TNF and obesity due to melanocortin 4 receptor deficiency: Obesity increases intra-abdominal pressure, which weakens the pelvic muscles and pelvic innervation, according to research by Ramalingam et al.[24] This pressure exacerbates detrusor instability and causes SUI by increasing pressure in the bladder and urethral mobility.[25] Obese people have dysregulated levels of inflammatory cytokines and factors, including interleukin 6 and tumor necrosis factor-alpha.