Older women who struggle with urinary incontinence may benefit from regular, low-impact exercise, and yoga, as well as stretching and strengthening, all show benefits in a new study published August 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 broader effort to identify low-risk, low-cost ways to treat one of the most common health problems facing women 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 strengthening exercises experienced a similar benefit over the same time period. The benefits are similar to the effects of medications used to treat incontinence, the researchers said.
“Our study was testing the kind of yoga that almost anyone can do, with modifications for different physical abilities,” said study senior author Dr. Leslee Subak, director of obstetrics and gynecology 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 in part during the COVID-19 pandemic, many participants received their yoga or exercise instruction through online meetings, working out in their own homes, she noted.
The study’s senior author is Dr. Alison Huang, professor of medicine, urology, epidemiology and biostatistics at UCSF.
Urinary incontinence, which affects more than half of middle-aged women and up to 80% of people in their 80s, can lead to a range 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 Professor III. “Or we hear the myth that it’s normal as you get older. In fact, it’s very common, but it’s not inevitable, and we have very effective ways to treat it.”
Addressing a common problem
Incontinence deserves proper treatment because of the many ways it interferes with people’s lives.
“It takes away their independence,” Subak said. “My patients say, ‘I can’t stay with my kids or grandkids because I’m afraid of wetting the bed, and I can’t talk about it; it’s too embarrassing.'”
Patients may avoid activities that could improve their well-being, such as exercise and seeing friends. They are more likely to be admitted to a nursing home and suffer certain serious medical problems, such as hip fractures.
“Incontinence and overactive bladder are two of the leading risk factors for falls and fractures among older women,” Subak said. “They run to the bathroom at night, with the lights off, trip, fall and break their hips.”
Some factors that contribute to the risk of incontinence cannot be modified, such as aging or having had children. But others can be modified.
“A lot of my research has focused on weight loss and physical activity, which are actually effective treatments,” Subak said. She became interested in studying yoga as a treatment 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 a yoga group and 119 to a fitness control group. The participants were women with urinary incontinence that caused symptoms at least once a day. They were between 45 and 90 years old, with a mean age of 62.
In the yoga program, participants learned 16 hatha yoga poses aimed at strengthening the pelvic floor, through two 90-minute sessions per week. The pelvic floor is made up 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 keep a log of the practice.
Participants in the control group spent the same 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 additional hour per week and to keep a log of their practice.
The studio began with in-person classes and then moved to a video conference format when COVID-19 lockdowns began.
Participants recorded when they leaked urine and classified each episode as urge 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 on the abdomen, such as when coughing or sneezing. They also answered standard questionnaires about their bladder function.
At baseline, 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.
At the end of the 12-week programs, participants in the yoga group experienced 2.3 fewer episodes of incontinence per day, on average, and those in the fitness group experienced 1.9 fewer episodes per day.
The two treatments are nearly equally effective, with both approaches reducing incontinence episodes by about 60%, and the benefits of both treatments are significant, Subak said. Patients who want to try these approaches can look for low-impact Iyengar yoga or low-impact exercise classes in their communities or online, she said, adding that instructors should be able to tailor the activity to participants’ physical limitations.
“I’m impressed that exercise worked so well and that yoga worked so well,” Subak said. “One of the takeaway messages from this study is, ‘Stay active!'”
Other nonsurgical treatments for incontinence, including medications, typically result in a 30% to 70% improvement in symptoms, he noted.
If a patient were to ask me if 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 is the potential for benefit not only for incontinence but also for 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.