22 Jun Bariatric Surgery Reduces Urinary Incontinence As Well As Obesity
MedicalResearch.com Interview with:
Leslee L. Subak, MD
University of California, San Francisco
Professor, Departments of Obstetrics, Gynecology & Reproductive Sciences, Urology and Epidemiology & Biostatistics
Chief of Gynecology, SF Veterans Affairs Medical Center
UCSF Women’s Health Clinical Research Center
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Subak: Urinary incontinence is very common, affecting an estimated 30 million adults in the U.S., and may account for as much as $60 billion in annual medical costs. Incontinence can cause significant distress, limitations in daily functioning, and reduced quality of life. Obesity is an important risk factor, with each 5-unit increase in body mass index – a ratio of someone’s weight divided by the square of their height – above normal weight associated with far higher rates of incontinence. The prevalence of incontinence has been reported to be as high as 70 percent among severely obese women, and 24 percent among severely obese men (BMI greater than 40, or more than about 100 pounds greater than ideal body weight).
Since obesity is a risk factor for incontinence, several studies have examined whether weight loss is a treatment for incontinence among obese people with the condition. Clinical trials have shown the low calorie diets, behavioral weight reduction, and bariatric surgery are associated with improvement in incontinence in obese women and men through one year, but evidence on the durability of this effect is lacking.
We performed this study to examine changes in urinary incontinence and identify factors associated with improvement among women and men in the first 3 years following bariatric surgery.
This study included 1987women and men in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study performed at 10 hospitals at 6 clinical centers in the U.S. who underwent bariatric surgery between 2005 and 2009. The study participants ranged in age from 18 to 78 years old – the median age was 47. The analysis controlled for factors such as age, race, smoking status and recent pregnancy. Nearly 79 percent of the participants in the study were women with 49% reporting at least weekly incontinence, compared with 2% of men reporting incontinence.
Following surgery and large weight loss of 29% for women and 26% for men, substantial improvements in incontinence were observed, with a majority of women and men achieving remission at 3 years post-surgery. The more weight lost, the higher the chances of improvement. While the risk of relapse rose with each gain of about 10 pounds, overall there was substantial improvement for both women and men. People who were older, had severe walking limitations or were recently pregnant showed less improvement.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Subak: Obesity is a strong risk factor for incontinence, with nearly half of women and more than a fifth of the men with severe obesity reporting having at least one episode of incontinence a week.
Surgical weight loss for severely obese men and women is an effective treatment with sustained improvement in incontinence through 3 years after surgery.
Improvement in urinary incontinence may be another important long-term benefit among the extensive health improvements associated with bariatric surgery.
Improvement in urinary incontinence may help motivate severely obese men and women with incontinence to undergo bariatric surgery or other weight loss interventions and improve long-term weight maintenance.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Subak: Explore why weight loss is an effective treatment and how to use incontinence (and other quality of life conditions such as erectile dysfunction) to motivate weight loss and weight maintenance.
Leslee L. Subak, MD, University of California, San Francisco, Professor, Departments of Obstetrics, Gynecology & Reproductive Sciences, Urology and Epidemiology & Biostatistics, Chief of Gynecology, SF Veterans Affairs Medical Center, & UCSF Women’s Health Clinical Research Center (2015). Bariatric Surgery Reduces Urinary Incontinence As Well As Obesity