South SFV Today

Older women struggling with urinary incontinence can benefit from regular, low-impact exercise, including yoga and stretching, according to a new study published on August 27 in the Annals of Internal Medicine.

The research, led by scientists at Stanford Medicine and the University of California, San Francisco (UCSF), aims to identify low-risk, low-cost treatments for one of the most common health issues women face as they age.

“Our study was testing the kind of yoga that just about anyone can do, with modifications for different physical abilities,” said 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.” Many participants received their yoga or exercise instruction via online meetings due to the COVID-19 pandemic.

The study’s lead author is Alison Huang, MD, professor of medicine, urology, and epidemiology and biostatistics at UCSF.

Urinary incontinence affects more than half of middle-aged women and up to 80% of 80-year-olds. It can lead to social isolation and bone fractures caused by falls.

“Part of the problem is that incontinence is stigmatized; we don’t talk about it,” said Subak. “Or we hear folklore about this being normal when you get older. In fact, it’s very common but it’s not inevitable.”

Incontinence impacts people’s lives significantly. “It takes away independence,” Subak noted. Patients may avoid activities like exercising and seeing friends due to embarrassment or fear. They are also more likely to be admitted to nursing homes or suffer 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.

Some risk factors for incontinence cannot be changed, such as aging or having had children. However, others are modifiable. “A lot of my research has focused on weight loss and physical activity,” Subak said. She became interested in studying yoga after patients reported benefits from it.

The study compared two 12-week exercise programs: 121 participants were randomly assigned to yoga classes while 119 were assigned to a physical conditioning control group focusing on nonspecific stretching exercises that did not engage the pelvic floor muscles.

Participants recorded their episodes of urinary leakage and classified them as urgency incontinence or stress incontinence. They also completed standard questionnaires about their bladder function.

At the beginning of the study, participants averaged 3.4 episodes of urinary incontinence per day. By the end of the programs, those in the yoga group experienced an average reduction of 2.3 episodes per day while those in the physical conditioning group saw a reduction of 1.9 episodes per day.

Both treatments proved effective by reducing episodes by around 60%, which Subak described as meaningful benefits.

“I’m impressed that exercise did so well and impressed that yoga did so well,” she said. “One of the take-home messages from this study is ‘Be active!’”

Other nonsurgical treatments for incontinence typically result in a 30% to 70% improvement in symptoms.

If asked whether yoga could help with incontinence, Subak would recommend trying it due to its low risk and potential benefits for general well-being.

The study was funded by grants from the National Institutes of Health (R01AG050588, R01DK116712-04S1, K24AG068601). Researchers from Yale University and San Francisco State University also contributed to the study.