29 March 2016

Physical therapy drastically reduces urinary leaks in post-menopausal women with osteoporosis

A new study reveals sustained, long-term improvement in incontinence with physical therapy in post-menopausal women.


A study published in Menopause, the journal of The North American Menopause Society (NAMS) this month (March 2016) has brought great news for post-menopausal women with osteoporosis who experience urinary leakage. 

According to the study, after menopause, women with osteoporosis struggle more with urinary incontinence than women with healthy bones do. The study, the first-ever randomised, controlled trial of physical therapy for bladder weakness in post-menopausal women with osteoporosis or low bone mass, shows that physical therapy that includes pelvic floor muscle training can produce dramatic improvements.

The researchers from the BC Women’s Hospital & Health Centre in Vancouver, British Columbia, and the University of Montreal, Quebec, recruited 48 women age 55 and older from an osteoporosis clinic and the waitlist for a continence clinic. All the women had gone through menopause and had incontinence and osteoporosis or low bone density.

Incontinence experienced by the women included stress incontinence – leaking urine with activity that puts pressure on the bladder, such as coughing, laughing, or running, urge incontinence - leaking urine before reaching the toilet when there is a strong urge to urinate, or a mixture of the two types.

Half of the women went through 12 weekly sessions of physical therapy with a trained physical therapist. The therapy involved pelvic floor muscle exercise and retraining with biofeedback as well as other advice and techniques such as urge control and dietary changes. The other women had a three-hour education session on physical activity, diet, and medications used to prevent or treat osteoporosis, one-on-one sessions with a dietitian and physical therapist, and extensive follow-up discussions with healthcare providers.

At the beginning of the study and after three months and one year, all of the women completed bladder diaries, incontinence and self-efficacy questionnaires, and pad tests, which measured how much urine leaked over 24 hours. The researchers who assessed patients’ progress or collected or analysed the data did not know which patients got physical therapy and which got osteoporosis education.

Three months after the study began, the women who underwent physical therapy enjoyed a dramatic 75% reduction in urine leaks, whereas the other women did not improve. The physical therapy group also had significantly better results on the incontinence questionnaires. One year later, the women who got physical therapy still enjoyed the 75% reduction in leak episodes, whereas the other women got worse.

The physical therapy group also had better pad test results and maintained better scores on one of the incontinence questionnaires. NAMS Executive Director JoAnn V. Pinkerton, MD, NCMP, says, “Many women with incontinence find themselves limiting physical activity out of fears of leakage. But women with bone loss or at risk for bone loss need strength training in addition to adequate calcium and vitamin D to prevent further bone loss and decrease fracture risk.”

It is still not known why women with osteoporosis after menopause have worse problems with incontinence than those who don’t have osteoporosis. But it is vital for them to have effective treatment for incontinence.

If you are experiencing bladder weakness, these small changes may help you regain control of your bladder: 

1) Tighten your pelvic floor. Pelvic floor exercises can help strengthen your pelvic floor muscles to achieve better bladder control. If you are not sure how to do pelvic floor exercises correctly, follow our step-by-step guide.

2) Watch what you drink and drink. Coffee, tea, cool drinks, alcohol, dairy products, sugar, sweeteners, corn syrup, honey, citrus fruits, tomato-based foods and spicy foods, are all bladder irritants, so limit these in your diet as much as possible.

3) Limit liquids later in the day. If you usually wake at night needing to go to the toilet, cut back on the amount of fluids you drink during the evening.

4) Keep a healthy weight. Extra kilos put more pressure on your bladder. Exercise regularly, even if it is just walking every day.

5) Time your bathroom trips. Use a chart or diary to record the times that you urinate and when you leak urine. This will give you an idea of your leakage patterns so you can go to the bathroom at those times. Doing this can help you regain control of your bladder muscles. 

6) Wear a purpose-made incontinence product to catch any leaks. Purpose-made products like those produced by TENA are designed to cope with leakage and odour, and are discreet and comfortable to wear.  TENA has range of products including liners, pads and protective underwear to suit all needs.

For advice on bladder weakness products, please call us on 0860 673 377. Visit or e-mail for more information or to order a free sample. You can also buy TENA products online at 


Read more
5 tips to tackle urinary incontinence during pregnancy and after childbirth
Retrain your bladder to 'hold it in'


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Incontinence Expert

Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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