HEALTH
Older women struggling with urinary incontinence can benefit from regular, low-impact exercise, with yoga as well as stretching and strengthening showing significant benefits in a new study published 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 episodes of incontinence. Women in a control group doing stretching and strengthening exercises experienced a similar benefit over the same time period. The benefits are on par with the effects of medications used to deal with incontinence, the researchers say.
“Our study was testing the kind of yoga that just about anyone can do, with modifications for different physical abilities,” says the study’s senior author, Leslee Subak, MD, chair of obstetrics and gynecology at Stanford Medicine. “What I love about it is that it’s safe, inexpensive, doesn’t require a doctor and accessible wherever you live.” Because the trial was conducted partly during covid, many participants received their yoga or exercise instruction via online meetings, exercising in their own homes, she notes.
Urinary incontinence, which affects more than half of middle-aged women and up to 80% of the over 80s, can lead to a variety of other problems, from social isolation to bone fractures caused by falls.
“Part of the problem is that incontinence is stigmatised; we don't talk about it,” says Subak. “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 says. “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 wellbeing, 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 says. “You’re rushing to the bathroom at night — with the lights off — tripping and falling, and breaking a hip.”
Subak says she became interested in studying yoga as a treatment after some of her patients told her it helped them.
The study, published on August 27, 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 a 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 a week outside of class and to maintain a practice log.
Those 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 didn’t engage the pelvic floor. They were also asked to practice for an extra hour a week and keep a log.
At the beginning of the study, participants had an average of 3.4 episodes of urinary incontinence a day. By the end, participants in the yoga group were experiencing 2.3 fewer episodes of incontinence per day, on average. Those in the physical conditioning group experienced 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 says. “One of the take-home messages from this study is ‘Be active!’,” she concludes.
Other nonsurgical treatments for incontinence, including medications, typically result in a 30-70% improvement in symptoms, she notes.
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