Older women suffering from urine incontinence can benefit from frequent, low-impact exercise, including yoga, stretching, and strengthening, according to a new study.
The research, led by
scientists at Stanford Medicine and the University of California, San
Francisco, is part of a bigger attempt to develop low-risk, low-cost treatments
for one of the most frequent health concerns that women encounter as they age.
After 12 weeks of a
low-impact yoga exercise, study participants experienced approximately 65 per
cent fewer incontinence episodes. Women in a control group who did stretching
and strengthening activities saw similar results over the same period.
According to the researchers, the benefits are comparable to the effects of
incontinence medications.
"Our study was
testing the kind of yoga that just about anyone can do, with modifications for
different physical abilities," said the study's senior author, Leslee
Subak, MD, chair of obstetrics and gynaecology at Stanford Medicine. "What
I love about it is that it's safe, inexpensive, 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 their yoga or exercise
instruction via online meetings, exercising in their own homes, 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 per cent of
80-year-olds, can lead to a variety of other problems, from social isolation to
bone fractures caused by falls. But there is help.
"Part of the
problem is that incontinence is stigmatized; we don't talk about it," said
Subak, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor
III. "Or we hear folklore about this being normal when you get older. In
fact, it's very common but it's not inevitable, and we have very effective ways
of treating it."
Incontinence deserves
good treatment because of the many ways it interferes with people's lives.
"It takes away
independence," Subak said. "My patients will say, 'I can't stay with
my kids or grandkids because I'm afraid I'll wet the bed, and I can't talk
about it; it's too embarrassing.'"
Patients may avoid
activities that could boost their well-being, such as exercising and seeing
friends. They are more likely to be admitted to a nursing home and to suffer
certain serious medical problems such as hip fractures.
"Incontinence and
overactive bladder are among the biggest risk factors for falls and fractures
among older women," Subak said. "You're rushing to the bathroom at
night -- with the lights off -- tripping and falling, and breaking a hip."
Some factors that
contribute to risk for incontinence can't be changed, such as aging or having
had children. But others are modifiable.
"A lot of my
research has focused on weight loss and physical activity, which in fact are
effective treatments," Subak said. She became interested in studying yoga
as a treatment after some of her patients told her it helped them.
The study compared two
12-week exercise programs: 121 participants were randomly assigned to yoga, and
119 to a physical conditioning control group. The participants were women with
urinary incontinence that caused symptoms at least once a day. They were 45 to
90 years old, with a mean age of 62.
In the yoga program,
participants learned 16 hatha yoga poses intended to strengthen the pelvic
floor, via 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 the
bladder and urethra -- in place. Participants were also asked to practice yoga for
at least one hour per week outside of class and to maintain a practice log.
Participants in the
control group spent an equal amount of time in exercise classes, but their
classes focused on nonspecific stretching and strengthening exercises that did
not engage the pelvic floor. They were also asked to practice for an additional
hour per week and keep a practice log.
The study began with
in-person classes, then transitioned to a videoconference format when the
COVID-19 pandemic lockdowns began.
Participants recorded
when they leaked urine and classified whether each episode was urgency
incontinence, when an overactive bladder causes a person to feel the need to
urinate more often than usual, or stress incontinence, in response to pressure
in the abdomen, such as from coughing or sneezing. They also answered standard
questionnaires about their bladder function.
At the beginning of the
study, the participants had an average of 3.4 episodes of urinary incontinence
per day, including 1.9 urgency-type episodes and 1.4 stress-type episodes.
By the end of the
12-week programs, participants in the yoga group were experiencing 2.3 fewer
episodes of incontinence per day, on average. Those in the physical
conditioning group were experiencing 1.9 fewer episodes per day.
The two treatments are
about equally effective, with both approaches reducing episodes of incontinence
by around 60%, and the benefits from both treatments are meaningful, Subak
said. Patients who would like to try these approaches can search for low-impact
Iyengar yoga or low-impact exercise classes in their communities or online, she
said, adding that instructors should be able to adapt the activity to
participants' physical limitations.
"I'm impressed that
exercise did so well and impressed that yoga did so well," Subak said.
"One of the take-home messages from this study is 'Be active!'"
Other nonsurgical
treatments for incontinence, including medications, typically result in a 30%
to 70% improvement in symptoms, she noted.
If a patient asked
whether yoga could help with incontinence, "I would say that I think it's
a great idea to try it if you're interested," Subak said. "It's very
low risk, and there's potential for benefit not only for incontinence but also
for your general well-being."
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