urinary incontinence risk: lifestyle factors

by Diane K. Newman, RNC, MSN, CRNP, FAAN

Smoking, obesity and the use of caffeine and alcohol are all lifestyle behaviors that may become risk factors for developing urinary incontinence. People who don't drink enough liquids and those who participate in high impact physical activities may also be at risk for urinary incontinence.

Smoking as a risk factor for urinary incontinence

Smoking increases the risk for all forms of urinary incontinence and is dependent on the number of cigarettes smoked. In addition, smokers cough more frequently than non-smokers, which may lead to earlier development of stress urinary incontinence.

A smoker’s chronic cough may damage structures that support the urethra and vagina and there may also be an association between nicotine and increased bladder contractions, which causes both urge urinary incontinence and overactive bladder.

Bump RC, McClish DM. (1994) Cigarette smoking and pure genuine stress incontinence of urine. A comparison of risk factors and determinants between smokers and nonsmokers. Am J Obstet Gynecol;170(2):579-82.

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Obesity as a risk factor for urinary incontinence

Obesity has been identified as a risk factor for urinary incontinence in women. According to recent research, urinary incontinence symptoms decrease in morbidly obese women who undergo extreme weight loss. The urinary incontinence seen in obesity may be secondary to increased pressure on the bladder and greater movement of the urethra. Obesity may also impair blood flow or compress nerves to the bladder.

Bump RC, Sugerman, H., Fantl, JA, McClish DM. (1992) Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol;166:392-9.

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Use of caffeine and alcohol as a risk factor for urinary incontinence

Caffeine and alcohol tend to irritate the bladder so their consumption may be associated with higher risk for urinary incontinence.

Research has shown that urinary incontinence decreased when caffeine consumption was reduced. Women can be taught to restrict caffeine through behavior modification using instructions to gradually replace caffeinated beverages or foods with non-caffeinated ones. Caffeine occurs naturally in coffee beans, tea leaves and cocoa beans and is found in sodas (for example, Mountain Dew, Pepsi, Coca-cola) and foods or candy containing milk chocolate. Additionally, over-the-counter drugs (Excedrin, Anacin) and prescription medications (Darvocet, Fiorinal, for example) contain caffeine.

Newman, DK. (1998) Controversies in Incontinence The Clinical Letter for Nurse Practitioners, 2(6), November/December: 1-8.
Newman, D.K. (1997) The Urinary Incontinence Sourcebook, Los Angeles: Lowell House.
Tomlinson, BU, Dougherty, MC, Pendergast, JF, Boyington, AR, Coffman, MA, Pickens, SM. (1999) Dietary caffeine, fluid intake and urinary incontinence in older rural women. International Urogynecolgy 10:22-28.

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Low fluid intake as a risk factor for incontinence

Many people with bladder control problems think that by decreasing their fluid intake, they can decrease the amount of urine their body produces and the number of times they urinate. In fact, decreasing fluid intake does cause the body to produce a smaller volume of concentrated urine. Unfortunately, the concentrated urine (dark yellow with a strong odor) irritates the bladder and can cause more frequent urination while increasing the chances for a urinary tract infection. Drinking adequate amounts of fluids, especially for older adults who may be more at risk for dehydration, can often eliminate urinary incontinence. Drinking eight 8-ounce glasses a day is a good rule for anyone with bladder control problems.

Newman, DK. The Urinary Incontinence Sourcebook. Los Angeles: Lowell House; 1999.

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Participating in high-impact physical activities as a risk factor for urinary incontinence

Many women who participate in such active sports as tennis, basketball, field hockey, track and gymnastics may experience urine leakage (urinary incontinence) due to an increase in the downward force on pelvic floor muscles. In a recent study, a total of forty athletes (28%) reported urine loss while participating in their sport, two-thirds described this as occurring frequently. Overall, it has been estimated that one third of women experience urine loss (urinary incontinence) during physical activities.

A survey in US Air Force female aircrew indicated that twenty-six percent experienced urinary incontinence with eighteen percent stating that the urine leakage occurred while flying. Urine loss during exercise was the most common cause of urinary incontinence reported by this group.

Interest in the prevalence and impact of urinary incontinence on working women and strategies they use to control urine loss has been increasing. Dr. Mary Palmer surveyed full-time employed women working in a large academic center and found that urinary incontinence occurred at least monthly in twenty-one percent of them. Only one-third of these women felt it was a problem and less than half (46%) reported their urinary incontinence to a health care provider. Strategies for managing or minimizing urine leakage included use of perineal pads for urine collection, avoidance of caffienated beverages and use of deodorants to mask odor.

Many women who leak urine during exercise will give up the activity causing the problem. DO NOT DO THIS—SEEK HELP.

Many men and women with urinary incontinence should assess their own risk factors and try to make changes in their lifestyles to decrease their symptoms and urinary incontence episodes.

Fischer, JR, Berg, PH. (1999) Urinary incontinence in United States Air Force Female Aircrew. Obstet. Gynecol. 94(4):532-536.

Nygaard, I, Thompson, FL, Svengalis, SL, Albright, JP (1994) Urinary incontinence in Elite Nulliparous Athletes. Obstetrics & Gynecology. 84(2), August: 183-187.

Palmer, MH, Fitzgerald, S., Berry, SJ, Hart, K (1999) Urinary Incontinence in Working women: An Exploratory Study. Women & Health 29(3): 67- 81.

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Posted January 2002
Last Updated August 2009

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