Fringe Benefit of Weight Loss Surgery: Bye, Bye Incontinence?

Bariatric surgery often produces a welcome fringe benefit for women affected by urinary incontinence (UI). As weight declines, women notice an improvement of the symptoms, or are even cured, according to new research.

incontinence and bariatric surgery

The improvements in the urinary symptoms are ''notable," says study researcher Mani Habibi, MD, a physician at the Antalya Training and Research Hospital and the Esenler Maternity and Child Health Hospital, both in Turkey. Depending on the type of incontinence, he saw as high as a 61% cure rate.

His team evaluated 120 women, all with obesity and over age 18, planning to undergo the weight loss surgery known as laparoscopic sleeve gastrectomy or LSG. In this procedure, about 80% of the stomach is removed, producing a very small stomach ''pouch'' with much less volume. 1,2

In all, 60% of the women reported having incontinence problems before the surgery. Of these 72 women, 23 had urge incontinence, 18 stress incontinence and 31 mixed type. In urge, urine leaks when a sudden need to urinate makes the bladder contract or spasm. In stress, also called activity-related, urine leaks during physical exertion, sneezing or coughing. In mixed, both situations occur.1

After six months, the women's excess weight loss averaged 70%. Those with incontinence problems reported on their symptoms at six months. Habibi's team used two standardized questionnaires accepted by incontinence experts.

Finding Relief

Improvement was found with all three types, but some types improved more. "Patients with stress urinary incontinence get the best benefit," Habibi tells Endocrine Web.  "Sixty one percent of the patients with stress (11 of 18) were totally cured by bariatric surgery," he says.1

In comparison, he found, 39% of those with urge were cured (9 of 23) and 25% of those with mixed 8 of 31). Others had improvements in symptoms.

The improvements held even after the researchers took into account other factors that can affect incontinence, such as the number of pregnancies a woman had. The average age of the women was 39. Before surgery, their BMI was 46, on average; after, it was 31.2

Finding relief for incontinence is important, as research has shown that it is often linked with depression and poorer quality of life. 3

Background & Perspective

Obesity, experts know, increases the risk of getting urinary incontinence. A five-point increase in body mass index (BMI), the researchers write, has been linked with a 20 to 70% increased risk of incontinence.  (What's an example of a five-point BMI increase? If a person 5'10" goes from 200 pounds and a BMI of 28.7 to 235 pounds, the BMI would go up five points, to 33.7. A BMI of 30 and higher is termed obese.)

The new research findings ''are consistent with prior studies that evaluate the effect of weight loss on urinary incontinence,'' says Leslee Subak, MD, professor of obstetrics, gynecology and reproductive sciences, urology and epidemiology & biostatistics, University of California, San Francisco. She published her research on the effects of bariatric surgery on urinary incontinence in JAMA Internal Medicine in 2015. 4  She tracked more than 800 men and women who had weekly or more frequent incontinence and had bariatric surgery. She, too, found improvements, including cure, decreased frequency or severity of symptoms or improved patient satisfaction.

"It is good to see the results repeated in a different population and [the study] shows how robust the intervention effect of weight loss is for UI,'' Dr. Subak says.

She says that weight loss typically produces improvement in incontinence, regardless of how the weight is lost—surgery, behavioral therapy or liquid diet.

Take-Home Messages

Having urinary incontinence can diminish quality of life, making it difficult to have a typical schedule, with such frequent bathroom visits.  The potential improvement in urinary incontinence can be motivating to help people live a healthier lifestyle, Dr. Subak says. "Women often note an improvement in UI with even small weight loss and this can encourage and motivate further weight loss," she says.

"Among overweight and obese people with UI, weight loss should be discussed and offered as first-line therapy," she says. "Anything that can help motivate people to achieve a healthier lifestyle should be encouraged and UI can sometimes be the motivating factor."

Dr. Habibi agrees, although he favors weight loss surgery if obesity is present.  "Obese patients suffering from UI should consider bariatric surgery for the treatment  of UI,'' he says. They also are likely to recover or see improvement in other conditions, he says, such as diabetes, high blood pressure and sleep apnea.

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