Shireen de Sam Lazaro1, Rahel Nardos2, Aaron B Caughey3. 1. Associate Physician, Department of Obstetrics and Gynecology, Kaiser Permanente, Martinez, CA. 2. Assistant Professor. 3. Professor and Chair, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Abstract
IMPORTANCE: Pelvic floor disorders (PFDs) comprise a broad spectrum of clinical conditions, including urinary incontinence, pelvic organ prolapse, fecal incontinence, and defecatory dysfunction. These disorders are common conditions that generate significant medical, emotional, social, and economic issues for many women. Obese women are disproportionately affected compared with their normal-weight peers, with more than half of women with a body mass index of greater than 35 kg/m(2) reporting a PFD, compared with only 32% in women with a normal body mass index. Despite this prevalence, little research is available to help guide and tailor treatment in obese populations. OBJECTIVE: This review outlines current knowledge regarding the relative contribution of obesity to PFDs, as well as its effect on treatment implications. EVIDENCE ACQUISITION: Literature relating to the incidence and treatment of PFDs in obese populations was reviewed. RESULTS: Both nonsurgical and surgical weight loss improves all PFDs. Obese women benefit from pelvic floor training, biofeedback, and pharmacologic treatments of urinary and fecal incontinence. Surgical treatments of stress urinary incontinence note increased operative times and perhaps slightly lower cure rates, but overall good treatment success in obese women. No increased risks of complications or treatment failure were noted in obese women treated for prolapse surgically, and pessaries work well for both prolapse and stress urinary incontinence in obese women. CONCLUSIONS/RELEVANCE: Although literature regarding treatment of PFDs in obese women is limited, the available evidence demonstrates good treatment outcomes in obese populations. Further research into how to best counsel and optimize treatment of obese patients is essential as the obesity epidemic continues.
IMPORTANCE: Pelvic floor disorders (PFDs) comprise a broad spectrum of clinical conditions, including urinary incontinence, pelvic organ prolapse, fecal incontinence, and defecatory dysfunction. These disorders are common conditions that generate significant medical, emotional, social, and economic issues for many women. Obesewomen are disproportionately affected compared with their normal-weight peers, with more than half of women with a body mass index of greater than 35 kg/m(2) reporting a PFD, compared with only 32% in women with a normal body mass index. Despite this prevalence, little research is available to help guide and tailor treatment in obese populations. OBJECTIVE: This review outlines current knowledge regarding the relative contribution of obesity to PFDs, as well as its effect on treatment implications. EVIDENCE ACQUISITION: Literature relating to the incidence and treatment of PFDs in obese populations was reviewed. RESULTS: Both nonsurgical and surgical weight loss improves all PFDs. Obesewomen benefit from pelvic floor training, biofeedback, and pharmacologic treatments of urinary and fecal incontinence. Surgical treatments of stress urinary incontinence note increased operative times and perhaps slightly lower cure rates, but overall good treatment success in obesewomen. No increased risks of complications or treatment failure were noted in obesewomen treated for prolapse surgically, and pessaries work well for both prolapse and stress urinary incontinence in obesewomen. CONCLUSIONS/RELEVANCE: Although literature regarding treatment of PFDs in obesewomen is limited, the available evidence demonstrates good treatment outcomes in obese populations. Further research into how to best counsel and optimize treatment of obesepatients is essential as the obesity epidemic continues.
Authors: Xiaoming Sheng; Jie Wang; Janet M Shaw; Maureen A Murtaugh; Ingrid E Nygaard Journal: Female Pelvic Med Reconstr Surg Date: 2022-02-16 Impact factor: 1.913
Authors: Andrzej Pomian; Wojciech Majkusiak; Wojciech Lisik; Paweł Tomasik; Edyta Horosz; Aneta Zwierzchowska; Jacek Kociszewski; Ewa Barcz Journal: Obes Surg Date: 2018-06 Impact factor: 4.129