Randomized Trial of a Behavioral Weight Loss Program for Urinary Incontinence in Overweight and Obese Women

Background

Obesity is an established and modifiable risk factor for urinary incontinence (UI) but conclusive evidence for a beneficial effect of weight loss on UI is lacking.

Objective

To determine whether weight loss reduces the frequency of urinary incontinence episodes in overweight and obese women recruited from the community.

Methods

The Program to Reduce Incontinence by Diet and Exercise (PRIDE) is a multi-center, randomized clinical trial in 338 overweight and obese women (BMI 25 - 50 kg/m2) experiencing >10 incontinent episodes per week at screening on a 7-day voiding diary. Participants were randomized in a 2:1 ratio to an intensive 6-month weight intervention program (lifestyle and behavior change; N=226) or to a usual care group (4 health information sessions; N=112). Both groups were given an instructional booklet describing standard behavioral therapy for incontinence. The primary per protocol analysis used GEE negative binomial models for repeated measurements to estimate the effect of treatment on change of weekly frequency of incontinent episodes and mixed linear regression models to compare the percent change in body weight between the two groups.

Results

Mean (+SD) participant age was 53 (+11) years. Body mass index (36+6 kg/m2) and weekly number of incontinent episodes (24+18) were similar for both groups at baseline. Women in the intervention group achieved a mean weight loss of 8.0% (7.8 kg) compared to 1.6% (1.5 kg) in the control group (P<0. 001). After 6 months, mean weekly incontinent episodes decreased by 46% in the intervention group compared to 25% in the control group (P=0.04). While the intervention group had a decrease in stress (P=.02) but not urge incontinent episodes (P=.23) compared to control, a higher proportion in the intervention group achieved a clinically relevant reduction of ≥70% of total (P<0.001), stress (P=0.010) and urge (P=0.04) incontinent episodes compared to control.

Conclusions

A 6-month behavioral intervention targeting weight loss reduced the frequency of UI episodes among overweight and obese women compared to control. Weight loss of as little as 5-10% has been shown to produce a cascade of other health benefits and weight reduction should be considered as a first-line therapy for urinary incontinence.

Keywords

urinary incontinence; urge incontinence; stress incontinence; urinary incontinence; urinary incontinence - therapy; urinary incontinence - diet therapy; obesity; obesity

Funding Support

For the Program to Reduce Incontinence by Diet and Exercise (PRIDE)

Supported by Grant Numbers U01DK067860, U01 DK067861 and U01 DK067862 from the National Institute of Diabetes and Digestive and Kidney Diseases.

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