The accumulation of visceral fat in the abdominal region is strongly linked to an increased risk of stress urinary incontinence among women, according to a study released on Apr. 17 by researchers at the Federal University of São Carlos (UFSCar) in Brazil.
This finding highlights the significance of body fat distribution, rather than just overall weight, as a factor influencing involuntary urine leakage. Stress urinary incontinence occurs when activities such as coughing or exercising cause pressure inside the abdomen that pelvic floor muscles cannot contain.
"It's that urinary leakage that occurs when pressure inside the abdomen increases and the pelvic floor can't hold it in," said Patricia Driusso, professor of physical therapy at UFSCar and advisor for the study. She noted that this condition affects women across all age groups due to rarely exercised pelvic floor muscles: "It happens to women of all ages, including very young women. These pelvic floor muscles are rarely exercised throughout life, and without proper training, they can become weak and lose function."
The research involved evaluating 99 women aged 18 to 49 using Dual-Energy X-ray Absorptiometry (DXA), which measures both total body fat and its distribution. About 39 percent reported episodes of urinary leakage—consistent with international estimates—and those with higher levels of visceral fat were about 51 percent more likely to experience stress urinary incontinence.
Driusso explained two possible reasons for this association: "Excess weight in this region creates constant strain. Over time, these muscles can become more fatigued and less efficient." She also pointed out metabolic effects from inflammatory substances released by visceral fat: "We're talking about low-grade chronic inflammation, which affects different tissues in the body. That can also contribute to muscle weakness."
While obesity is already recognized as a risk factor alongside aging and childbirth-related factors, Driusso emphasized appropriate care during delivery: "The problem isn't childbirth itself, but obstetric care... inappropriate interventions... can increase the risk of pelvic floor dysfunction." The study's cross-sectional design means it cannot prove causation but does suggest prevention strategies should focus on both excess weight and how fat is distributed.
Driusso recommended strengthening exercises under professional supervision as an effective treatment: "Today we have a high level of evidence that training these muscles is effective... it's the gold standard for treating stress urinary incontinence." She added ongoing exercise is necessary since muscle strength declines if practice stops.
Future research will include MRI studies on myosteatosis—the infiltration of fat into muscle tissue—and explore targeted protocols for obese women. Driusso concluded by stressing awareness: "Urinary incontinence impacts quality of life... But it can be treated and prevented. The most important thing is for women to know that they don't have to live with it."
