If you are dealing with urinary incontinence, also called stress urinary incontinence (bladder leaks), you have likely been inundated with information about how to manage your bladder leaks. Weight loss is a common recommendation since central adiposity (or carrying weight around your middle) can increase intra-abdominal pressure which increases bladder pressure and urethral mobility¹.

But… here’s the problem with weight loss advice: it doesn’t work long-term AND it doesn’t provide you with actionable changes you can make that help with pelvic strengthening or minimize bladder leaks.

We are going to outline the actual behaviours associated in research studies that have been correlated to reducing bladder leaks. The thing is, we do not have any research studies that prove weight loss is what reduces bladder leaks, all we have are correlation studies, which means weight loss is lumped in there for improving bladder leaks because of its association. But is it the weight loss or the behaviour changes that lessen bladder leaks?  Here's the thing, focusing on weight loss can increase the likelihood of yo-yo dieting, weight regain and following unhealthy behaviours that might worsen bladder leaks. If you are planning to make nutrition changes to support overall wellness, why not take a non-diet approach that is linked to more lasting and sustainable changes (plus it tastes better)?

Gentle nutrition - the “add-in” approach

This time of year we all have the best intentions of making resolutions that help us to live healthier, happier and feeling better. Many fad diets are promoted in full gear too which require us to eliminate food groups or restrict our calories below our daily needs and activities. Restricting calories can lead to muscle wasting, which we need for our muscles to be fueled to help support our pelvic strengthening. Instead of restricting or cutting back, focus on what’s missing and what nourishment could you add in more of? Check in with your internal cues that regulate how much your body needs, such as your hunger and fullness. Are you eating when you need to refuel? Are you stopping when you are comfortably satisfied? A registered dietitian who specializes in non-diet approaches can help you learn more and guide you on how to implement into your lifestyle, especially if you have had a lot of experience with dieting (don’t feel bad, many women have been on over 10 diets in their lifetime!). I always say, sometimes you need to find what doesn’t work so you can move on with what does!

Here are some gentle nutrition tips to get you started (and guess what, these are the behavioural actions many of those weight loss studies are correlated with improving urinary incontinence but we are going to approach from a more sustainable angle using an add-in approach):

• Mix your plate with colour and variety to avoid boredom.
• Add nourishment that fuels and fills you: ½ plate with veggies/fruit, protein, fibre and a healthy fat source.
• Drop the “good” and “bad” or “healthy” and “unhealthy” labels and focus on experimenting with what feels good, nourishing and satisfying.
• Fill your emotional cup so food isn’t your only way to nurture emotions. Food becomes food again vs trying to stop emotional eating, focus on what you can add in.
• Decide how it is you want to feel, then seek out choices that may help to get you more of that!
• Add more joyful movement. Exercise may come with some negative associations. The best type of movement is the one you do consistently, enjoy and celebrates how your body can move. It doesn’t need to hurt or sweat to be worth it. Aim for 30 minutes of daily movement in whatever form (structured activities like running, sports, gym, yoga or unstructured like house cleaning, gardening, making your day more active like parking your car further away).

When you focus on satisfaction, what feels good and what you can add in more of, this approach to nourishing your body has more long-term and sustainable benefits including mental wellness²!

1. Find a support that is encouraging, uplifting and supportive.
   Making changes to your wellness is a life-long process.  Find a friend, colleague, relative or health care provider who aligns with a non-diet approach. Having someone to check in when things get tough (because it is inevitable after all, it’s life!) will help you to problem solve and overcome challenges. Using a mindful approach helps you to get curious, drop the judgment and with self-compassion experiment with finding solutions to keep you moving forward! It’s all learning, there are no failures.
2. Learn more about non-diet approaches: Intuitive Eating and Mindful Eating.
   Just check you aren’t looking at non-diet approaches that have been co-opted by the diet industry (for example if you see anything about promoting a focus on weight loss, it’s a diet!). In the US alone, the diet industry makes over $70 billion per year (yep- you read that right!). Considering the diet industry is so successful, it will do whatever it takes, including fancy marketing to get you to continuously fail, so you come back year over year and keep their stockholders happy. When you adopt a non-diet approach to your wellness, you no longer need to buy into the diet industry (insert sad face from them). At the end of the day, the best diet is the one you can eat and drink enjoyably while feeling well! Check out the resources below.
3. Non-diet approaches help you to find your natural set point range.
   Your body weight is set and fluctuates up to 15 pounds in a week or a day. It’s not that non-diet approaches are against weight loss, they just don’t focus on goals or the pursuit of weight loss. Instead, by becoming more mindful of your nourishment using a gentle approach to nutrition allows your body to be the weight its meant to be at comfortably.

Weight loss may help manage stress urinary incontinence but not if it comes with the cost of losing your muscle or if it’s not something you can maintain for the long-term. Keep in mind there are many active and strong women who also experience bladder leaks. You are going to be more successful if you learn to adopt a gentle approach to nourishing your body, mind and wellness. There are lots of non-diet registered dietitians out there to connect, follow and provide ongoing support. Feel free to reach out!

Kori Kostka is a registered dietitian and mindful eating, non-diet dietitian with a Masters in Health Science. With over 15 years of varied nutrition experience, Kori loves helping folks bring the joy back to eating and nourishing bodies with a gentle approach. Kori is a mom of 2 and a dog mom of a Sheepadoodle and loves spending time lakeside with her husband and kids year-round.

Follow Kori here for more non-diet nutrition tips:

Instagram: @korikostka

References & Non-Diet Resources:

1. Wing, R. R., West, D. S., Grady, D., Creasman, J. M., Richter, H. E., Myers, D., Burgio, K. L., Franklin, F., Gorin, A. A., Vittinghoff, E., Macer, J., Kusek, J. W., Subak, L. L., & Program to Reduce Incontinence by Diet and Exercise Group (2010). Effect of weight loss on urinary incontinence in overweight and obese women: results at 12 and 18 months. The Journal of urology, 184(3), 1005–1010. https://doi.org/10.1016/j.juro.2010.05.031Emily L Whitcomb, Leslee L Subak, “Effect of weight loss on urinary incontinence in women,” Open Acess J Urol3 (2011): 123-132, doi: 10.2147/OAJU.S21091
2. Harrison, C. (2019). Anti-diet: reclaim your time, money, well-being and happiness through intuitive eating. Yellow Kite.
3. Tribole, E. & Resch, E. (2020). Intuitive Eating, 4^th ed: A Revolutionary Anti-Diet Approach. St. Martin’s Press. 
4. https://www.thecenterformindfuleating.org/