Surgically induced weight loss helps improve symptoms of pelvic floor disorders
In obese women who undergo bariatric surgery, weight loss is associated with a significant improvement in pelvic floor disorders—including urinary incontinence (UI), pelvic organ prolapse and colorectal-anal complaints—as well as in sexual performance, a recent study suggests.
The prospective study included 150 female bariatric surgery patients (mean age 43 years; mean preoperative body mass index [BMI], 42 kg/m2). All patients completed four questionnaires—International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI), Bristol Female Lower Urinary Tract Symptom-Scored Form (BFLUTS-SF), Pelvic Floor Disability Index (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)—at baseline and at 3 to 6 months after surgery to evaluate pelvic floor disorders and sexual dysfunction.
According to baseline data, 37.3 percent of patients had UI, 29.3 percent had pelvic organ prolapse symptoms and 44 percent had colorectal-anal symptoms.
Compared with baseline scores, the postoperative scores indicated that surgically induced weight loss was associated with statistically significant improvements in UI (mean ICIQ score, 9.3 vs 3.3; p<0.001), pelvic organ prolapse symptoms (mean PFDI score, 19 vs 11; p<0.001) and colorectal-anal symptoms (mean PFDI score, 21 vs 14; p=0.004). Complete resolution of symptoms was reported in half of women with UI and in more than one quarter of those who had either pelvic organ prolapse or colorectal-anal symptoms.
Furthermore, a statistically significant improvement in sexual function was also noted during the follow-up, as shown by both BFLUTS-SF (from 0.3 at baseline to 0.1 after surgery; p=0.011) and PISQ-12 (from 37.9 to 39.5; p=0.003) scores.
In women, the prevalence of pelvic floor disorder increases with the degree of obesity, ranging between 57 and 44 percent. Obesity negatively affects pelvic floor function through a chronic increase in intra-abdominal pressure, damage to pelvic musculature and intervertebral disc herniation, among others. Weight reduction can thus improve the symptoms of pelvic floor disorders by reducing pressure on the bladder and pelvic floor, and altering systemic inflammation and hormonal milieu. [Int Urogynecol J 2009;20:289–4; The Obstetrician & Gynaecologist 2011;13:133–142; JAMA Intern Med 2015;175:378–1387]
The current data suggest that successful weight reduction by bariatric surgery in women is likely to improve the symptoms of pelvic floor dysfunction, even eliminating the need for further intervention in some.