Top

Obesity Surgery

Published in:

01-07-2013 | Clinical Research

Bariatric Surgery Improves Urinary Incontinence but Not Anorectal Function in Obese Women

Authors: Gitana Scozzari, Fabrizio Rebecchi, Claudio Giaccone, Paolo Chiaro, Massimiliano Mistrangelo, Mario Morino

Published in: Obesity Surgery | Issue 7/2013

Abstract

Background

While the association between obesity and urinary incontinence (UI) in women has been clearly documented, the relationship with anal incontinence (AI) is less well defined; moreover, while bariatric surgery has been shown to improve UI, its effect on AI is still unclear.

Methods

A total of 32 obese women were studied by means of PFDI-20 and PFIQ-7 questionnaires and anorectal manometry before and after bariatric surgery and compared with 71 non-obese women.

Results

Obese women showed worse overall questionnaire results (OR 5.18 for PFDI-20 and 2.66 for PFIQ-7). Whereas obese women showed worse results for urinary sub-items and a higher urge UI incidence (43.8 vs 18.3 %, p = 0.013), they did not show worsening in colorecto-anal symptoms. Post-operatively, median PFDI-20 total score did not change (24.2 vs 26.6, p = ns), while there was an improvement in urinary score (14.6 vs 8.3, p < 0.001); median PFIQ-7 improved (4.8 vs 0.0, p = 0.044), but while the urinary score improved (2.4 vs 0.0, p = 0.033), the colorecto-anal score did not change significantly. Although after surgery urge UI decreased from 43.8 to 15.6 % (p = 0.029), the incidence of any AI increased from 28.1 to 40.6 % (p = ns) and flatus incontinence increased from 18.8 to 37.5 % (p = ns). Anorectal manometry did not show significant changes after surgery.

Conclusions

Obese women had worse questionnaire results, but while showing a higher incidence of UI, they did not experience anorectal function worsening. After bariatric surgery, there was a slight improvement in PFD symptoms related to UI, but anorectal function did not change significantly and flatus incontinence increased.

Available only for authorised users

Greer WJ, Richter HE, Bartolucci AA, et al. Obesity and pelvic floor disorders: a systematic review. Obstet Gynecol. 2008;112:341–9.PubMedCrossRef

Johanson JF, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol. 1996;91:33–6.PubMed

Elia G, Dye TD, Scariati PD. Body mass index and urinary symptoms in women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:366–9.PubMedCrossRef

Kapoor DS, Davila GW, Rosenthal RJ, et al. Pelvic floor dysfunction in morbidly obese women: pilot study. Obes Res. 2004;12:1104–7.PubMedCrossRef

Uustal Fornell E, Wingren G, Kjølhede P. Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand. 2004;83:383–9.PubMedCrossRef

Lawrence JM, Lukacz ES, Liu IL, et al. Pelvic floor disorders, diabetes, and obesity in women: findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care. 2007;30:2536–41.PubMedCrossRef

Brown JS, Seeley DG, Fong J, et al. Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol. 1996;87:715–21.PubMedCrossRef

Richter HE, Burgio KL, Clements RH, et al. Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol. 2005;106:1272–7.PubMedCrossRef

Poylin V, Serrot FJ, Madoff RD, et al. Obesity and bariatric surgery: a systematic review of associations with defecatory dysfunction. Colorectal Dis. 2011;13:e92–e103.PubMedCrossRef

10.

Deitel M, Stone E, Kassam HA, et al. Gynecologic–obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988;7:147–53.PubMed

11.

Bump RC, Sugerman HJ, Fantl JA, et al. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol. 1992;167:392–7.PubMedCrossRef

12.

Subak LL, Johnson C, Whitcomb E, et al. Does weight loss improve incontinence in moderately obese women? Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:40–3.PubMedCrossRef

13.

Kuruba R, Almahmeed T, Martinez F, et al. Bariatric surgery improves urinary incontinence in morbidly obese individuals. Surg Obes Relat Dis. 2007;3:586–90. discussion 590–1.PubMedCrossRef

14.

Burgio KL, Richter HE, Clements RH, et al. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110:1034–40.PubMedCrossRef

15.

Wasserberg N, Petrone P, Haney M, et al. Effect of surgically induced weight loss on pelvic floor disorders in morbidly obese women. Ann Surg. 2009;249:72–6.PubMedCrossRef

16.

Roberson EN, Gould JC, Wald A. Urinary and fecal incontinence after bariatric surgery. Dig Dis Sci. 2010;55:2606–13.PubMedCrossRef

17.

Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18:1287–96.PubMedCrossRef

18.

Chen CC, Gatmaitan P, Koepp S, et al. Obesity is associated with increased prevalence and severity of pelvic floor disorders in women considering bariatric surgery. Surg Obes Relat Dis. 2009;5:411–5.PubMedCrossRef

19.

Wasserberg N, Haney M, Petrone P, et al. Morbid obesity adversely impacts pelvic floor function in females seeking attention for weight loss surgery. Dis Colon Rectum. 2007;50:2096–103.PubMedCrossRef

20.

Laungani RG, Seleno N, Carlin AM. Effect of laparoscopic gastric bypass surgery on urinary incontinence in morbidly obese women. Surg Obes Relat Dis. 2009;5:334–8.PubMedCrossRef

21.

