Open Access Journal of Urology
Dovepress open access to scientific and medical research
Review
Open Access Full Text Article
Effect of weight loss on urinary incontinence in women This article was published in the following Dove Press journal: Open Access Journal of Urology 29 July 2011 Number of times this article has been viewed
Emily L Whitcomb 1 Leslee L Subak 2 1 Southern California Permanente Medical Group, Female Pelvic Medicine and Reconstructive Surgery, Orange County-Irvine Medical Center, Irvine, CA, USA; 2University of California San Francisco, UCSF Departments of Obstetrics, Gynecology and Reproductive Sciences, and Urology, and Epidemiology and Biostatistics, SF Veterans Affairs Medical Center, San Francisco, CA, USA
Background: The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence. Methods: A literature review of the association between urinary incontinence and overweight/ obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized. Results: Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%–70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4–5. The odds of incident urinary incontinence over 5–10 years increase by approximately 30%–60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence. Conclusion: Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence. Keywords: urinary incontinence, obesity, women
Introduction
Correspondence: Emily L Whitcomb Southern California Permanente Medical Group, Orange County Irvine Medical Center, Female Pelvic Medicine and Reconstructive Surgery, 6650 Alton Parkway, Irvine, CA 92618 Tel +1 949 932 5677 Fax +1 949 932 6348 Email [email protected]
submit your manuscript | www.dovepress.com
Dovepress http://dx.doi.org/10.2147/OAJU.S21091
Urinary incontinence affects almost 50% of middle-aged and older women,1,2 including approximately 18.3 million women currently in the US, with an estimated increase to 28.4 million women by 2050 as our population increases and ages.3 Urinary incontinence is associated with a profound adverse effect on quality of life4,5 and accounts for more than $30 billion in annual direct costs in the US.6 Risk factors for urinary incontinence include aging, childbirth, diabetes, and increased body mass index (BMI).7 More than 50% of American women are overweight (BMI: 25–29.9 kg/m2) or obese (BMI: $30 kg/m2), and the prevalence of obesity is increasing by almost 6% per year.8 Obesity directly contributes to more than 300,000 deaths per year, accounts for expenditure of more than US$100 billion per year, is associated with medical comorbidities including heart disease, hypertension, diabetes, cancer, and depression, and adversely affects quality of life.8,9
Open Access Journal of Urology 2011:3 123–132 123 © 2011 Whitcomb and Subak, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
Dovepress
Whitcomb and Subak
A
6 Urge UI
Association of weight and urinary incontinence Observational epidemiological evidence Epidemiological studies demonstrate that obesity is a strong risk factor for urinary incontinence. A recent systematic literature review examined the association between urinary incontinence and overweight/obesity in women.15 While the definition of urinary incontinence varies according to the study, data from a large number of studies indicate that urinary incontinence in women is associated with higher BMI and weight.10,13,16–29 Most studies demonstrate a clear dose-response effect of weight on the prevalence of urinary incontinence,15,16 with odds ratios (OR) of 4–5 for the maximum effect of weight on urinary incontinence (Figure 1). A stronger association is reported between increasing weight and stress-predominant incontinence (including mixed incontinence), than for urge-predominant incontinence.12,16,22,27,30 Each 5-unit increase in BMI is associated with an approximately 20%–70% increase in risk of daily inco ntinence10,12,13,17,22,25,26 and, in one study, obesity had the largest
124
submit your manuscript | www.dovepress.com
Dovepress
Mixed UI
4 3 2 1 0
Methods
Dovepress open access to scientific and medical research
Review
Open Access Full Text Article
Effect of weight loss on urinary incontinence in women This article was published in the following Dove Press journal: Open Access Journal of Urology 29 July 2011 Number of times this article has been viewed
Emily L Whitcomb 1 Leslee L Subak 2 1 Southern California Permanente Medical Group, Female Pelvic Medicine and Reconstructive Surgery, Orange County-Irvine Medical Center, Irvine, CA, USA; 2University of California San Francisco, UCSF Departments of Obstetrics, Gynecology and Reproductive Sciences, and Urology, and Epidemiology and Biostatistics, SF Veterans Affairs Medical Center, San Francisco, CA, USA
Background: The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence. Methods: A literature review of the association between urinary incontinence and overweight/ obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized. Results: Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%–70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4–5. The odds of incident urinary incontinence over 5–10 years increase by approximately 30%–60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence. Conclusion: Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence. Keywords: urinary incontinence, obesity, women
Introduction
Correspondence: Emily L Whitcomb Southern California Permanente Medical Group, Orange County Irvine Medical Center, Female Pelvic Medicine and Reconstructive Surgery, 6650 Alton Parkway, Irvine, CA 92618 Tel +1 949 932 5677 Fax +1 949 932 6348 Email [email protected]
submit your manuscript | www.dovepress.com
Dovepress http://dx.doi.org/10.2147/OAJU.S21091
Urinary incontinence affects almost 50% of middle-aged and older women,1,2 including approximately 18.3 million women currently in the US, with an estimated increase to 28.4 million women by 2050 as our population increases and ages.3 Urinary incontinence is associated with a profound adverse effect on quality of life4,5 and accounts for more than $30 billion in annual direct costs in the US.6 Risk factors for urinary incontinence include aging, childbirth, diabetes, and increased body mass index (BMI).7 More than 50% of American women are overweight (BMI: 25–29.9 kg/m2) or obese (BMI: $30 kg/m2), and the prevalence of obesity is increasing by almost 6% per year.8 Obesity directly contributes to more than 300,000 deaths per year, accounts for expenditure of more than US$100 billion per year, is associated with medical comorbidities including heart disease, hypertension, diabetes, cancer, and depression, and adversely affects quality of life.8,9
Open Access Journal of Urology 2011:3 123–132 123 © 2011 Whitcomb and Subak, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
Dovepress
Whitcomb and Subak
A
6 Urge UI
Association of weight and urinary incontinence Observational epidemiological evidence Epidemiological studies demonstrate that obesity is a strong risk factor for urinary incontinence. A recent systematic literature review examined the association between urinary incontinence and overweight/obesity in women.15 While the definition of urinary incontinence varies according to the study, data from a large number of studies indicate that urinary incontinence in women is associated with higher BMI and weight.10,13,16–29 Most studies demonstrate a clear dose-response effect of weight on the prevalence of urinary incontinence,15,16 with odds ratios (OR) of 4–5 for the maximum effect of weight on urinary incontinence (Figure 1). A stronger association is reported between increasing weight and stress-predominant incontinence (including mixed incontinence), than for urge-predominant incontinence.12,16,22,27,30 Each 5-unit increase in BMI is associated with an approximately 20%–70% increase in risk of daily inco ntinence10,12,13,17,22,25,26 and, in one study, obesity had the largest
124
submit your manuscript | www.dovepress.com
Dovepress
Mixed UI
4 3 2 1 0
Methods
