Reduce Incontinence in Women with Yoga

February 29, 2020 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“The pelvic floor is an instrumental player in the health and function of your bladder. Specifically, the perineum and the dynamic layers of muscle that compromise the inner pelvis, which are active in the passage of urine and control of the bladder. If you do experience leaks . . . strengthening your perineum with yoga will isolate the muscle, only furthering your ability to reduce leaks caused by incontinence.” – TENA

Urinary incontinence is common, particularly in women, and involves an involuntary loss of urine. This can range from slightly bothersome to debilitating. Possible public humiliation results in many women refraining from otherwise enjoyable public activities. This occurs due to problems with nerves and weakening of muscles that normally hold or discharge urine. Urinary incontinence occurs in about 10% of women and 2% of men under age 65 and 35% of women and 22% of men over age 65. Treatment can involve exercise, drugs, electrical stimulation, or even surgery.

Effective exercises for urinary incontinence strengthen the muscles of the pelvic floor and sphincter muscles. Yoga is a gentle exercise with a number of poses that strengthen the pelvic floor. In addition, yoga practice increases body awareness helping the individual to better sense and control the muscles involved. Also, yoga can reduce anxiety and stress which can contribute to urinary incontinence. So, it would seem reasonable to examine the application of yoga exercises for the treatment of urinary incontinence.

In today’s Research News article “A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314206/?report=classic), Huang and colleagues recruited older women (> 50 years of age) who had urinary incontinence and provided them with a “written pamphlet providing basic patient-directed information about behavioral self-management of incontinence (such as pelvic floor exercises and timed urination) consistent with usual first-line care.” They were randomly assigned them to either receive additional 3 months, twice a week for 90 minutes, of yoga training or non-specific muscle stretching and strengthening. They were also asked to practice at home for an hour at least once a week. The yoga poses taught were selected to improve bladder control. They were measured before and after training for safety, feasibility, frequency of incontinence, and incontinence quality of life.

They found that over the 3-month program incontinence decreased by 76% in the yoga group and 56% in the exercise group, stress induced incontinence decreased by 61% in the yoga group and 35% in the exercise group. Group differences were not statistically significant. Participation rates were high and no serious adverse events were reported.

Yoga training produced on average superior results to the exercise program the lack of a statistically significant difference does not allow definitive conclusions. Yoga practice has been shown to reduce the effects of stress on the individual. So, the reduction in stress induced incontinence would be expected. Hence, the results make it clear that yoga training is a feasible, safe, and effective treatment for urinary incontinence in older women.

So, reduce incontinence in women with yoga.

“yoga can help women who suffer from urinary incontinence by improving pelvic health and help gain more control over their bladders.“ – Attends

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Huang, A. J., Chesney, M., Lisha, N., Vittinghoff, E., Schembri, M., Pawlowsky, S., … Subak, L. (2019). A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial. American journal of obstetrics and gynecology, 220(1), 87.e1–87.e13. doi:10.1016/j.ajog.2018.10.031

Structured Abstract

Background:

Due to the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking.

Objectives:

To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence and examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months.

Study Design:

Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were temporarily willing to forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice weekly group classes and once weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group) or a non-specific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months.

Results:

Of the 56 women randomized (28 to yoga, 28 to control), mean age was 65.4 (±8.1) years (range 55–83 years), mean baseline incontinence frequency was 3.5 (±2.0) episodes/day, and 37 (66%) had urgency-predominant incontinence. Fifty women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P=0.19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P=0.07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P=0.045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. Forty-eight non-serious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice.

Conclusions:

Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women’s clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314206/?report=classic

Improve Bladder Problems with Mindfulness

September 6, 2016September 6, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Good news: You may be able to ease your bladder discomfort and Overactive Bladder Symptoms by tapping into mind-body techniques such as meditation. Slowing your breathing calms your autonomic nervous system, which slows your heart rate and can decrease spasms of the bladder.” – Karen Sebastian

Interstitial cystitis/bladder pain syndrome (IC/PBS) involves recurring discomfort or pain in the bladder and the surrounding pelvic region, including mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area and/or an urgent and frequent need to urinate. There are an estimated 3.3 million adult U.S. women, or 2.7 percent, and 1.6 million adult U.S. men, or 1.3 percent who suffer from IC/PBS. The causes of IC/PBS are unknown and the current treatments employed are aimed at relieving symptoms. These include drugs, diet, exercise, bladder training, physical therapy, bladder washing and distension, and even surgery. These treatments have varying effectiveness and may become ineffective over time. So, there is a need to develop other treatments for IC/PBS.

