title: Prolapse symptoms in overweight and obese women before and after weight loss.
abstract: OBJECTIVE
  The objective of this study was to estimate the association between body mass index (BMI) and pelvic organ prolapse symptoms and bother among overweight and obese women with urinary incontinence before and after weight loss.
  
  
  METHODS
  Women (N = 338) were randomized to either an intensive 6-month weight loss or educational program (control); they were evaluated for prolapse symptoms at baseline and 6 months. Symptomatic prolapse was defined as a positive response to at least 1 prolapse subscale question of the Urogenital Distress Inventory. "Bother" was defined as responses of slight, moderate, or great. Women with prolapse symptoms were analyzed by baseline BMI category: overweight, obese, and severely obese at baseline and at 6 months. Proportional odds regression and χ tests for trend were used for analysis.
  
  
  RESULTS
  Age mean was 53 (SD, 10) years, BMI mean was 36 (SD, 6) kg/m, and 78% were white. A higher proportion of obese women reported feeling vaginal bulging compared with overweight women (13% vs 0%, P = <0.01). At baseline, 37% (n = 124) reported bothersome "lower abdominal pressure"; 18% (n = 62), bothersome "heaviness in the pelvic area"; and 14% (n = 48), bothersome "pelvic discomfort when standing." Nine percent (n = 31) reported bothersome "feeling," and 2% (n = 6) reported bothersome "seeing a bulge" in the vagina. At 6 months, there were no significant differences in improvement of self-reported bothersome prolapse symptoms in women in the weight loss or the control group.
  
  
  CONCLUSIONS
  In this study of overweight and obese women, increasing BMI was associated with only "feeling" a vaginal bulge. Weight loss did not improve bothersome prolapse symptoms.
authors.affiliation: Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA. dmyers@wihri.org
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Myers
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Sung
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Jennifer
authors.initials: J
authors.lastname: Creasman
authors.forename: Leslee L
authors.initials: LL
authors.lastname: Subak
mesh_terms: D000005:Abdomen / Q000503:physiopathology; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D056887:Pelvic Organ Prolapse / Q000150:complications* / Q000175:diagnosis; D011312:Pressure; D012044:Regression Analysis; D057566:Self Report; D012677:Sensation; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000150:complications* / Q000175:diagnosis; D014621:Vagina / Q000473:pathology; D015431:Weight Loss