title: Obesity is associated with increased prevalence and severity of pelvic floor disorders in women considering bariatric surgery.
abstract: BACKGROUND
  Although an association between obesity and urinary incontinence (UI) has been reported, the association between obesity and other PFDs is less clear. The aim of this study was to determine the prevalence of pelvic floor disorders (PFDs), including stress urinary incontinence (SUI), urge urinary incontinence (UUI), pelvic organ prolapse (POP), and anal incontinence (AI), in obese women contemplating bariatric surgery compared with nonobese subjects at a tertiary care referral hospital.
  
  
  METHODS
  From September 2006 to December 2007, obese women contemplating bariatric surgery and nonobese women from general gynecology clinic completed a validated screening questionnaire for PFDs, the Sandvik urinary incontinence severity index, and the Rockwood fecal incontinence severity index.
  
  
  RESULTS
  A total of 217 obese (mean body mass index of 50 +/- 10 kg/m(2)) and 210 nonobese controls (mean body mass index 23 +/- 3 kg/m(2)) were screened. The presence of any PFD occurred in 159 patients (75%) in the obese group compared with 89 nonobese patients (44%; P <.0001). More obese patients experienced SUI, UUI, and AI, but not POP. Obese patients also had more severe UI and AI. Obesity remained a significant risk factor for UI and AI, even after adjusting for baseline differences in demographics and medical conditions, with an adjusted odds ratio of 4.1 (95% confidence interval 2.3-7.8) and 2.1 (95% confidence interval 1.1-4.1), respectively.
  
  
  CONCLUSIONS
  The prevalence of PFDs, including SUI, UUI, and all forms of AI, was greater in the obese and morbidly obese women contemplating bariatric surgery. Obesity was also associated with an increased severity of UI and AI. Obesity appears to confer a fourfold and twofold increased risk of UI and AI, respectively.
authors.affiliation: Section for Urogynecology and Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Chi Chiung Grace
authors.initials: CC
authors.lastname: Chen
authors.forename: Patrick
authors.initials: P
authors.lastname: Gatmaitan
authors.forename: Sidney
authors.initials: S
authors.lastname: Koepp
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050110:Bariatric Surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000473:pathology / Q000601:surgery; D017773:Pelvic Floor; D015995:Prevalence; D011391:Prolapse; D012307:Risk Factors; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000453:epidemiology*; D055815:Young Adult