Weight Loss in Overweight and Obese Women Reduces Urinary Incontinence

Reducing urinary incontinence can now be added to the extensive list of health benefits of weight loss, according to a clinical trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Office of Research on Women’s Health (ORWH), both part of the National Institutes of Health (NIH). The paper reporting the results of the trial will be published in the January 29 issue of the New England Journal of Medicine.

The Program to Reduce Incontinence by Diet and Exercise (PRIDE), conducted in Birmingham, Alabama, and Providence, Rhode Island, recruited a total of 338 obese and overweight women who leaked urine at least 10 times per week. The women were randomly assigned to either an intensive six-month weight-loss program of diet, exercise and behavior modification (226 women) or to a group that received information about diet and exercise, but no training to help them change habits (112 women).

The investigators report that women in the intensive weight-loss group lost an average 8 percent of their body weight (about 17 pounds) and reduced weekly urinary incontinence episodes by nearly one-half (47 percent). In contrast, women in the information-only group lost an average 1.6 percent of body weight (about 3 pounds) and had 28 percent fewer episodes.
'Clearly, weight loss can have a significant, positive impact on urinary incontinence, a finding that may help motivate weight loss, which has additional health benefits such as preventing type 2 diabetes,' said NIDDK Director Griffin P. Rodgers, M.D.

Urinary incontinence affects more than 13 million women in the United States and accounts for an estimated $20 billion in annual health care costs, according to the paper. Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence has been lacking. The PRIDE trial provides evidence supporting weight loss as a treatment for incontinence.

An important finding of the study is the difference between the two groups in the reduction of incontinence. Among women in the weight-loss group, 41 percent achieved a clinically relevant reduction of at least 70 percent of total incontinence episodes per week, whereas 22 percent of women in the information-only group achieved the same level of reduction.

At six months, women in the weight-loss group were significantly more satisfied with the change in their incontinence than were women in the information-only group. This was assessed through self-reported perceived change in frequency of incontinence, volume of urine loss, the degree to which incontinence was a problem, and satisfaction with the change in incontinence.

'Studies have documented that behavioral interventions help people lose weight, which helps decrease the risk of developing type 2 diabetes and high blood pressure, improve control of high blood pressure and cholesterol levels, and enhance mood and quality of life,' explained Leslee L. Subak, M.D., of the University of California, San Francisco (UCSF) and lead author of the study. 'Our results suggest that a decrease in urinary incontinence is another health benefit associated with weight loss and that weight reduction can be a first-line treatment in overweight and obese women.'

Results from previous studies suggest that a weight loss of 5% to 10% has an efficacy similar to that of other nonsurgical treatments and should be considered a first line therapy for incontinence.

Weight loss in PRIDE is comparable to that observed in the Diabetes Prevention Program (DPP) and in the ongoing Action for Health in Diabetes (Look AHEAD), two NIDDK-sponsored clinical trials in people with type 2 diabetes. The PRIDE intensive weight-loss program was modeled after these two trials.

In an interview, earlier today, the investigators noted that while the results of the study indicated that incontinence diminished in both groups, they believe that some of reduced incontinence in the 'information-only group' is based on adopting some of the additional techniques included in the educational materials.

Because weight loss and weight maintenance can be highly challenging for the individual patient, clinicians are encouraged to help their patients by identifing a number of appropriate local or online resources to which they can refer patients for additional support.

For more information:

• Subak LL, Wing R, Smith West D, et al. Weight Loss to Treat Urinary Incontinence in Overweight and Obese Women. NEJM 360 (5):481-490, January 29, 2009.

Also read:

• Program to Reduce Incontinence by Diet and Exercise (PRIDE) click here and type NCT00091988 in the search window;
• Diabetes Prevention Program DPP and the Look AHEAD trials.
• Incontinence in women

Also read PubMed abstracts:

• Richter HE, Creasman JM, Myers DL, et al. Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Dec;19(12):1653-1658. Epub 2008 Aug 5.
• Subak LL, Whitcomb E, Shen H, et al. Weight loss: a novel and effective treatment for urinary incontinence. J Urol. 2005 Jul;174(1):190-5. Click here to contact the authors.
• Subak LL, Brubaker L, Chai TC, et al. High costs of urinary incontinence among women electing surgery to treat stress incontinence. Obstet Gynecol. 2008 Apr;111(4):899-907.