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It is estimated that approximately 64% of Canadians over the age of 18 are obese. We also know that over 3.3 million Canadian adults suffer from urinary incontinence. The two may not seem related, but let's take a closer look. Could there be a link between the two?

Obesity, which is the accumulation of excessive body fat, can have negative effects on health. The body mass index (BMI) is a concept used to help determine obesity. BMI values over 30 define obesity, but >35 is severe obesity, with values >40 morbid obesity and >45 super obesity. Obesity is one of the leading causes of preventable death. It is associated with adverse effects on multiple body organ systems, including the urinary tract. It also affects the heart, endocrine organs, musculoskeletal and neurological systems as well as a patient’s mental health.

Incontinence and Obesity

Obesity is a known risk factor for urinary incontinence, with susceptibility and severity of symptoms closely related to BMI. The mechanisms underlying this relationship have yet to be fully established, but the strong correlation between BMI and intra-abdominal pressure is thought to be a significant factor in the development of stress urinary incontinence and urge urinary incontinence. Obese individuals are also known to exhibit reduced nerve conduction velocities, potentially impacting upon the time taken for the nerve signals controlling bladder function to be relayed, which may play a part in overflow incontinence. Obese individuals also, often experience reduced mobility, and this can contribute to episodes of what is known as functional incontinence, where leakage of urine or feces occurs because of difficulty accessing toilet facilities in a sufficiently timely manner. Studies have also observed altered stool consistency in obese individuals with fecal incontinence, and elevated BMI has been linked to upper gastrointestinal symptoms and diarrhea.

Certain drugs used as a medical weight loss treatment include fecal incontinence as a known side effect; their action upon fat absorption can lead to altered stool consistency and bowel habits in a significant number of cases.

Diabetes is another condition frequently associated with obesity. It is also a risk factor for developing urinary incontinence, particularly in individuals who are insulin-dependent. The cause of this is currently unknown, but diabetes is understood to impact urine production and nerve sensitivity. The elevated levels of blood glucose observed with poorly controlled diabetes can lead to increased thirst and urine production as the body seeks to rid itself of unwanted glucose through urinary excretion. Nerve damage associated with diabetic neuropathy can affect bladder sensation and detrusor activity. Constipation is also a common complication of diabetes, and can make it difficult to fully empty the bladder, potentially resulting in overflow incontinence.

Where obesity is a factor, significant weight loss, whether achieved through lifestyle modification or surgery may frequently lead to a marked reduction in episodes of urinary incontinence, with several studies reporting complete resolution of urinary incontinence symptoms in morbidly obese individuals who lost weight following bariatric procedures. Maintaining a healthy weight may help lessen your symptoms of incontinence. People who are overweight typically have a much greater amount of stress and pressure to the pelvic area, resulting in a weakened pelvic floor. Additionally, more weight and pressure on the bladder can cause an increase in leakage. Weight loss is also important in controlling diabetes. Reaching and maintaining a healthy weight can lead to complete resolution of type 2 diabetes in some cases. Please remember, though, that certain drugs used as a medical weight loss treatment include fecal incontinence as a known side effect. Their action upon fat absorption can lead to altered stool consistency and bowel habits in a significant number of cases.

Losing weight can be difficult for many people. But, keeping a healthy diet and a strong exercise routine can help you shed those pounds and stay healthy. Also, be sure to consult with your physician and/or a nutritionist to help you to lose wait as safely and effectively as possible.