Obesity is known to be an important risk factor in the development of UI (urinary incontinence). In obese people, it seems that increased intra-abdominal pressure applies mechanical stress to the pelvic floor muscles (PFM) and eventually leads to UI. Physiotherapy (exercise therapy and biofeedback) has been presented as a common treatment for the improvement of UI. Pelvic floor physiotherapy (PFPT) with weight loss (WL) may significantly improve UI in obese women. This study aimed to compare the effects of PFPT with and without WL on UI symptoms in obese women.

This non-randomized clinical trial was performed on 51 middle-aged obese women with UI. Twenty-nine women in the PFPT group received 12 sessions of PFPT, and 22 women in the PFPT+WL group received 12 sessions of PFPT and nutritionist recommendations for WL. The outcome measures included anthropometric measurements, strength and endurance of pelvic floor muscles, intravaginal pressure (IVP), international consultation on incontinence questionnaire (ICIQ-SF), visual analog scale (VAS), and quality of life (QOL).
All measurements were taken at baseline and after the 12-session treatment.

The PFPT+WL group had a 4.95 kg weight loss (P<0.001). Strength and endurance of PFM, IVP, ICIQ UI-SF, VAS, and QOL showed significant improvement in both groups (P<0.001). The ICIQ UI-SF and total I-QOL in the PFPT+WL group were significantly different from those in the PFPT group (P=0.015, P=0.033, respectively), (95% CI: 2.23-5.10 vs. 2.85-5.35 and 180.48- 214.67 vs. 164.13-203.39, respectively).

In the present study, PFPT resulted in a significant improvement in UI symptoms compared to before treatment. Combining WL with PFPT resulted in more significant improvement in UI severity and QOL compared to PFPT alone. Considering the statistically significant difference in the value of waist circumference in the PFPT and PFPT+WL groups after the intervention, it seems that decreasing waist circumference along with PFPT has reduced central fat mass, consequently reduced pressure on the pelvic floor structures, and improved UI severity. Furthermore, it appears that improvement in QOL in the PFPT+WL group was influenced by the psychological issues and placebo effect of the WL in obese women with UI.
In this study, no statistically significant difference in the other variables (strength and endurance of PFM, IVP, VAS) was seen between the two groups after treatment. This result might be due to low WL (4.95 kg), and it appears that the examination of the effects of WL on other variables in obese women needs a prolonged course of treatment and greater WL in these individuals.

Overall, this study showed that PFPT can improve PFM performance, UI severity, and QOL in obese women with UI. Applying PFPT with WL in comparison to PFPT alone leads to much improvement in UI severity and QOL score in obese women with UI.

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