Research Shows How Yoga May Help Bladder Control

If you’re of a certain age or have given birth, there’s a good chance your bladder might not cooperate all the time. Leaking urine—aka urinary incontinence—is very common, affecting up to 60% of adult women in the U.S. Hence, why you see all those commercials and ads for absorbent underwear.

But despite its commonality, Leslee Subak, MD, chair of obstetrics and gynecology at Stanford Medicine and co-author of a new study published on August 27, 2024, in Annals of Internal Medicine, says that urinary incontinence (UI) doesn’t have to be a normal part of aging.

“Part of the problem is that incontinence is stigmatized—we don’t talk about it,” says Subak in a Stanford Medicine press release. “Or we hear folklore about this being normal when you get older. In fact, it’s very common but it’s not inevitable, and we have very effective ways of treating it.”

Some of these treatments include medications and surgery. But many people don’t want to resort to those measures. If you’re one of them, certain exercises might be more fitting for you and your lifestyle—and a lot less invasive than surgery and with fewer potential side effects than medications. 

The pelvic floor is the bottom of your “core box,” which is made up of the muscles that support your trunk, including your abdominal muscles, back muscles, chest muscles and pelvic floor muscles. The pelvic floor muscles are also the muscles that start and stop the flow of urine. When they’re not functioning properly, you can experience urine leaking—and often at the most inopportune times.

Low-impact yoga has been recommended by some to be an effective complementary treatment for UI since regularly practicing yoga postures has been shown to strengthen many muscle groups throughout the body, including the pelvic floor. And yogic breathing and relaxation may also soothe the nervous system, potentially helping to calm overactive bladder (the need to pee urgently and frequently).

But actual evidence of yoga’s efficacy for UI is minimal. So lead study author, Alison Huang, MD, professor of medicine, urology and epidemiology and biostatistics at the University of California San Francisco and her team of researchers set out to see if low-impact yoga was effective for reducing UI. Let’s see what they found.

How Was This Study Conducted & What Does it Suggest?

Participants for this study were a mix of women—Black, Asian, Hispanic/Latina and multiracial—with an average age of 62 (ranging from 45 to 90 years old). They had to have existing UI for at least 3 months and had to meet mobility criteria (like being able to walk 2 blocks on level ground), but could not be engaging in organized yoga or muscle-strengthening activities at baseline (the beginning of the study). They also could not be using drugs to correct UI or formal behavioral treatments (like physical therapy) and invasive UI treatments (like surgery) within the previous 3 months. In addition, other criteria excluded participation as well.

After screening and demographic information and medical history were gathered, 240 participants were randomly assigned to one of two groups: a low-impact yoga group that included specific postures and exercises for the pelvic floor, or a muscle strengthening and stretching group that did not include specific pelvic floor exercises. 

Both the yoga and exercise classes took place at three different locations in northern California. The yoga groups were led by instructors with at least 2 years of experience teaching yoga. The poses that were included in the classes were chosen by an expert panel of yoga consultants due to their potential to improve pelvic floor function. This included 16 standard Hatha yoga postures, some of which were active postures that engaged the pelvic floor muscles and others that were more passive and encouraged pelvic floor relaxation. 

The muscle strengthening and stretching groups were led by personal trainers or physical therapists. These classes focused on upper- and lower-body strengthening and stretching, but avoided specific exercises for the pelvic floor muscles. 

Both groups attended two 90-minute sessions per week and were encouraged to do the exercises on their own once a week at home and to keep a log of their time and what they did. To help them maintain their home practice and keep it cohesive between participants, those in the yoga group were given a written manual that included yoga posture descriptions and pictures, along with a yoga mat, belt, bolster and blocks, which are support tools to help people more comfortably get into postures. Those in the exercise group also received a written practice manual, exercise mat, stretch strap and resistance bands. 

Initially, the groups met in person for the classes. But then COVID-19 happened and lockdowns took place, so they had to transition to virtual classes. 

At baseline, participants’ frequency and type of UI were assessed, and again at 6 and 12 weeks using a 3-day voiding diary. Participants who made it through the 12 weeks were then asked to complete and return diaries at 24 and 36 weeks so that researchers could see if any changes in UI persisted.

In addition to the UI diary, other structured questionnaires were also filled out by participants that focused on how UI affected their lives, including lifestyle and relationships.

At baseline, the average UI frequency among all participants was 3.5 episodes per day. 

At the end of the study and after several statistical analyses were run, researchers found that both the yoga and the exercise groups saw a significant improvement in UI—65% fewer episodes of leaking urine.

How Does This Apply to Real Life?

UI is about more than just peeing your pants—which can be super embarrassing—it also affects wellbeing. For starters, because it’s common to experience leaking during exercise that places pressure on the abdomen, some people may just skip exercise altogether. Laughing with friends at your local cafe or dancing at a show? Forget about it.

“[UI] takes away independence,” says Subak. “My patients will say, ‘I can’t stay with my kids or grandkids because I’m afraid I’ll wet the bed, and I can’t talk about it. It’s too embarrassing.”

UI can also be dangerous. “Incontinence and overactive bladder are among the biggest risk factors for falls and fractures among older women,” says Subak. “You’re rushing to the bathroom at night—with the lights off—tripping and falling and [potentially] breaking a hip.”

The good news is that treating UI doesn’t have to involve costly interventions. The results of this study were on par with medications used to treat UI, which show about the same amount of reduction in UI episodes. Exercise and yoga can be free and have fewer potential negative side effects. And just most people can do some form of exercise, even with modifications.

What I found interesting is that the exercise group, which did not do exercises focused on the pelvic floor, had just as many fewer UI episodes as the yoga group, which did focus on the pelvic floor. One possibility to explain this is that perhaps the participants in the exercise group were contracting the pelvic floor muscles during the exercises to prevent leakage. 

These results suggest that any type of upper and lower body strengthening and stretching may be effective for improving the function of the pelvic floor. So if yoga isn’t your thing, grab some dumbbells or resistance bands, lace up your walking shoes or get moving in any way you enjoy and will stick with. 

There are also specific exercises for the pelvic floor, often referred to as Kegels, that can be done at home or with a physical therapist specifically trained in pelvic floor functioning. 

It’s important to note that both strengthening and being able to relax the pelvic floor muscles are necessary for a healthy, fully functioning pelvic floor. One reason is that if you cannot fully relax these muscles, you might not be able to fully void your bladder. Then when you stand up—hello, leakage. Or you find yourself right back in the bathroom soon after. 

Hydration can also affect the urgency to pee. While you want to be well-hydrated, you can also overdo it with fluids. Peeing 6 to 10 times a day can be normal, but beyond 10 times may indicate you’re drinking too much water or other fluids. Caffeine and alcohol can also increase urgency—and the potential to leak. If you find you’re peeing more than 10 times a day or your urine is clear, you may want to adjust the amount you’re drinking. Other signs of overhydration can include bloating, nausea, headaches and brain fog. Ultimately, overhydrating can become life-threatening when the fluid you’re taking in dilutes your body’s electrolytes or your kidneys simply cannot handle the load (though instances of this happening are rare). 

The Bottom Line

This study found that a 12-week program of low-impact yoga that includes poses that involve the pelvic floor was as effective as a 12-week general upper- and lower-body strengthening and stretching exercise program for reducing UI. Both groups showed a 65% decrease in the number of episodes of urine leakage. Yoga, muscle strengthening and stretching all have benefits beyond improving urine leakage, too. From improved mental health to a reduced risk of chronic disease, like heart disease and diabetes, moving your body more in general has far-reaching benefits.