“I have more flesh than another man and therefore more frailty.”
William Shakespeare (King Henry the Fourth)
The prevalence of obesity is increasing and has reached epidemic proportions in the United States. The burden of extra pounds is an important risk factor for many health problems, including the development of a variety of female pelvic disorders—urinary incontinence (leakage problems) and pelvic organ prolapse (the descent of pelvic organs including the bladder, uterus and rectum).
Although I practice general urology, my fellowship training and subspecialty is female urology, particularly incontinence and pelvic prolapse. My other passionate interest is public health, wellness, health maintenance and disease avoidance. These two seemingly disparate disciplines actually interface quite profoundly, as incontinence and female pelvic floor disorders have clearly been shown to be causally related to weight gain and obesity, although there are many other factors involved. The other key determinants in the occurrence of incontinence and pelvic organ prolapse are child-bearing, aging, menopause and any source of chronic increase in intra-abdominal pressure such as straining with bowel movements, coughing, etc.
There are two main types of urinary incontinence in women, stress incontinence and urgency incontinence. Stress incontinence is leakage with exertion, jumping, running, sneezing, coughing, etc., and is usually due to weakened pelvic support of the urethra (the tube running from the bladder out). Urgency incontinence is the sudden and urgent desire to urinate with the inability to get to the bathroom in time to prevent leakage—it is often due to abnormal contractions (squeezes) of the bladder, essentially a bladder that contracts without its owners’ permission—often referred to as an overactive bladder.
Why is there a relationship between being overweight and incontinence? Increased BMI (Body Mass Index) increases the pressure within our abdomens. Obesity puts mechanical pressure on the pelvic floor because of excessive intra-abdominal pressures that promote the development of stress incontinence and pelvic organ prolapse. The bladders of obese women have been shown to have chronic low-grade inflammatory changes that can trigger the symptoms of an overactive bladder—frequency, urgency, night-time urination, the need to literally run to the bathroom, and leakage occurring before arrival in the bathroom.
Obesity has many other associated negative effects with respect to the diagnosis and management of incontinence and pelvic organ prolapse. It is much more difficult to do a satisfactory pelvic exam on an obese woman. The results of surgical treatment of stress incontinence are not as effective in overweight women. Higher doses of bladder relaxant medications are often required in the obese population. Anesthetic risks are greater as well. Overweight and obese women have an increased prevalence of Type 2 diabetes, which is a common underlying cause of incontinence because of the havoc that diabetes wreaks on the complex nerve supply to the bladder, urethra, and pelvic muscles.
The good news is that weight loss has been proven to be a helpful part of the overall management of urinary incontinence and pelvic organ prolapse. Most cases of incontinence and pelvic prolapse are readily treatable.
The following are links to videos that I have created that will provide further insights into stress incontinence, overactive bladder, bladder prolapse and pelvic floor exercises:
Female stress urinary incontinence:
Pelvic floor exercises I:
Pelvic floor exercises II:
This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: www.promiscuouseating.com. It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living. It is also available on Amazon Kindle.