American Urogynecologic Society Systematic Review: The Impact of Weight Loss Intervention on Lower Urinary Tract Symptoms and Urinary Incontinence in Overweight and Obese Women

Abstract

Objective Obesity can contribute to urinary symptoms such as urgency, frequency, and incontinence. In addition to classic treatments, weight loss interventions offer a unique clinical opportunity to improve these symptoms. Study Design The American Urogynecologic Society Systematic Review Group conducted a review of articles on the impact of surgical and behavioral weight loss (BWL) interventions on urinary symptoms in overweight and obese women. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation criteria. Results The review group identified 43 publications from 39 studies, including 10 reports that used data from 5 randomized trials. Overall, there is high-certainty evidence that BWL, such as diet and exercise, decreases the prevalence of stress urinary incontinence 15% to 18% and overall urinary incontinence (UI) by 12% to 17% at 1 to 2.9 years. The certainty of evidence on the long-term impact of these interventions was lower. The certainty of the evidence was moderate to low regarding the benefit of BWL on urgency UI and overactive bladder symptoms. No randomized trials evaluated the impact of surgical weight loss on urinary symptoms, and the certainty of evidence of other study types was very low. Conclusions There is high-certainty evidence that BWL results in modest improvements in stress and overall UI in overweight and obese women at 1 to 2.9 years after the intervention. Robust studies with low risk of bias are needed to assess whether these benefits are maintained over the long term and are associated with adverse events and to assess the impact of surgical weight loss interventions on urinary outcomes in overweight and obese women.

Remission and Transition of Female Urinary Incontinence and Its Subtypes and the Impact of Body Mass Index on This Progression: A Nationwide Population-Based 4-Year Longitudinal Study in China

“…24 They also add to a range of adverse health effects that have already been identified as being associated with excess weight. 25,26 Together with previous evidence from randomized trials showing that weight loss may decrease the prevalence or number of episodes of UI, 27–29 the current findings provide further evidence that a higher BMI may be an important target for clinical intervention in patients with UI in the future.…”

Urinary incontinence and its association with pelvic floor muscle exercise among pregnant women attending a primary care clinic in Selangor, Malaysia

“…Similarly, a previous study also reported that pregnant women who were obese had a 9-fold higher risk of UI [Adjusted Odds Ratio [AOR] = 9.29, 95% CI (2.09, 41.37)]. As obesity is also one of the cause leading to UI, pregnancy with obesity could double up the risk of developing UI [ 33 ]. A cohort study on the other hand reported that rapid weight gain before week 15 of pregnancy was associated with UI at week 30 of pregnancy, while rapid weight gain after week 15 did not show such association [ 34 ].…”

Urinary Incontinence and Sleep Quality in Older Women with Type 2 Diabetes: A Cross-Sectional Study

“…More than half (~54%) of the middle-aged or older Taiwanese women were overweight (~29%; BMI 24.00–<27.00 kg/m 2 ) or obese (~25%; BMI ≥27.00 kg/m 2 ) [ 46 ]. There is evidence that behavioral weight loss interventions have beneficial effects on reducing UI in overweight and obese women [ 47 , 48 ]. Healthcare providers should focus on promoting the prevention of weight gain and losing excess body weight and developing continence management strategies for older women.…”