Older women struggling with urinary incontinence may benefit from regular, low-intensity exercise, with yoga as well as stretching and strength training showing benefits in a new study published Aug. 27 in Annals of Internal Medicine.
The research, led by scientists at Stanford Medicine and the University of California, San Francisco, is part of a larger effort to identify low-risk, low-cost ways to treat one of the most common health problems women face as they age.
After 12 weeks of a low-impact yoga program, study participants had about 65% fewer incontinence episodes. Women in a control group who did stretching and strength exercises had a similar benefit over the same time period. The benefits are equal to the effects of drugs used to treat incontinence, the researchers said.
“Our study tested the kind of yoga that almost anyone can do, with modifications for different physical abilities,” said senior study author Leslee Subak, MD, chair of obstetrics and gynecology at Stanford Medicine. “What I like is that it’s safe, cheap, doesn’t require a doctor and is accessible wherever you live.” Because the trial was conducted partly during the COVID-19 pandemic, many participants received the yoga or exercise instruction via online meetings, practicing at home, she noted.
The study’s lead author is Alison Huang, MD, professor of medicine, urology and epidemiology, and biostatistics at UCSF.
Urinary incontinence, which affects more than half of middle-aged women and up to 80% of those in their 80s, can lead to a range of other problems, from social isolation to broken bones caused by falls. But there is help.
“Part of the problem is that incontinence is stigmatized; we don’t talk about it,” said Schuback, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor III. “Or we hear folklore that this is normal as you get older. In fact, it’s very common, but it’s not inevitable, and we have very effective ways to deal with it.”
Addressing a common problem
Incontinence deserves good treatment because of the many ways it interferes with people’s lives.
“It takes away independence,” Shubak said. “My patients will say, ‘I can’t be with my children or grandchildren because I’m afraid I’ll wet the bed and I can’t talk about it; it’s very embarrassing.’
Patients may avoid activities that could boost their well-being, such as exercise and seeing friends. They are more likely to be admitted to a nursing home and suffer some serious medical problems such as hip fractures.
“Incontinence and overactive bladder are among the biggest risk factors for falls and fractures in older women,” Subak said. “You stumble into the bathroom at night – with the lights off – trip and fall and break a hip.”
Some factors that contribute to the risk of incontinence cannot be changed, such as aging or having children. But others are modifiable.
“A lot of my research has focused on weight loss and physical activity, which are actually effective treatments,” Shubak said. She became interested in studying yoga as a therapy after some of her patients told her it helped them.
Being active helps
The study compared two 12-week exercise programs: 121 participants were randomly assigned to yoga and 119 to a physical conditioning control group. Participants were women with urinary incontinence that caused symptoms at least once a day. They were 45 to 90 years old, with an average age of 62.
In the yoga program, participants learned 16 hatha yoga postures to strengthen the pelvic floor through two 90-minute sessions per week. The pelvic floor consists of the muscles that form the base of the pelvis and hold its organs -? including bladder and urethra -? in their place. Participants were also asked to practice yoga for at least one hour per week outside of class and to keep a practice journal.
Participants in the control group spent an equal amount of time in exercise classes, but their classes focused on non-specific stretching and strengthening exercises that did not involve the pelvic floor. They were also asked to practice for an extra hour a week and keep a training diary.
The study began with in-person classes and then transitioned to a video conference format when the COVID-19 pandemic lockdowns began.
Participants recorded when they leaked urine and classified whether each episode was urge incontinence, when an overactive bladder causes a person to need to urinate more often than usual, or stress incontinence, in response to pressure on the abdomen, such as from coughing or sneezing. They also answered standard questionnaires about their bladder function.
At the start of the study, participants had an average of 3.4 urinary incontinence episodes per day, including 1.9 urge-type episodes and 1.4 stress-type episodes.
By the end of the 12-week programs, participants in the yoga group experienced 2.3 fewer incontinence episodes per day, on average. Those in the physical conditioning group experienced 1.9 fewer episodes per day.
The two treatments are equally effective, with both approaches reducing incontinence episodes by about 60 percent, and the benefits of both treatments are substantial, Subak said. Patients who would like to try these approaches can look for Iyengar or low-impact yoga classes in their communities or online, he said, adding that instructors should be able to adapt the activity to the participants’ physical limitations.
“I’m impressed that the exercise went so well and I’m impressed that the yoga did so well,” Subak said. “One of the key messages from this study is ‘Be active!'”
Other nonsurgical treatments for incontinence, including medications, typically result in a 30% to 70% improvement in symptoms, he noted.
If a patient asked if yoga could help with incontinence, “I would say I think it’s a good idea to try it if you’re interested,” Subak said. “It’s very low-risk, and there’s potential for benefit not just for incontinence but for your overall well-being.”
The study was funded by the National Institutes of Health (grants R01AG050588, R01DK116712-04S1, and K24AG068601). Researchers from Yale University and San Francisco State University also contributed to the study.
