Urinary incontinence and weight
If your bladder leaks started or got worse as you gained weight, the two are connected. Extra weight puts steady pressure on your pelvic floor. Weight is also one of the few risk factors for leaking that you can change, and even a modest loss can help.
Why this happens
Extra weight around your belly presses down on your bladder and pelvic floor all day long. That makes it harder for the urethra to stay closed when pressure spikes with a cough, a sneeze, or a lift. This is stress incontinence, and it’s the type most tied to weight. Extra weight may add to urgency too, though the link with urge leaking is less clear.
The more weight, the higher the risk. In a large Norwegian survey, women with a BMI of 30 to 34 were about 3 times as likely to have severe stress leaks as women with a BMI under 25. At a BMI of 40 or more, the risk was about 5 times higher.
What the research shows
In the largest trial, called PRIDE, women who lost about 8% of their body weight over 6 months had 47% fewer leaks per week. Women in the comparison group lost only about 1.6% of their weight and had 28% fewer leaks.
Stress leaks dropped the most, by 58%, and about 1 in 4 women stopped having stress leaks completely (compared with about 1 in 5 in the comparison group). Urge leaks dropped by 42%, but that wasn’t clearly better than the comparison group.
Most of the benefit shows up once you’ve lost at least 5% of your body weight. For a 200-pound woman, 5 to 10% is about 10 to 20 pounds.
The benefit tends to fade. In PRIDE, the gap in stress leaks between the two groups had closed by 18 months, even though the weight-loss group had kept off more weight. Other long-term studies found no difference at 5 years. Most people regain 1 to 2 kilograms (2 to 4 pounds) a year after a weight-loss program, which may explain part of it.
Weight-loss surgery may help too, but the evidence is weaker because no randomized trials exist. In one large study, 5 years after surgery, 38% of women had leaking, compared with 58% of women with obesity who didn’t have surgery.
Signs you should seek help
- Bladder leaking that started or got worse with weight gain
- Leaking that keeps you from exercising or being active
- Leaking that hasn’t improved after losing weight
Treatment options
Weight loss is one option. You don’t have to lose weight, or try and fail any other treatment, before you choose the one you want. The right treatment depends on the type of leaking. Stress leaking happens when you cough, sneeze, laugh, or exercise. Urge leaking comes with a sudden need to go. Many women have both, and then we start with whichever bothers you more. We decide together based on your symptoms and goals.
For any type of leaking:
- Weight loss: losing about 5 to 10% of your body weight can cut leaks, though the effect may not last
- Pelvic floor physical therapy: a pelvic floor PT works on strength, relaxation, and coordination of the pelvic floor, along with your hips, core, and breathing. We have in-office pelvic floor physical therapists who work closely with our team.
For stress leaking:
- A pessary or vaginal insert that supports the urethra during exercise
- Urethral bulking, an in-office injection that helps the urethra close
- A midurethral sling. Expert guidance says a sling may work a little less well in women with obesity, but it’s still a good option.
For urge leaking:
- Bladder training: spacing out bathroom trips and adjusting fluids and caffeine
- Medication
- Botox injected into the bladder, which lasts about 6 to 9 months
- Nerve stimulation: sacral neuromodulation, a small implanted device whose battery lasts 10 to 15 years, or a tibial nerve implant placed near the ankle
How I approach it
When a patient tells me her leaks got worse as she gained weight, I bring it up, because it’s one thing she can change. I don’t make weight loss a condition of treatment. If you want to work on weight, we can start PT or another treatment at the same time, and we’ll see how much better you get from each.
Your weight shouldn’t decide whether you get help for leaking.
Your next steps
If leaking bothers you, get it evaluated wherever you are with your weight. A urogynecologist can sort out what type of leaking you have and what’s driving it, and build a plan that fits your life.
Learn more about urinary incontinence
References
- Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. New England Journal of Medicine. 2009. doi:10.1056/NEJMoa0806375
- Yazdany T, Jakus-Waldman S, Jeppson PC, et al. American Urogynecologic Society systematic review: the impact of weight loss intervention on lower urinary tract symptoms and urinary incontinence in overweight and obese women. Female Pelvic Medicine & Reconstructive Surgery. 2020. doi:10.1097/SPV.0000000000000802
- ACOG Committee on Practice Bulletins—Gynecology, American Urogynecologic Society, Kenton KS, et al. Urinary incontinence in women (ACOG Practice Bulletin No. 155). Obstetrics & Gynecology. 2015. doi:10.1097/AOG.0000000000001148
- Lukacz ES, Santiago-Lastra Y, Albo ME, et al. Urinary incontinence in women: a review. JAMA. 2017. doi:10.1001/jama.2017.12137
- Wu JM. Stress incontinence in women. New England Journal of Medicine. 2021. doi:10.1056/NEJMcp1914037
- Nygaard IE, Heit M. Stress urinary incontinence. Obstetrics & Gynecology. 2004. doi:10.1097/01.AOG.0000137874.84862.94
- Kobashi KC, Albo ME, Dmochowski RR, et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. The Journal of Urology. 2017. doi:10.1016/j.juro.2017.06.061