Being overweight can have a negative effect on multiple health conditions such as heart disease, diabetes, hypertension, gallbladder and liver disease, depression, arthritis and cancer. Studies show that obesity has a positive correlation with urinary incontinence (UI). Urinary incontinence affects close to 50% of middle-aged and older women. Aging, childbirth, being overweight and obesity are 3 major risk factors for UI. Aging and childbirth are not factors you can modify. Being overweight or obese can be modified and controlled. Weight reduction has been shown to improve stress UI.
Obesity can create chronic strain on the bladder, stretch and weaken the nerves and muscles of the pelvic floor which contributes to UI.
There are 6 different types of urinary incontinence:
Stress incontinence (SUI)is the inability to hold on to urine with activity such as coughing, sneezing, laughing or bending. Increased weight has a strong association or connection with SUI and mixed UI. The accumulation of adipose (fat) tissue around the abdomen creates internal pressure on the urinary bladder. This pressure can cause UI or worsen UI that is present for other reasons. Bladder muscles relax, allowing the bladder to expand and hold urine. With excess pressure from abdominal adipose tissue, the bladder may not have room to expand, reducing the capacity to hold urine. This will increase the need to void more frequently, increasing the urge.
The connection between being overweight or obese on urge incontinence is much lower. Urge incontinence is the sudden and intense urge to urinate and is followed by involuntary loss of urine.
Overactive bladder is not generally linked with being overweight. It is caused by involuntary bladder contractions which create an urgent need to urinate. This can be improved with dietary changes such as avoiding caffeine and alcohol. Medications can also help.
Mixed incontinence is both stress and urges incontinence combined. Weight plays a role in this type of UI. Losing even a small amount of weight can help decrease these types of bladder leakage. One study has found that women with prediabetes who lost weight not only reduced the risk of developing type 2 diabetes but also reduced UI symptoms (Pericoach, 2018, para 8). A high body mass index (BMI) is associated with most types of UI but the strongest association is in mixed UI (Bray & Digesu, 2015, para 2).
With overflow incontinence, the bladder never completely empties which causes urine leakage with or without feeling the need to urinate. It can be caused by the blockage of urinary flow such as an enlarged prostate in men or a prolapsed uterus in women. The bladder muscle can become underactive, causing no signaling or urge to void. The last cause is a bladder spasm. This can be related to conditions like diabetes or cardiovascular disease. Being overweight or obese puts you at greater risk for diabetes and cardiovascular disease, therefore, increasing your risk for overflow UI.
For those suffering from functional UI, the problem is not getting to a toilet quick enough to avoid UI. This is common in those people with mobility issues caused by arthritis, musculoskeletal pain, and neurological conditions such as Parkinson’s disease and multiple sclerosis. Another factor contributing to this is that restrooms are not always easy to get to. Consider those who cannot remove clothing quickly enough to use the toilet. For the most part, obesity is not a risk factor for functional UI but can add to arthritis, back and joint pain, limiting movement. In this way, it contributes to functional UI.
Functional UI is also connected with cognitive conditions such as Alzheimer’s disease and dementia. These conditions can limit the thought process to plan trips to the bathroom, realizing the need to urinate or to find a bathroom. Those suffering from these conditions may have a sense or feeling something is different but do not understand it is the need to void. If caring for this population, watching for signs of confusion or uncertainty may give some time to be sure he or she gets to a bathroom to void.
Growing evidence can be found relating obesity-associated vascular and metabolic comorbidities with Alzheimer’s disease. Obesity-related comorbidities include insulin resistance, hyperglycemia, and type 2 diabetes. Therefore, obesity is yet another risk factor for functional UI.
Overall, being overweight or obese has a negative impact on urinary incontinence. It contributes to all forms of incontinence with the exception of an overactive bladder. Managing weight early on will reduce the physical strain on the pelvic floor muscles, reduce the risk for vascular problems associated with obesity and also decrease your risk for insulin resistance and type 2 diabetes. Managing weight will also decrease stress on joints, thereby reducing mobility impairment as we age. This in turn will decrease the risk for UI.
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Christine Kijek is a colorectal nurse at Danbury Hospital in Danbury, CT. She has a wealth of knowledge in this field as well as personal experience. HPFY is thrilled that she has been ...
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