontinence, the leakage of urine that occurs when working out on an abs machine, or using the Stairmaster, or walking up or down stairs, or making love, or laughing, crying, shouting, or similar activities. Working out or losing weight weren't helpful for overactive bladder, or for overflow problems, or for chronic conditions that predispose someone to loss of bladder control. That doesn't mean that there is nothing to be done:

• Avoid drinking alcohol to excess. Your brain sends messages to the muscles lining the wall of your bladder sphincter to hold urine in. Alcohol interferes with those messages.
• Avoid artificially sweetened soft drinks and sugar-free desserts. They can "excite" the bladder so that it dumps urine at awkward times.
• Don't smoke, and don't let up your guard against bladder episodes when you are using nicotine chewing gums or nicotine pads. Nicotine stimulates bladder activity.
• Avoid dehydration, but don't drink so much water that you slosh. Your body only needs about 1200 ml (five cups) of water every day.
• Consider acupuncture. It doesn't always help, but sometimes it works wonders.

Men who have bladder control issues won't be hurt by losing fat mass or gaining muscle mass, but there isn't as much clear-cut evidence that weight control makes a critical difference in managing the problem for them. Men will benefit from following the simple guidelines above, and nearly always improve after treating obesity.