When Laughing is No Longer Funny

Dr Mathews

The Effects of Obesity and Weight Loss on Urinary Incontinence.
By J. Kyle Mathews, MD
Originally appeared in the October, 2011 issue of Quality Care®

Do you leak urine when you laugh, cough, or sneeze? Do you have trouble making it to the bathroom when you suddenly realize you need to void? You are not alone. Over 25 million Americans experience urinary incontinence (UI). UI is the involuntary leakage of urine.

Urinary incontinence is described as stress urinary incontinence (SUI), urgency incontinence, or mixed incontinence. SUI is the involuntary leakage of urine when pressure is placed upon the bladder such as when coughing, laughing or sneezing. The supporting tissues around the bladder outlet no longer provide adequate support to prevent leaking of urine. Urgency incontinence is the sudden loss of urine associated with a strong urge to urinate. This is often referred to as overactive bladder syndrome. Mixed incontinence involves both stress and urgency incontinence and is most common condition, especially in women.

As you may know these condition are often treated with medication or surgery. What you may not know is that being overweight can significantly increase ones risk of having UI and weight loss can significantly reduce this risk.

Obesity has become a worldwide problem and a recent poll estimated that two-thirds of the U.S. population is overweight or obese. In the United States, obesity is one of the leading health issues resulting in approximately 300,000 deaths each year and costs the nation over $147 billion in medical expenses. While it is common knowledge that being over weight increases ones risk of high blood pressure, diabetes, high cholesterol, and heart disease, you may not be aware that obesity also increases one’s risk of UI.

One-third of men and women ages 30-70 have experienced loss of bladder control at some point in their adult lives and researchers have estimated the economic cost to exceed $30 billion annually. This does not take into consideration indirect costs associated with accidents, such as injuries from falls rushing to the toilet. The impact of UI on quality of life can be significant and can result in social isolation and depression. It is also costly to manage and can be a burden to caregivers.

Numerous studies have shown that weight loss often leads to significant improvement in UI. Obesity, often described by body mass index (BMI) of 30 kg/m2, is equal to a weight of 175 pounds for a 5 foot 4 inch woman and to a weight of 221 pounds for a 6 foot man (Know that BMI cannot tell apart lean muscle mass and body fat, it tends to overestimate the level of body fat in people who have a lot of muscle). Studies have found that for each five points of increase in BMI, the risk of UI increases 20% to 70%. A decrease in BMI of 8% to 10% has been shown to reduce the incidence of UI by greater than 50%. Weight loss, regardless of how achieved, (diet or surgical) has shown significant reduction in UI complaints and increases in quality of life issues. Most experts today regard weight loss as a first-line treatment recommendation for UI in those people who are excessively overweight or obese.

Losing weight improves an obese person’s health in many ways. They will feel experience better quality sleep at night, which will lead to an increase in energy levels. Many chronic health concerns can be prevented, such as Type 2 diabetes, angina, chest pains, and joint problems. They may even experience lower cholesterol levels, lower blood pressure, and an improved blood sugar levels. All of these benefits can even help the person financially. They will need fewer doctor visits, require less medication, and save more money to use for activities they enjoy.

About The Author
J. Kyle Mathews, MD is a board-certified physician in Obstetrics & Gynecology specializing in Female Pelvic Medicine and Reconstructive Surgery, Urogynecology. Dr. Mathews has a special interest in Restorative Vaginal Surgery and Incontinence. He is currently director of Pelvic Reconstructive Surgery, Urogynecology, and Continence.

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