By Laura Gater
CHICAGO -- September 5, 2008 – Initiation of weight loss should be considered a first-line approach to the treatment of overweight and/or obese women with urinary incontinence (UI), researchers reported at the American Urogynecologic Society 19th Annual Scientific Meeting (AUGS).
Overweight is a strong risk factor for UI, and weight loss results in improved continence, said study presenter Rena Wing, MD, The Miriam Hospital, Providence, Rhode Island, in a presentation on September 4.
The Program to Reduce Incontinence by Diet and Exercise (PRIDE) is a multicentre, randomised clinical trial including 338 overweight and obese women (BMI 25-30 kg/m2) experiencing up to 10 episodes of UI per week. The cohort had a mean age of 53 years and mean weight of 97 kg.
According to patients' reports on 7-day voiding diaries, 22% of the women experienced stress incontinence, 43% had urge incontinence, and 35% experienced mixed UI.
Although the main objective was to determine the effect of weight loss on UI among obese and overweight women at 18 months, the study's secondary objective was to evaluate the association between the magnitude of weight loss and frequency of incontinence episodes.
The women were randomised to either an intensive 6-month weight loss program that included diet, exercise, and behavioural modification followed by a 12-month weight maintenance program or to a structured education program.
Overall, 86% of the women completed the 18-month trial. The mean weight loss at 18 months in the intervention and control groups was 6.5 kg and 1.7 kg, respectively.
Although there were large within-group differences in weight loss and UI improvement, differences at 18 months between the intervention and control groups were not significant in decreased total incontinence (61% vs 55%), stress incontinence (70% vs 64%), or urge incontinence (55% vs 50%).
However, when the researchers combined the 2 treatment groups, there was a strong dose-response relationship between magnitude of weight loss and UI improvement. The decreases in UI frequency by type were significant at 6 months (P = .02), at 12 months (P < .01), and at 18 months (P = .40).
The cohort analysis concluded that greater weight loss was associated with a greater decrease in UI frequency. There was no difference between the groups in the use of the UI behavioural techniques in the UI behavioural training booklet.
A modest weight loss of just 5% can have a marked impact on UI, and participation in a behavioural weight loss program was an effective short- and long-term treatment for UI in overweight and obese women, concluded Dr. Wing.
[Presentation title: Weight Loss Improves Urinary Incontinence in Overweight & Obese Women Through 18 Months. Paper 16]
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