Weight Loss Improves Incontinence and Pelvic Organ Prolapse

Abstract & Commentary

By Frank W. Ling, MD, Clinical Professor, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, is Associate Editor for OB/GYN Clinical Alert.

Dr. Ling reports no financial relationship to this field of study.

Synopsis: After undergoing weight reduction surgery, obese women show improvement in pelvic floor symptoms, urinary function, and anterior vaginal support.

Source: Daucher JA, et al. Pelvic support and urinary function improve in women after surgically induced weight reduction. Female Pelvic Med Reconstr Surg 2010;16:263-267.

Baseline and 6-month data were collected on morbidly obese women who planned to undergo weight reduction surgery. A POP-Q (Pelvic Organ Prolapse Quantification) examination was performed and multiple questionnaires were completed. Six months after surgery, the average body mass index (BMI) was 33 compared to 46 at baseline. Patients who demonstrated stage 2 prolapse or more at baseline improved an average of 0.5 cm in the anterior vaginal compartment. Twelve patients were incontinent at baseline, with six of them becoming continent after surgery and the other six having reduced frequency of incontinent episodes.

Commentary

You've seen it. I've seen it. We all talk about it. We discuss it with our patients. It's been studied before with plenty of data showing that incontinence improves when significant weight loss is achieved. Here are some additional data to support those findings, but with the additional examination measures of the POP-Q examination to demonstrate that prolapse also is improved.

I offer this study for your consideration not so much because it demonstrates the mechanism by which weight loss improves incontinence and/or prolapse (it does not), but because it reinforces the notion that morbid obesity significantly impacts urogynecologic health along with the well-understood cardiovascular and general health (type 2 diabetes, hyperlipidemia, hypertension, obstructive sleep apnea, heart disease, stroke, and depression). The authors remind us that although the exact mechanism is unknown, pelvic floor and urethral dysfunction might be related to alterations in the autonomic nervous system associated with increasing BMI. Clearly weight is a modifiable risk factor that greatly impacts many aspects of health, including urinary incontinence and pelvic organ prolapse.

This should serve as a reminder to all of us that obesity is a near-epidemic in our country with plenty of adverse implications. Of specific note, when and if an obese woman complains of incontinence, the concept of weight loss is not an inappropriate treatment strategy. This is not to say that the obesity should be used as an excuse to avoid treating the problem. Unfortunately, I've seen obese patients with significant pelvic pathology that needed surgery being told by their gynecologist that they would not do the surgery until they had lost "x" number of pounds. Even though it sounds as though it is encouraging the patient to lose weight for her own good, it is often merely an excuse for the surgeon to avoid the challenges and some of the risks associated with such large patients. It almost becomes punitive since it is highly unlikely that the patient will undergo a long-term weight loss plan just to have the surgery. Remember that this study was done over a short period of time with patients who were going to have a relatively "quick fix" to their weight problem, i.e., weight reduction surgery.

How we use the issue of weight loss relative to management of various gynecologic conditions must fall back to individualizing how we treat each of our patients. By using the data in this paper, weight reduction and its affect on incontinence and prolapse certainly can be put into proper context. It can be used both as a carrot and stick when dealing with certain patients depending on what the health problems are. Ultimately, the doctor and the patient must make an informed choice together. Sounds familiar, doesn't it?