Mindfulness training, including Mindfulness-Based Stress Reduction (MBSR) have been repeatedly shown to be safe and effective treatments for a variety of painful conditions. In today’s Research News article “Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial” (See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1315503701806886/?type=3&theater

or see summary below), Kanter and colleagues randomly assigned female patients with interstitial cystitis/bladder pain syndrome (IC/PBS) to either receive treatment as usual or an 8-week Mindfulness-Based Stress Reduction (MBSR) program. MBSR is taught in 2-hour weekly sessions with home practice encouraged. It is a combination of training in body scan, meditation, and yoga. Prior to and after the 8-week treatment period the patients were assessed with measures of Global Response Assessment, symptom assessment, pain, pain coping ability, quality of life, sexual function.

They found that MBSR in comparison to treatment as usual produced significant improvements of 28% with IC/PBS symptoms, including a 22% improvement in total symptoms and a 38% improvement in symptom problems and of 25% with pain coping ability. Hence, MBSR was found to be effective in reducing the symptoms of interstitial cystitis/bladder pain syndrome (IC/PBS) and to improve the patient’s ability to cope with the pain. This may well have occurred because of mindfulness training’s proven ability to reduce the psychological and physiological responses to stress. This would in turn, reduce stress induced symptom exacerbation. MBSR training did not reduce pain per se. Instead, because of the development of focus on the present moment, it improves the ability of patients to cope with the pain, making it less disruptive in their lives. Mindfulness has been shown to reduce catastrophizing, worry and rumination. So, it decreases the patient’s responses that amplify the pain. All in all, MBSR training would appear to be a viable treatment for interstitial cystitis/bladder pain syndrome (IC/PBS).

Because the Mindfulness-Based Stress Reduction (MBSR) program is a complex treatment that includes body scan, meditation, and yoga, it is impossible to assess which components or combination of components were responsible for its’ effectiveness. Future research, perhaps a component analysis design, is needed to determine what parts of the MBSR program are responsible for the effects.

So, improve bladder problems with mindfulness.

“Being mindful is about being in the present, and the conscious choice to experience your life in the present moment. Being mindful may be able to help you associate overactive bladder as just another function of the body.” – Urology Experts

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Kanter G, Komesu YM, Qaedan F, Jeppson PC, Dunivan GC, Cichowski SB, Rogers RG Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial. Int Urogynecol J (2016). doi:10.1007/s00192-016-3022-8

Abstract

INTRODUCTION AND HYPOTHESIS: Mindfulness-based stress reduction (MBSR) is a standardized meditation program that may be an effective therapy for interstitial cystitis/bladder pain syndrome (IC/BPS), a condition exacerbated by stress. The aims of this study were to explore whether MBSR improved IC/BPS symptoms and the feasibility/acceptability of MSBR among women with IC/BPS.

METHODS: This randomized controlled trial included women with IC/BPS undergoing first- or second-line therapies. Women were randomized to continuation of usual care (UC) or an 8-week MBSR class + usual care (MBSR). Participants completed baseline and 8-week post-treatment questionnaires, including the O’Leary-Sant Symptom Problem Index (OSPI), the visual analog pain scale (VAS), the Short Form Health Survey (SF-12), the Female Sexual Function Index (FSFI), and the Pain Self-Efficacy Questionnaire (PSEQ). The Global Response Assessment (GRA) was completed post-treatment. Analyses were performed using Student’s t test, Chi-squared, and MANOVA where appropriate.

RESULTS: Eleven women were randomized to UC and 9 to MBSR, without differences in group characteristics. More MBSR participants’ symptoms were improved on the GRA (7 out of 8 [87.5 %] vs 4 out of 11 [36.4 %], p = 0.03). The MBSR group showed greater improvement in the OSPI total (p = 0.0498) and problem scores (p = 0.036); the OSPI symptom score change did not differ. PSEQ scores improved in MBSR compared with UC (p = 0.035). VAS, SF-12, and FSFI change did not differ between groups. Eighty-six percent of MBSR participants felt more empowered to control symptoms, and all participants planned to continue MBSR.

CONCLUSIONS: This trial provides initial evidence that MBSR is a promising adjunctive therapy for IC/BPS. Its benefit may arise from patients’ empowerment and ability to cope with symptoms.