You can add incontinence relief to the list of benefits obese patients gain from losing weight, according to a recent NIH-funded clinical trial.

The Program to Reduce Incontinence by Diet and Exercise (PRIDE) recruited 338 obese and overweight women (BMI 25-50) who reported at least 10 episodes of stress or urge incontinence weekly. All of them received a booklet with basic information on managing leaks and strengthening the pelvic floor. They were then randomly divided into two groups.

After six months, those enrolled in an intensive weight-loss regimen lost an average of 8% of their body weight, about 17 pounds. Their weekly incontinence episodes declined by 47%. The control group attended general education sessions about healthy eating and physical activity. They lost only 1.6% of their body weight on average, about 3 pounds, but they had 28% fewer incontinenence episodes nonetheless (N Engl J Med. 2009;360:481-490).

Obese women frequently experience overactive bladder (OAB) and urine leakage. A recent survey of 311 patients found these conditions are “under-diagnosed in the primary care setting,” (BMC Fam Pract. 2009;10:8. Available at biomedcentral.com/1471-2296/10/8).

Given in the waiting rooms of primary care clinics, the questionnaire asked patients to rate how much they were bothered by OAB or incontinence symptoms. OAB was significantly associated with obese women (BMI >30; risk ratio [RR], 1.72), especially those who were premenopausal (<55 years; RR, 1.98). Incontinence accompanied the majority of cases.

Overall, the OAB prevalence was 48.3% in women and 60.5% in men. That's substantially higher than the NOBLE telephone survey of 11,740 Americans about six years ago. It pegged the overall prevalence of OAB at 16.9% in women and 16.0% in men (World J Urol. 2003;20:327-336).

The researchers attribute the discrepancy to patients' reluctance to admit embarrassing symptoms. “A valid and user-friendly screening questionnaire may allow patients to comfortably report their bladder complaints and increase the ability of primary-care providers to recognize, evaluate, and treat OAB,” they concluded.