title: Fecal incontinence among morbid obese women seeking for weight loss surgery: an underappreciated association with adverse impact on quality of life.
abstract: OBJECTIVE
  Morbid obesity is associated with urinary incontinence (UI). The study purpose was to determine the prevalence of fecal incontinence (FI), its associated risk factors, and its impact on quality of life (QOL) in morbidly obese women.
  
  
  METHODS
  A questionnaire-based study on morbidly obese women [body mass index (BMI)>or=35 m/kg2], attending a bariatric surgery seminar, was conducted. Data included demographics, past medical, surgical and obstetric history, and obesity-related co-morbidities. Patients who reported of FI, completed the Cleveland Clinic Foundation Fecal Incontinence scale (CCF-FI) and the Fecal Incontinence Quality of Life scale (FIQL).
  
  
  RESULTS
  Participants included 256 women [median age 45 years (19-70)] and mean BMI of 49.3+/-9.4 m/kg2. FI was reported in 63%. History of obstetric injury (OR: 2.4, 95% CI: 1.33-4.3; p<0.001) and UI (OR: 1.2, 95% CI: 1.1-1.4; p<0.001) were significantly associated with FI. There was no association with age, BMI, parity, and presence of diabetes or hypertension. Median CCF-FI score was 7 (1-20); 34.5% scored>or=10. Incontinence for gas was the most frequent type (87%) of FI, followed by incontinence for liquids (80%), which also had the highest impact on QOL (p<0.01). Mean FIQL scores were >3 for all four domains studied. CCF-FI scores were significantly correlated with FIQL scores in all domains (p=0.02).
  
  
  CONCLUSIONS
  The prevalence of FI among morbidly obese women may be much higher than the rates reported in the general population. FI has adverse effects on QOL. Its correlation with UI suggests that morbid obesity may pose a risk of global pelvic floor dysfunction.
authors.affiliation: Division of Colorectal and Pelvic Floor Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. nwasserberg@gmail.com
authors.forename: Nir
authors.initials: N
authors.lastname: Wasserberg
authors.forename: Mark
authors.initials: M
authors.lastname: Haney
authors.forename: Patrizio
authors.initials: P
authors.lastname: Petrone
authors.forename: Peter
authors.initials: P
authors.lastname: Crookes
authors.forename: Jason
authors.initials: J
authors.lastname: Rosca
authors.forename: Manfred
authors.initials: M
authors.lastname: Ritter
authors.forename: Howard S
authors.initials: HS
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D016017:Odds Ratio; D017773:Pelvic Floor / Q000503:physiopathology; D015995:Prevalence; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000150:complications / Q000209:etiology; D015431:Weight Loss