Can obesity cause urinary incontinence?

Urinary incontinence is the medical term for unintentionally passing urine. It is a widespread issue with many potential causes. Obesity can be a risk factor for urinary incontinence.
Obesity can contribute to urinary incontinence by increasing pressure on the abdomen and bladder and damaging the muscles and nerves that support the bladder.
It also increases the risk of diseases that can impair the function of the urinary system, such as insulin resistance, diabetes, and kidney disease.
Can obesity lead to urinary incontinence?
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Obesity has an association with urinary incontinence.
A 2023 study investigated the association between obesity and urinary incontinence in older adults. The study found that, on average, those with urinary incontinence had a significantly higher body mass index (BMI) and waist circumference than those without.
2023 study
While this study indicates an association between obesity and urinary incontinence, it does not show whether obesity is a cause.
A 2021 review reported an association between obesity and urinary incontinence in women. It noted that those with obesity also had a less favorable response to surgical treatment for urinary incontinence compared to those without obesity.
2021 review
The reviewers also refer to several older studies in which participants who completed a weight loss intervention experienced a reduction in their BMI and improved urinary incontinence symptoms.
Learn more about how obesity affects the body.
how obesity affects the body
How does obesity lead to urinary incontinence?
A 2023 study notes that several mechanisms may underlie the association between obesity and urinary incontinence. These include:
2023 study
Abdominal obesity or “central obesity” refers to an excessive accumulation of fat in the abdominal region. This type of obesity increases pressure in the abdominal area, which then increases pressure on the bladder.
refers to
It can also lead to urethral hypermobility, which is a condition in which a weakness in the pelvic floor muscles causes the urethra to move out of its usual position, resulting in urine leakage.
Abdominal obesity can also cause the muscles and nerves of the pelvic floor to stretch and weaken. This may cause or contribute to the following:
Stress urinary incontinence (SUI): SUI is a type of urinary incontinence in which physical activities that temporarily increase abdominal pressure trigger urine leakage. Examples include coughing, sneezing, and exercise.
increase
Urgency urinary incontinence (UUI): Also called overactive bladder, UUI involves a sudden urge to urinate, even when the bladder is not full.
involves
Detrusor instability: The detrusor muscles are muscles in the walls of the bladder. They relax to allow the bladder to fill with urine and contract to let it out. Detrusor instability is where the muscles contract involuntarily, resulting in urinary incontinence.
are
Learn more about types of urinary incontinence.
types of urinary incontinence
Obesity increases the risk of a range of chronic diseases that can affect the function of the urinary system, including:
insulin resistance
insulin resistance
diabetes
diabetes
kidney disease
kidney disease
Learn more about urinary incontinence and diabetes.
urinary incontinence and diabetes
Oxidative stress occurs when the number of harmful free radicals in the body exceeds the number of healthy antioxidants, resulting in cell damage. As a 2021 review notes, studies have shown that obesity contributes to the development of widespread or “systemic” oxidative stress in both humans and animals.
free radicals
2021 review
A 2021 review suggests that obesity and oxidative stress may also play a role in urinary incontinence. Specifically, oxidative stress may damage collagen and other structures that help to support the pelvic floor, increasing the risk of UI.
2021 review
Learn more about oxidative stress.
oxidative stress
Can weight loss help improve symptoms of urinary incontinence?
Some clinical guidelines indicate that for people with UI and obesity, losing excess weight can result in fewer leaks.
clinical guidelines
It can also reduce the risk of diabetes and other health issues that may cause or contribute to UI.
Tips for weight loss and weight maintenance include:
include
setting realistic, short-term weight loss goals that can help toward achieving the long-term weight loss goal
using a food diary or tracking app to track eating habits and gain insights into triggers that may lead to unhealthy food choices or overeating
managing portion sizes to help prevent overeating
performing at least 150 minutes of moderate-intensity exercise per week, which may include activities such as gardening or brisk walking
may include
Learn some tips for successful weight loss.
tips for successful weight loss
Treatment for urinary incontinence
Below are some potential treatment options for urinary incontinence.
Bladder training is a type of therapy that helps the bladder hold more urine. Bladder training can help reduce urinary incontinence.
reduce
One type of bladder training is “timed voiding,” which involves urinating according to a set schedule. Gradually increasing the time between bathroom visits helps stretch the bladder so that it can hold more urine. Some people might find recording and monitoring their daily bathroom habits in a bladder diary helpful.
bladder diary
Another type of bladder training is “urgency suppression,” which involves suppressing the strong urge to urinate. Techniques to help with urgency suppression include:
distraction, where a person engages in activities that take their mind off urinating
being still or taking long, deep breaths
rapid and intense pelvic floor contractions
Learn more about bladder training.
bladder training
Pelvic floor exercises or “kegel exercises” can help to treat UI. People can perform pelvic floor exercises three times per day and perform the following steps:
three times per day
Step 1: Ensure the bladder is empty, then stand, sit, or lie down.
