Lifestyle Intervention Is Associated With Lower Prevalence of Urinary Incontinence

Abstract

OBJECTIVE -Diabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence.RESEARCH DESIGN AND METHODS -We analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660 (34%) were randomized to intensive lifestyle therapy, 636 (32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years).RESULTS -The prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P ϭ 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence.CONCLUSIONS -Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes. Diabetes Care 29:385-390, 2006T ype 2 diabetes and urinary incontinence are chronic, common, and costly disorders. While ϳ18 million adults in the U.S. have diabetes, estimates of adults with pre-diabetes, defined as impaired glucose tolerance and/or impaired fasting glucose (1,2), range from 17 to 43 million. Recently, large randomized controlled trials have shown that diabetes can be prevented by intensive lifestyle intervention in this high-risk pre-diabetic group (3,4) Urinary incontinence, present in nearly 50% of middle-aged and older women, results in psychological stress and social isolation and has a profound effect on quality of life (5,6). The costs of incontinence are substantial, accounting for up to $32 billion per year in the U.S., greater than the annual direct costs for breast, ovarian, cervical, and uterine cancers combined (7,8).Type 2 diabetes is associated with a 50 -70% increased risk of incontinence in women (5,9,10). There have been no studies to determine whether nondiabetic women with abnormal glucose levels (pre-diabetes) are at increased risk for incontinence. Weight reduction and increased physical activity in individuals with pre-diabetes decreases the risk of type 2 diabetes (3,4). Weight reduction in obese women with incontinence has been shown to significantly decrease incontinence in small prospective studies (11-13). However, some studies have reported that increased physical activity worsens incontinence and that incontinence may be a barrier to exercise (14,15).We therefore examined data from 1,987 overweight women at high risk for diabetes who were enrolled in the Diabetes Preventi...

Stress Urinary Incontinence in Women with a History of Gestational Diabetes Mellitus

“…Of note, rates of incontinence were seen to be as high as 38%. 18 Women with a history of GDM tend to be poor and racial/ethnic minorities and also have low education levels and incomes, as opposed to our largely non-Hispanic white, well-educated, and affluent sample. It is possible that less advantaged women are more affected by stress urinary incontinence than our sample, perhaps because they have low self-efficacy for physical activity already, and stress incontinence is more difficult to surmount.…”

“…17,18 In NHANES, the frequency of stress incontinence was assessed by the question: "During the past 12 months, have you leaked or lost control of even a small amount of urine with an activity like coughing, lifting, or physical activity?" We modified this question by replacing "during the past 12 months" with "during your [GDM] pregnancy" and also "after your [GDM] pregnancy."…”

Diabetes mellitus and female urinary incontinence: a time for change

“…However, autonomic neuropathy affecting the innervations of the striated muscle of the urethral sphincter and pelvic floor muscles can lead to the development of an incompetent urethral mechanism and consequently stress UI [11]. Obesity, which is often associated with type 2 DM, is also a well-known risk factor for development of stress UI due to increased intra-abdominal and pelvic pressure [12]. Causes of stress UI in diabetic women also include the effects of gestational diabetes and delivery conditions such as macrosomia, prolonged second stage of labor, and the increased risk of instrumental delivery on the pelvic floor.…”

“…Weight loss, in obese patients, through diet and exercise, has long been advocated as an integral part of the conservative management plan for women with UI. Interestingly, a number of studies have also shown that the development of DM can be prevented by lifestyle interventions like exercise and diet regulation with a consequent decrease in the overall prevalence of female UI by nearly 50 % [11,12].…”

“…Management strategies should include lifestyle interventions like weight loss from dietary modification and exercise, cessation of smoking, and optimization of volume and type of fluids taken. Data analysis from the Diabetes Prevention Program, a large randomized controlled trial from 27 centers in the USA [12], showed that obese women at risk of DM and UI in the active lifestyle intervention group benefitted from dietary modification and exercise and reduced their odds of suffering from UI as compared to women in the metformin or placebo group. Pelvic floor exercise and bladder retraining have been shown to be effective first-line management in women with UI in general and would seem to be appropriate in diabetic women.…”