6th July 2015
Urinary incontinence is a common, though often ignored, problem among patients with chronic weight problems. It can cause significant distress, limitation in daily functioning and reduced quality of life. For anatomical and other reasons the condition is much more common in women, but it can occur in both sexes. The prevalence of incontinence has been reported to be as high as 70% among severely obese women and around 25% of men. There is good evidence that losing weight can act as an effective treatment to either improve or entirely resolve incontinence problems, at least in the short-term. However, until recently, evidence relating to longer-term outcomes has been lacking. Now a group based in San Francisco has examined the effects of bariatric surgery on incontinence, 3-years later.
The study, published in JAMA, involved almost 2000 people who underwent bariatric surgery between 2005 and 2009 and who were asked about their problems with incontinence. The study participants were aged 18-78 years, nearly 80% of whom were women. All subjects were followed for a period of three years following weight loss surgery.
At baseline, 49.3% of women reported problems with incontinence compared with 21.8% of men. One-year after surgery, the prevalence of incontinence had fallen to 18.3% in women and 9.8% in men. The evidence showed that the more weight the patient lost, the greater the improvement in symptoms. The incontinence prevalence at three-years was higher than the one-year prevalence in both sexes (24.8% and 12.2% for women and men respectively) but still much lower than the baseline prevalence. This observed increase in the three-year prevalence was probably due to weight regain. Older people, those with severe walking limitations or were recently pregnant, showed less improvement.
This is the first study to report on the long-term impact of bariatric surgery on urinary incontinence and patients should find the results very encouraging.
Subak LL, King WC, Belle SH et al. Urinary Incontinence Before and After Bariatric Surgery.
JAMA Intern Med. 2015 Jun 22. [Epub ahead of print]
Dr David Ashton MD PhD