Step 2: Squeeze and tighten the pelvic floor muscles as if trying to hold in gas. This should create a pulling sensation. Hold for a count of eight.
Step 3: Relax the muscles and count to 10.
Step 4: Repeat the exercise 10 to 15 times.
Importantly, a person should not perform pelvic floor exercises while they are urinating, as this can weaken the pelvic floor muscles and damage the bladder and kidneys.
Learn more about pelvic floor exercises.
pelvic floor exercises
Some lifestyle changes that may help to treat urinary incontinence include:
include
drinking plenty of water during the day
stopping drinking liquids a few hours before bedtime to help prevent the need to urinate during the night
limiting foods and drinks containing caffeine
limiting alcohol, as alcohol can increase urine production
engaging in regular physical activity
maintaining a moderate weight, and losing excess weight if necessary
Learn about ways to improve urinary incontinence.
ways to improve urinary incontinence
In some cases, doctors may prescribe medications to help relax the bladder and prevent episodes of urinary incontinence. These medications are available as pills, liquids, or patches. Examples include:
include
anticholinergics, such as oxybutynin
anticholinergics
beta-3 agonists, such as myrbetriq
tricyclic antidepressants, such as amitryptiline
tricyclic antidepressants
If the above medications are not effective, doctors may recommend Botox injections into the bladder. This helps to relax the bladder so that it can hold more urine and is less prone to leaking.
Learn about over-the-counter medications for urinary incontinence.
over-the-counter medications for urinary incontinence
Some medical devices that may help with urinary incontinence include:
A catheter: A tube that allows urine to drain freely from the bladder. Doctors may recommend this for a type of incontinence called overflow incontinence, where the bladder leaks urine because it is too full.
A pessary: A soft, plastic device that inserts into the vagina to help treat SUI in women. The pessary presses against the wall of the vagina and nearby urethra, helping to support the urethra and prevent urine leakage.
Bulking agents: These are gels or pastes that a doctor injects near the urinary sphincter to treat SUI. The urinary sphincter is the opening of the bladder. Injecting material near this area helps to keep the urinary sphincter closed, thus helping to prevent urine leakage.
Electric nerve stimulation: This procedure involves delivering mild pulses of electricity to help stimulate the nerves that control the bladder and urinary sphincter, thus altering the bladder’s reflexes. Doctors may recommend this procedure for UUI that does not respond to other treatments.
Learn about overflow incontinence.
overflow incontinence
Preventing urinary incontinence
While urinary incontinence is not always preventable, certain lifestyle habits can help to keep the bladder as healthy as possible. These include:
not always preventable
avoiding bladder irritants, such as alcohol and spicy foods
drinking enough fluids
going to the bathroom when they feel the need to go, as holding in urine weakens the bladder muscles and increases the risk of a UTI
avoiding constipation, if possible
practicing pelvic floor exercises
quitting smoking, if applicable
Learn more about the nerves that control the bowel and bladder.
nerves that control the bowel and bladder
When to contact a doctor
People should contact a doctor if they experience symptoms of UI, such as:
urine leakage during physical activity or immediately following a sudden urge to urinate
frequent urination
frequent urination
getting up more than once in the night to urinate
A doctor will ask about a person’s medical and family history and perform a physical examination. They may also ask a person to keep a bladder diary and request additional tests to help determine the cause of urinary incontinence.
Learn more about frequency of urination.
frequency of urination
Self-advocacy
Urinary incontinence can occur for many reasons and is not always related to obesity. Other factors that can cause or contribute to urinary incontinence include:
include
aging
urinary tract infection
urinary tract infection
constipation
chronic cough
a blockage in the urinary tract, from a kidney stone or tumor
nerve damage from surgery, or diseases such as: strokemultiple sclerosisParkinson’s disease
stroke
multiple sclerosis
Parkinson’s disease
pregnancy and childbirth
pregnancy and childbirth
pelvic organ prolapse
pelvic organ prolapse
menopause
If a person feels that their doctor is wrongly attributing their UI symptoms to obesity, they may want to seek a second opinion from a weight-inclusive healthcare professional (W-IHP). The following websites can help people to find a W-IHP:
The Association for Size Diversity and Health
The Association for Size Diversity and Health
Bare Health
Bare Health
Health at Every Size
Health at Every Size
People can also consider asking a friend or family member to join them during their appointment to help advocate for a more weight-inclusive healthcare approach.
Summary
Research suggests that obesity is a risk factor for urinary incontinence. Obesity may cause or contribute to urinary incontinence directly by increasing intra-abdominal pressure or weakening and damaging structures that support the bladder. Obesity also increases the risk of diabetes and other diseases that can affect the urinary system.
Those who experience symptoms of urinary incontinence should speak with a doctor. People with overweight and obesity may want to take a friend or family member to their appointment to help them advocate for a more weight-inclusive healthcare approach.
If a person feels that their doctor is wrongly attributing urinary incontinence to their weight, they may wish to seek a second opinion from a W-IHP.