McDermott CD, Terry CL, Mattar SG, et al. Female pelvic floor symptoms before and after bariatric surgery. Obes Surg 2012;22:1244–50.

22.

NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–61.CrossRef

23.

Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193:103–13.PubMedCrossRef

24.

Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.PubMedCrossRef

25.

Agachan F, Chen T, Pfeifer J, et al. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39:681–5.PubMedCrossRef

26.

Whitcomb EL, Lukacz ES, Lawrence JM, et al. Prevalence and degree of bother from pelvic floor disorders in obese women. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:289–94.PubMedCrossRef

27.

Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:41–4.PubMedCrossRef

28.

Phelan S, Kanaya AM, Subak LL, et al. Prevalence and risk factors for urinary incontinence in overweight and obese diabetic women. Diabetes Care. 2009;32:1391–7.PubMedCrossRef

29.

Macmillan AK, Merrie AE, Marshall RJ, et al. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Dis Colon Rectum. 2004;47:1341–9.PubMedCrossRef

30.

Erekson EA, Sung VW, Myers DL. Effect of body mass index on the risk of anal incontinence and defecatory dysfunction in women. Am J Obstet Gynecol. 2008;198:596. e1-596.e4.PubMedCrossRef

31.

Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology. 2005;129:42–9.PubMedCrossRef

32.

Wasserberg N, Haney M, Petrone P, et al. Fecal incontinence among morbid obese women seeking for weight loss surgery: an underappreciated association with adverse impact on quality of life. Int J Colorectal Dis. 2008;23:493–7.PubMedCrossRef

33.

Altman D, Falconer C, Rossner S, et al. The risk of anal incontinence in obese women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1283–9.PubMedCrossRef

34.

Varma MG, Brown JS, Creasman JM, et al. Fecal incontinence in females older than aged 40 years: who is at risk? Dis Colon Rectum. 2006;49:841–51.PubMedCrossRef

35.

Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137:512–7.PubMedCrossRef

36.

Sugerman H, Windsor A, Bessos M, et al. Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity. Int J Obes Relat Metab Dis. 1998;22:230–5.CrossRef

37.

Markland AD, Richter HE, Burgio KL, et al. Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J. 2011;22:1151–7.PubMedCrossRef

38.

Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481–90.PubMedCrossRef

39.

Auwad W, Steggles P, Bombieri L, et al. Moderate weight loss in obese women with urinary incontinence: a prospective longitudinal study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1251–9.PubMedCrossRef

40.

Noblett KL, Jensen JK, Ostergard DR. The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8:323–6.PubMedCrossRef

41.

Mommsen S, Foldspang A. Body mass index and adult female urinary incontinence. World J Urol. 1994;12:319–22.PubMedCrossRef

42.

Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis. 2009;5:524–8.PubMedCrossRef

43.

Sugerman H, Windsor A, Bessos M, et al. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med. 1997;241:71–9.PubMedCrossRef

44.

De Keulenaer BL, De Waele JJ, Powell B, et al. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med. 2009;35:969–76.PubMedCrossRef

45.

Frezza EE, Shebani KO, Robertson J, et al. Morbid obesity causes chronic increase of intraabdominal pressure. Dig Dis Sci. 2007;52:1038–41.PubMedCrossRef

46.

Legendre G, Fritel X, Capmas P, et al. Urinary incontinence and obesity. J Gynecol Obstet Biol Reprod (Paris). 2012;41:318–23.CrossRef

47.

De Groat WC. The urothelium in overactive bladder: passive bystander or active participant? Urology. 2004;64:7–11.PubMedCrossRef

48.

Epanomeritakis E, Koutsoumbi P, Tsiaoussis I, et al. Impairment of anorectal function in diabetes mellitus parallels duration of disease. Dis Colon Rectum. 1999;42:1394–400.PubMedCrossRef

49.

Heliövaara M. Body height, obesity, and risk of herniated lumbar intervertebral disc. Spine. 1987;12:469–72.PubMedCrossRef

50.

Nathan PA, Keniston RC, Myers LD, et al. Obesity as a risk factor for slowing of sensory conduction of the median nerve in industry. A cross-sectional and longitudinal study involving 429 workers. J Occup Med. 1992;34:379–83.PubMedCrossRef

Title: Bariatric Surgery Improves Urinary Incontinence but Not Anorectal Function in Obese Women
Authors: Gitana Scozzari
Fabrizio Rebecchi
Claudio Giaccone
Paolo Chiaro
Massimiliano Mistrangelo
Mario Morino
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Obesity Surgery / Issue 7/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-013-0880-8

At a glance: The STEP trials

Springer Medicine

Bariatric Surgery Improves Urinary Incontinence but Not Anorectal Function in Obese Women

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2013

Adjustable Intragastric Balloon vs Non-Adjustable Intragastric Balloon: Case–Control Study on Complications, Tolerance, and Efficacy

A Prospective Randomized Study Comparing Patients with Morbid Obesity Submitted to Sleeve Gastrectomy With or Without Omentectomy

Reply to “Overweight Patients Achieve Ideal Body Weight Following Curative Gastrectomy Resulting in Better Long-Term Prognosis. Letter”

A Meta-analysis: To Compare the Clinical Results Between Gastric Bypass and Sleeve Gastrectomy for the Obese Patients

Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 Years Experience from an Asian Center of Excellence

Pharmacotherapy Prevention and Management of Nutritional Deficiencies Post Roux-en-Y Gastric Bypass