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Urinary and Fecal Incontinence After Bariatric Surgery

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Abstract

Background

Morbidly obese women have markedly high rates of urinary and fecal incontinence. Weight loss reduces prevalence and severity of urinary incontinence; however, the effect of weight loss on fecal incontinence is unknown.

Aims

The aim of this study was to document the prevalence of urinary and fecal incontinence in subjects who underwent bariatric surgery and associated weight loss.

Methods

We mailed a detailed survey to all 404 adults who underwent bariatric surgery at the University of Wisconsin prior to May 2006. Type and severity of urinary and fecal incontinence was obtained using previously validated questionnaires. Perceived effect of surgery on bowel and bladder function was also assessed.

Results

Forty-eight percent (193) of the surveys were returned. Urinary incontinence was reported in 72% of the women, 39% of whom perceived improvement after surgery. Only 21% of the men reported urinary incontinence. In contrast, fecal incontinence was common in both men and women; 48% of the women and 42% of the men reported liquid stool incontinence and 21% of the women and 30% of the men reported solid stool incontinence. Fifty-five percent of the women and 31% of the men with fecal incontinence perceived worsening after surgery. Women with diarrhea were four times more likely to report fecal incontinence (P < 0.0001). Furthermore, women who perceived worsening of diarrhea after surgery were significantly more likely to have fecal incontinence (P = 0.003).

Conclusions

Both fecal and urinary incontinence were common after bariatric surgery. Risk factors for fecal incontinence in women after bariatric surgery include diarrhea and worsening of diarrhea; we suggest that such surgery may uncover prior weaknesses in the continence mechanism.

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References

  1. Wang Y, Beydoun MA. The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28.

    Article  CAS  PubMed  Google Scholar 

  2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–1555.

    Article  CAS  PubMed  Google Scholar 

  3. Proceedings of the ASBS consensus conference on the state of bariatric surgery and morbid obesity: Health implications for patients, health professionals and third-party payers, Washington, DC, USA, May 6–7, 2004. Surg Obes Relat Dis 2005;1:105–153.

    Google Scholar 

  4. Richter HE, Burgio KL, Clements RH, Goode PS, Redden DT, Varner RE. Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol. 2005;106:1272–1277.

    PubMed  Google Scholar 

  5. Fenner DE, Trowbridge ER, Patel DA, et al. Establishing the prevalence of incontinence study: racial differences in women’s patterns of urinary incontinence. J Urol. 2008;179:1455–1460.

    Article  PubMed  Google Scholar 

  6. Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology. 2005;129:42–49.

    Article  PubMed  Google Scholar 

  7. Greer WJ, Richter HE, Bartolucci AA, Burgio KL. Obesity and pelvic floor disorders: a systematic review. Obstet Gynecol. 2008;112:341–349.

    PubMed  Google Scholar 

  8. Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121:885–893.

    Article  PubMed  Google Scholar 

  9. Subak LL, Johnson C, Whitcomb E, Boban D, Saxton J, Brown JS. Does weight loss improve incontinence in moderately obese women? Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:40–43.

    Article  CAS  PubMed  Google Scholar 

  10. Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110:1034–1040.

    PubMed  Google Scholar 

  11. Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health. 1993;47:497–499.

    Article  CAS  PubMed  Google Scholar 

  12. Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn. 2000;19:137–145.

    Article  CAS  PubMed  Google Scholar 

  13. Sandvik H, Espuna M, Hunskaar S. Validity of the incontinence severity index: comparison with pad-weighing tests. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:520–524.

    Article  PubMed  Google Scholar 

  14. Hanley J, Capewell A, Hagen S. Validity study of the severity index, a simple measure of urinary incontinence in women. BMJ. 2001;322:1096–1097.

    Article  CAS  PubMed  Google Scholar 

  15. Murphy M, Culligan PJ, Arce CM, Graham CA, Blackwell L, Heit MH. Construct validity of the incontinence severity index. Neurourol Urodyn. 2006;25:418–423.

    Article  PubMed  Google Scholar 

  16. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446–1456.

    Article  CAS  PubMed  Google Scholar 

  17. Drossman DA. The functional gastrointestinal disorders and the Rome II process. Gut. 1999;45(Suppl 2):II1–II5.

    Article  PubMed  Google Scholar 

  18. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44:77–80.

    Article  CAS  PubMed  Google Scholar 

  19. te Riele WW, Vogten JM, Boerma D, Wiezer MJ, van Ramshorst B. Comparison of weight loss and morbidity after gastric bypass and gastric banding. A single center European experience. Obes Surg. 2008;18:11–16.

    Article  CAS  PubMed  Google Scholar 

  20. 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;23:493–497.

    Article  PubMed  Google Scholar 

  21. Chen CC, Gatmaitan P, Koepp S, Barber MD, Chand B, Schauer PR, Brethauer SA. Obesity is associated with increased prevalence and severity of pelvic floor disorders in women considering bariatric surgery. Surg Obes Relat Dis 2009;5:411–415.

    Google Scholar 

  22. Aitola P, Lehto K, Fonsell R, Huhtala H. Prevalence of faecal incontinence in adults aged 30 years or more in general population. Colorectal Dis 2009. doi:10.1111/j.1463-1318.2009.01878.x.

  23. Kuruba R, Almahmeed T, Martinez F, Torrella TA, Haines K, Nelson LG, Gallagher SF, Murr MM. Bariatric surgery improves urinary incontinence in morbidly obese individuals. Surg Obes Relat Dis 2007;3:586–590 (discussion 590–581).

    Google Scholar 

  24. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–2693.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge DeAnne Day for her administrative assistance and Dr. Ronald Gangnon for his assistance with planning the statistical analysis. This research was supported by the William S. Middleton VA and the Section of Gastroenterology and Hepatology at the University of Wisconsin School of Medicine and Public Health. None of the authors have any affiliation with any organization with a financial interest, direct or indirect, in the subject matter or materials discussed in the manuscript that may affect the conduct or reporting of the work submitted nor was there any assistance with preparation of the manuscript.

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Authors and Affiliations

  1. Section of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, GRECC, 2500 Overlook Terrace, Madison, WI, 53705, USA

    Erica N. Roberson

  2. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Box 7375 Clinical Science Center-H4, 600 Highland Ave, Madison, WI, 53792, USA

    Jon C. Gould

  3. Section of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, UWHC-H6/516, 600 Highland Ave, Madison, WI, 53792, USA

    Arnold Wald

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  1. Erica N. Roberson
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  2. Jon C. Gould
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  3. Arnold Wald
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Correspondence to Arnold Wald.

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Roberson, E.N., Gould, J.C. & Wald, A. Urinary and Fecal Incontinence After Bariatric Surgery. Dig Dis Sci 55, 2606–2613 (2010). https://doi.org/10.1007/s10620-010-1190-9

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  • DOI: https://doi.org/10.1007/s10620-010-1190-9

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