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Aug 20

Stress urinary incontinence in women – Foster’s Daily Democrat

Long Term Weight Loss Comments Off on Stress urinary incontinence in women – Foster’s Daily Democrat

By Pam Stuppy

According to statistics, as high as 2 percent to 40 percent of American women experience stress urinary incontinence. SUI occurs when urinary leakage is triggered by activities that increase intra-abdominal pressure. Examples include sneezing, coughing, laughing or certain forms of physical activity.

For younger women, increased involvement in high impact physical activity or pregnancy may be the precipitating causes. Approximately 19 percent to 75 percent of pregnant women experience SUI. Interestingly, middle age women going through perimenopause (around 45-49 years of age) are the age bracket at highest risk, even more so than older women.

SUI involves functions of the bladder sphincter and/or the pelvic floor muscles. Pressure in these areas can lead to accidental opening of the urethra resulting in leakage. For this reason, activities that increase intra-abdominal pressure or even the presence of excess abdominal fat can increase the risk.

A number of factors can contribute to the risk of SUI. Studies indicate that there may be a genetic connection. Also, gynecological issues related to hormones or physiological changes can be triggers. This includes decreases in estrogen levels and/or weakening of pelvic floor muscles. Having had multiple births can be a contributing factor as well.

Constipation can cause pelvic floor stress due to straining. Many medications as well as diet, dehydration and sedentary behaviors can affect constipation. Women who experience SUI are often fearful of leakage and restrict fluid intake as a result. This can further increase the risk of constipation and its negative impact on SUI. They may also limit physical activity for the same reason, which can then lead to increased abdominal fat.

Chronic coughing that causes pelvic floor stress, such as from smoking or asthma, can increase the risk of SUI. High impact exercise over an extended period of time or excessive weight lifting are other risk factors.

Rapid weight increase or long-term elevated body weight, especially in the abdominal area, can lead to SUI. Excess fat not only puts pressure on the bladder, but can also weaken the pelvic floor muscles and tissues supporting the urethra.

In addition, visceral abdominal fat can negatively affect hormones that otherwise sustain a healthy pelvic floor. Some of these hormones are also involved in fullness and hunger cues so changes can lead to weight gain. Note that abdominal fat may increase the risk of bladder inflammation, which often results in increased urinary frequency and urgency.

Factors that increase abdominal fat would then be considered contributors to SUI. Diet is implicated since excess calorie intake with a higher intake of added sugars/sugar sweetened beverages can promote abdominal fat. Studies suggest that higher saturated fat intake is another risk factor for SUI. A sedentary lifestyle is another contributor. According to the research, higher levels of total daily fluid intake does not increase the risk of SUI or the onset of symptoms.

Sleep habits have been shown to be related to SUI risk. A lack of restorative sleep exacerbates SUI symptoms. A high intake of calories or consuming alcohol or caffeine shortly before bedtime can counter high quality sleep as well. There is also an association between higher levels of abdominal fat and having to get up to urinate more frequently through the night. This in turn interferes with proper sleep. Being overweight increases the possibility of sleep apnea, which reduces sleep quality if untreated.

So, in considering the possible factors that can increase the risk of SUI, making a few lifestyle changes can help to reduce that risk. Losing some weight, even if not down to an ideal body weight, can be especially helpful. As part of weight loss, a healthy diet that limits added sugars and saturated fat is useful. The DASH diet, which was originally developed to lower blood pressure, has been suggested as a good format for healthy weight loss, promotes higher fiber intake, and recommends a lower intake of saturated fats.

Exercise can not only benefit weight loss, but can directly strengthen the tissues involved in SUI. Ongoing moderate activity is a better choice than higher impact exercises or extreme weight lifting. A good goal is at least 30 minutes of cardiovascular exercise most days. In addition, exercises that strengthen the pelvic floor muscles and other supporting tissues are recommended. A physical therapist can be extremely helpful for guidance in this area.

Addressing constipation reduces the stress on the pelvic floor from straining. A high fiber diet with sufficient fluids is a great goal. If a medication is causing the constipation, consider if there is another medication that could be substituted that does not promote constipation.

Improving sleep hygiene may involve a number of action steps. As noted, weight loss can help to reduce urinary frequency during the night. Reducing the intake of food and fluids shortly before bedtime can improve sleep quality, as can limiting alcohol intake and caffeine within about six hours or so before bedtime. Obviously, addressing sleep apnea can improve sleep as well.

If stress urinary incontinence is negatively affecting the quality of your life, consider what steps you can take to reduce the risk of symptoms. Do not hesitate to ask professionals for support and guidance medical professionals, a physical therapist, exercise professionals, a registered dietitian, or possibly a mental health professional can help you deal with the stress of stress urinary incontinence.

Pam Stuppy, MS, RD, CSSD, LD, is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and Portsmouth. She is also the nutritionist for Phillips Exeter Academy, presents workshops nationally, and is board certified as a specialist in sports dietetics. Visit http://www.pamstuppynutrition.com for nutrition information, healthy cooking tips and recipe ideas.

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Stress urinary incontinence in women - Foster's Daily Democrat

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