Urinary incontinence is common in women of all body shapes and sizes, but the risk is higher in women with obesity. While up to half of middle-aged women report incontinence, the risk of severe incontinence is over 3 times higher in women with BMI of 30+, compared to women with BMI 22-24. An earlier age of onset of obesity increases the risk of incontinence, and for each 5-unit increase in BMI, the risk of daily incontinence increases by about 60%. The association between elevated weight and stress incontinence (urine leakage with coughing, sneezing, or physical activity) is strongest, but also present for urge incontinence (strong, uncontrollable urge to urinate).
Does obesity put men at risk of urinary incontinence too?
The data in men are suprisingly sparse, compared to the extensive data in women. An observational study of almost 1000 men and women (about half of each) with average age of 59 presenting from a urinary dysfunction research network found that for every 10cm larger waist, there was a 24% higher risk of urge incontinence in both men and women with central obesity. An increased risk of stress incontinence with increasing waist size was only noted for females. Another observational study found that while the risk of incontinence started to go up for older women at a BMI of about 25 (‘overweight’) and increased from there, the risk for older men only started to rise above a BMI of 35.
How does obesity lead to urinary incontinence? The increased pressure in the abdomen due to collection of fat increases pressure on the bladder and causes strain of the pelvic floor muscles. The increased production of inflammatory hormones and oxidative stress that is common in obesity are also thought to play a role.
How much weight loss is needed to improve urinary incontinence? Most of the data looking at the benefits of weight loss for urinary incontinence is also in women, with at least 5-10% weight loss recommended to see improvement. These numbers are based on lifestyle intervention studies. A study of bariatric surgery patients found that the percentage of men reporting urinary incontinence decreased from 22% to 10% at 1 year (with 27% weight loss), and the percentage of women reporting urinary incontinence decreased from 49% to 18% (with 30% weight loss). No studies have yet evaluated the effect of weight management medications on urinary incontinence in any gender.
BOTTOM LINE: While urinary incontinence is more common in women with obesity, with risk increasing at just a slightly elevated BMI, men with obesity are at risk as well. It’s important to have the conversation about this health issue in the clinic, and it can be an important treatment target of weight management for all genders. Studies to evaluate weight loss medication for benefit to urinary incontinence are lacking.
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