Body Fat & Pelvic Floor Problems: What Matters Most Is *Where* The Fat Is

Pelvic floor problems, often leading to various degrees of urinary incontinence, become increasingly common especially for women especially over a certain age.

But why?

It’s not just a matter of “getting old”, although it is often a case of the pelvic floor muscles weakening through atrophy, which is why pelvic floor muscle exercises are often recommended.

As to why this atrophy occurs, the largest single reason is that muscular atrophy all over the body is occurring, and it simply becomes more noticeable when one of the muscle groups is responsible for holding one’s pee back. If you struggle to open a jar, you think “this jar is stuck”. If you leak urine, however, it’s not likely you’ll blame an external factor, so you’re certain to notice that “something wrong is not right”.

We’ve previously explored some other factors, too, for example:

Foods Linked To Urinary Incontinence In Middle-Age (& Foods That Avert It)

Another risk factor has generally been described very loosely and unhelpfully as “obesity“, so let’s look into that:

Where is your fat?

Very often, when it comes to body fat distribution, the most health-critical factor is visceral fat—that is to say, the fat that lives in your abdomen, cushioning your internal organs (as opposed to subcutaneous fat, the kind that lives just under your skin, and that you can prod and poke and squish, unlike visceral fat, which can’t be reached that way).

For more details on that, see: Visceral Belly Fat & How To Lose It

For this reason, waist circumference is often a critical measure of health in many ways. See for example: Better Than BMI and The Other Waist Ratio.

However! In this case, that’s not the main issue.

A Finnish team of researchers (Dr. Mari Kuutti et al.) investigated body composition and symptoms of pelvic floor disorders in 376 middle-aged women (47–55 years at baseline, follow-up 4 years later).

Here’s the paper, for reference: Association of body composition with the symptoms of pelvic floor disorders in middle-aged women: a longitudinal study

They found results that are not too surprising in words, but get more surprising once we look at the numbers:

❝Having a higher total or regional body fat mass, higher BMI, or larger waist circumference may increase the risk of stress urinary incontinence in middle-aged women.❞

So far, so expectable.

❝In cross-sectional analysis, the symptoms of stress urinary incontinence were found to be associated with total fat mass (OR 1.03, 95% CI: 1.01-1.06, P=0.017), trunk fat mass (OR 1.06, 95% CI: 1.02-1.11, P=0.009), android fat mass (OR 1.33, 95% CI: 1.05-1.70, P=0.020), visceral fat area (OR 1.01, 95% CI: 1.00-1.02, P=0.019), BMI (OR 1.07, 95% CI: 1.01-1.13, P=0.027), and waist circumference (OR 1.03, 95% CI: 1.01-1.05, P=0.008).❞

Did you notice that unexpected spike in the odds ratio (OR) figures?

While the other factors all yielded increased risks in the single-digit range (when expressed as a percentage, so for example OR 1.03 = a 3% increased risk), each kilogram of additional android fat mass increased the risk by 33%,

It doesn’t take a lot of arithmetic to see that this adds up very quickly.

So, what’s “android fat mass”?

It has nothing to do with artificial life forms or cellphones; rather, it’s how much fat is distributed according to typically male distribution patterns (as opposed to gynoid fat mass, which is how much fat is distributed according to typically female distribution patterns).

You can read more about that here: Increase in Android Fat Mass With Age in Healthy Women With Normal Body Mass Index

Now we see an extra reason why the risk for women getting pelvic floor disorders rises sharply in untreated menopause—it’s not just about age; it’s because the hormonal changes result in many physical changes to the body, and one of them is a redistribution of body fat now that estrogen and progesterone aren’t so strongly directing them to feminine proportions. This is why younger men and women usually have very different fat distribution patterns, while older men and women often have quite similar fat distribution patterns (notably, men’s testosterone also usually declines from midlife onwards, so there comes a sort of “meeting in the middle” of fat distribution patterns).

So, with that in mind, the issue is less about how much fat you have, and whether or not it’s in the expected typically feminine places. In other words, you should be hoping to have/retain more of a pear-shaped distribution and less of an oval-shaped distribution, and definitely not an inverted triangle distribution.

Good news: Can We Do Fat Redistribution? ← the answer is “yes” and this article explains how

See also: 5 Ways to Beat Menopausal Weight Gain!

Want to learn more?

Check out:

Pelvic Floor Exercises (Not Kegels!) To Prevent Urinary Incontinence ← for a less fat-focused angle, if body recomposition isn’t on your to-do list

Take care!