Many of the changes that come with aging are not always reported to a doctor, especially if the change is embarrassing to talk about. Urinary incontinence, the involuntary leakage of urine during everyday activities, falls into this category. However one of the problems with under-reporting is that many individuals miss the opportunity to get medical help with this issue. And it’s not a small issue in terms of prevalence, because 25-45% of individuals have urinary incontinence. A coughing bout or surprise sneeze does not need to be something to fear. Studies show they are common triggers for urine leakage. 
The average adult completes less physical activity with every passing decade beyond age 30. This causes the muscles of the abdomen, hips, and pelvic floor to shrink and weaken. Pelvic floor muscles support the organs in the lower part of the body, including the bladder and bowel, and they also help to keep urine from leaking. Kegels are exercises for men and women that activate the pelvic floor muscles (including the levator ani muscle) to improve their strength and size, effectively reducing some forms of urinary incontinence.
How much does muscle matter when it comes to urinary incontinence? Large-scale reviews suggest that in those with urinary incontinence, improving pelvic floor muscle strength through several weeks of exercise training makes adults 8 times more likely to report that their urinary issues “were cured” and 17 times more likely to notice at least improved management of their condition. In other words, working toward a stronger pelvic floor is a powerful way to begin to address urinary incontinence.
Among the largest risk factors for urinary incontinence is pregnancy. This is part of why women show a higher prevalence than men. Almost half of all women experience bladder control problems during pregnancy. This occurs especially towards the end as the abdomen is greatly distended. But it’s not just a big belly that’s part of the issue, because pregnancy hormones also reduce muscle tone in the pelvic floor muscles, raising urinary incontinence risk. Delivery has the potential to stretch and damage many pelvic tissues, and deliveries that require lengthy pushing phases can damage the nerves that control the pelvic muscles, too. 
How much does pregnancy impact the risk of urinary incontinence? Studies suggest that the odds increase linearly for every child a woman delivers. The timing matters, too, because pregnancies that occur in a woman’s 30s or 40s are stronger predictors of urinary leakage issues than at younger ages. Cesarean or vaginal deliveries both carry increased risks compared to those who’s had zero pregnancies, because pregnancy loads the pelvic region heavily, causing changes to the pelvic floor. Caesareans are less stressful for the pelvic region on average, reducing the risk of urinary incontinence by half compared to vaginal deliveries.
Many experts on this topic consider obesity to be a top risk factor for urinary incontinence in women. Waist circumference is a general measure of excess body fat and is closely linked to urinary incontinence. The risk of this condition rises steeply as BMI increases. Fat around the waist matters because it greatly increases the pressure within the abdomen.
How much does obesity matter for this condition?
Compared to individuals who have a “normal” BMI between 22 and 25, those who have obesity (a BMI of 30 and above) are two to three times more likely to experience urinary incontinence. The good news is that as weight is lost, pressure subsides in the abdomen and bladder. As a result, even small amounts of weight loss can help. As low as 2% of one’s body weight, are enough to improve the symptoms of urinary incontinence. Losing 5-10% of body weight improves symptoms even more.
Although most of the research focuses on this condition in women, men deal with this condition, too. They may be less prone to discussing it with their doctors. Research suggests that about 5 to 32% of men have this condition, with age-related increases in prevalence.
One of the surprises to emerge from the research is that even when individuals make gym visits a habit, urinary incontinence often persists. Yet as mentioned, studies that use exercise interventions show excellent success, in solving the issue for most individuals. The reason for this persistence is likely because few individuals specifically train their pelvic floor, and those who do so may not train it often enough. (It seems that two or more training sessions per week may be needed for improvements). Also, many individuals with severe incontinence may qualify for surgical options. Sharing symptoms with physicians is important to find personalized solutions to this common issue.
Another possible way to mitigate urinary incontinence when exercising is to select lower-impact activities. This helps because some types of exercise increase intra-abdominal pressure and involve high impacts from ground reaction forces. As the workout wears on, fatigue sets in, and the pelvic floor muscles may lack the endurance to maintain activity.
Treo members enjoy a wide array of exercise options, with hundreds of on-demand videos. We ensure lower-impact options are available, as there are many conditions that benefit from exercise sessions that are joint- and bladder-friendly. Members can use workouts that activate the core to begin to rebuild the muscles that surround the organs. On-demand options also mean that members tend to complete most classes from the comfort of their own homes. This makes quick bathroom breaks and pauses in the workout convenient.
Interested in learning more? Email us at info@treowellness.com.
As Treo’s Global Wellness Researcher, Karlie uses recent research findings to support healthier daily habits. Karlie earned her doctorate in Neuroscience and Behavior and bachelors in Health and Exercise Science.
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