Body weight raises pressure inside the abdomen, and that pressure is carried by the pelvic floor. This is one of the mechanisms behind stress incontinence — leaking when you cough, sneeze, laugh or lift — and it contributes to prolapse symptoms as well.
What the evidence shows. Weight reduction is one of the better-evidenced non-surgical interventions for stress incontinence in women carrying excess weight. Importantly, the improvement often appears well before a target weight is reached, which matters because a goal that feels far away is the most common reason women stop.
Why it works alongside pelvic floor training rather than instead of it. Losing weight lowers the load; training improves the support that carries the load. Doing only one leaves half the problem in place. Technique matters far more than repetitions, and a single assessment distinguishes a weak pelvic floor from an overly tight one — two conditions with overlapping symptoms and opposite treatments.
What to do first. Get the leaking characterised, because stress and urge incontinence respond to different things. Get the treatable contributors to weight checked — thyroid, PCOS, sleep apnoea, medications that cause weight gain. Then the plan is built on what is actually going on rather than on a guess.
When to see a doctor. If you leak during exercise, if you have stopped exercising because of it, if you feel a bulge or heaviness, or if you are getting up more than once a night to pass urine.