Low-impact yoga and exercise have been shown to help older women manage urinary incontinence

Older women struggling with urinary incontinence may benefit from regular, low-impact exercise, with both yoga and stretching and strengthening providing benefits in a new form. study published on August 27 in Annals of Internal Medicine.

The study, led by scientists from Stanford Medicine and the University of California, San Francisco, is part of a greater effort to identify low-risk, low-cost ways to treat one of the most common health problems women face as they age.

After twelve weeks of a low-impact yoga program, study participants had approximately 65% ​​fewer episodes of incontinence. Women in a control group who did stretching and strengthening exercises experienced a similar benefit over the same period. The benefits are similar to the effects of medications used to address incontinence, the researchers said.

“Our study tested the type of yoga that virtually anyone can do, with modifications for different physical abilities,” says the study’s senior author, Leslee Subak, MD, chairman of obstetrics and gynecology at Stanford Medicine. “What I like about it is that it’s safe, cheap, doesn’t require a doctor and is accessible no matter where you live.” Because the trial was conducted partly during the COVID-19 pandemic, many participants received their yoga or exercise instruction through online meetings, training in their own homes, she noted.

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

Urinary incontinence, which affects more than half of middle-aged women and up to 80% of 80-year-olds, can lead to a variety of other problems, from social isolation to broken bones caused by falls. But there is help.

“Part of the problem is that incontinence is stigmatized; we don’t talk about it,” said Subak, Katharine Dexter McCormick and Stanley McCormick Memorial Professor III. “Or we hear folklore that this is 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 disrupts people’s lives.

“It takes away independence,” Subak said. “My patients will say, ‘I can’t stay with my children or grandchildren 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 can promote their well-being, such as exercising and seeing friends. They are more likely to be admitted to a nursing home and develop certain serious medical problems, such as hip fractures.

“Incontinence and overactive bladder are among the biggest risk factors for falls and fractures in older women,” Subak said. “You rush to the bathroom at night – with the lights off – and trip and fall, and break a hip.”

Some factors that contribute to the risk of incontinence cannot be changed, such as growing older or having children. But others are customizable.

“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 yoga and 119 to a physical fitness 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 an average age of 62 years.

In the yoga program, participants learned 16 hatha yoga postures intended to strengthen the pelvic floor, through two 90-minute sessions per 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 outside of class for at least one hour per week and keep a practice log.

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 an extra hour per week and to keep a practice log.

The study started with in-person classes and then moved to videoconferencing when lockdowns due to the COVID-19 pandemic began.

Participants recorded when they leaked urine and classified whether each episode was urgency incontinence, when an overactive bladder causes a person to urinate more often than normal, or stress incontinence, in response to pressure in the abdomen, such as coughing or sneezing. They also answered standard questionnaires about their bladder function.

At the start of the study, participants had an average of 3.4 episodes of urinary incontinence per day, of which 1.9 were urgency-type episodes and 1.4 were stress-type episodes.

By the end of the twelve-week programs, participants in the yoga group had an average of 2.3 fewer episodes of incontinence per day. Those in the physical conditioning group experienced 1.9 fewer episodes per day.

The two treatments are about equally effective, with both approaches reducing the number of incontinence episodes by about 60%, and the benefits of both treatments are meaningful, Subak said. Patients who want to try these approaches can look for low-impact Iyengar yoga or low-impact exercise classes in their community or online, she said, adding that instructors should be able to adapt the activity to participants’ physical limitations.

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

Other nonsurgical treatments for incontinence, including medications, typically result in a 30% to 70% improvement in symptoms, she noted.

If a patient were to ask whether yoga can help with incontinence, “I would say I think it’s a good idea to try it if you’re interested,” Subak said. “The risk is very low and there is potential benefit, not only for incontinence, but also for your general well-being.”