Behavioral weight-loss programs can be an effective way to reduce urinary incontinence in women who are overweight or obese, according to a study led by researchers at the University of California, San Francisco.
Volunteer participants in the Program to Reduce Incontinence by Diet and Exercise (PRIDE) experienced both significant weight loss and a significant reduction in the frequency of their incontinence episodes, according to the study. Findings appear in the January 29, 2009 issue of the New England Journal of Medicine.
The multi-center, randomized clinical trial was conducted at UCSF, Brown University and the University of Alabama in Birmingham.
The results support the inclusion of weight reduction as a first-line treatment for incontinence for overweight and obese women, according to Leslee L. Subak, MD, lead author on the study and associate professor in the obstetrics, gynecology and reproductive sciences; urology, and epidemiology and biostatistics departments at UCSF.
"It has been well documented that behavioral weight-loss interventions decrease the risk of developing type 2 diabetes and high blood pressure, improve control of high blood pressure and cholesterol levels, and improve mood and quality of life," Subak said. "Our results suggest that a decrease in urinary incontinence can now be added to the extensive list of health benefits associated with weight loss."
Previous studies have indicated that obesity is a strong risk factor for urinary incontinence, a condition that affects more than 13 million women in the United States and accounts for an estimated $20 billion in annual health care costs, Subak said. The PRIDE research team sought to provide evidence of the beneficial effect of a weight loss program involving diet and exercise on urinary incontinence.
The study randomly assigned 338 overweight and obese women aged 42 to 64 years with at least 10 episodes of urinary incontinence per week to either an intensive 6-month weight-loss program that included group diet, exercise, and behavioral modification sessions, or to a control group who received weight loss information but no rigorous guidance. All participants received a booklet describing current methods for improving incontinence, including exercises for pelvic floor muscles.
Study participants in the weight-loss group lost an average of 17 pounds and reduced the weekly number of incontinence episodes by almost half (47 percent). In comparison, the control group lost an average of 3 pounds per person and had a 28 percent decrease in weekly number of incontinence episodes. The study also found that weight loss was more effective for stress incontinence (involuntary urine loss with coughing, sneezing, straining, or exercise) than urge incontinence (loss of urine associated with a strong urge to void).
Among women in the weight-loss group, a higher proportion achieved a clinically relevant reduction of at least 70 percent of total stress and urge incontinence episodes per week compared to the control group. Additionally, women in the weight loss group perceived greater improvement in the frequency of their urinary incontinence, lower volume of urine lost, less of a problem with incontinence and higher satisfaction with the change in their incontinence at 6 months, compared to women in the control group.
The research team will now examine additional data to determine whether the effect of weight loss can be maintained over an 18-month period.
"Improvement in urinary incontinence may be an additional way to motivate overweight women to make healthy lifestyle choices, such as weight loss and increased physical activity, impacting public health as well as an individual's health and quality of life," Subak said.
Other investigators and co-authors on the paper were Deborah Grady, MD, MPH, of UCSF and the San Francisco Veterans Affairs Medical Center; Rena Wing, PhD, Miriam Hospital and Brown University; Delia Smith West, PhD, University of Arkansas; and Frank Franklin, MD, PhD, University of Alabama in Birmingham. The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Research on Women's Health.
NIDDK is part of the National Institutes of Health and conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases.
ORWH serves as the focal point for women's health research at the NIH, including setting and monitoring policy; promoting, stimulating, and supporting research; and enhancing the recruitment and advancement of women in biomedical careers.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit www.ucsf.edu.
New England Journal of Medicine