Weight loss to treat urinary incontinence in overweight and obese womenLe Subak, R. Wing PhD, Delia Smith West PhD, Frank Franklin MD PhD.The New England Journal of Medicine Vol 360: 481-490 Jan 29, 2009 No 5

The association between obesity and urinary incontinence has long been clinicallyobserved. Despite being a recognised correlation, the evidence to suggest the benefits of weight loss with regard to urinary incontinence, is continuously accumulating from various centres.

In view of this, a behavioural interventional study was performed on a cohort of 338 overweight and obese women in Providence, Rhode Island and Birmingham in the USA. Their mean age was 53 years, with a minimal age of 30 yrs. A baseline BMI was that of 36 kg/m and included women affected by a combination of stress and urge urinary incontinence. All patients experienced on the average, ten urinary incontinence episodes per week.

The cohort was split into two groups. The interventional group underwent a 6-month intensive weight-loss programme. The control group did not, but both groups received a self help book regarding bladder control including pelvic floor exercises. Both groups were asked to complete a 7-day voiding diary at baseline and subsequently at follow up.

The differences between the interventional and control groups at follow up regarding weight loss were found to be 8% (7.9kg) : 1.6% (1.5kg) respectively. These differences were found to be strongly statistically significant. The study also showed that the frequency of weekly incontinence episodes decreased by 48% to 28% from the baseline. The greatest improvement was found to be that of stress as opposed to urge urinary incontinence, but unfortunately, not statistically different. However, a clinically relevant reduction of 70% for overall frequency of incontinence episodes was found in the intervention group (P<0.001).

This was a well-conducted study showing that intervention with weight loss and techniques involved within educational materials, greatly improves symptoms of urinary incontinence. The use of weight loss adjuncts in overweight and obese patients appears to be a cost effective method of improving incontinence symptoms.

The challenge would however, remain in sustaining a healthy BMI in previously obese women.