title: Bariatric surgery improves urinary incontinence but not anorectal function in obese women.
abstract: BACKGROUND
  While the association between obesity and urinary incontinence (UI) in women has been clearly documented, the relationship with anal incontinence (AI) is less well defined; moreover, while bariatric surgery has been shown to improve UI, its effect on AI is still unclear.
  
  
  METHODS
  A total of 32 obese women were studied by means of PFDI-20 and PFIQ-7 questionnaires and anorectal manometry before and after bariatric surgery and compared with 71 non-obese women.
  
  
  RESULTS
  Obese women showed worse overall questionnaire results (OR 5.18 for PFDI-20 and 2.66 for PFIQ-7). Whereas obese women showed worse results for urinary sub-items and a higher urge UI incidence (43.8 vs 18.3 %, p = 0.013), they did not show worsening in colorecto-anal symptoms. Post-operatively, median PFDI-20 total score did not change (24.2 vs 26.6, p = ns), while there was an improvement in urinary score (14.6 vs 8.3, p < 0.001); median PFIQ-7 improved (4.8 vs 0.0, p = 0.044), but while the urinary score improved (2.4 vs 0.0, p = 0.033), the colorecto-anal score did not change significantly. Although after surgery urge UI decreased from 43.8 to 15.6 % (p = 0.029), the incidence of any AI increased from 28.1 to 40.6 % (p = ns) and flatus incontinence increased from 18.8 to 37.5 % (p = ns). Anorectal manometry did not show significant changes after surgery.
  
  
  CONCLUSIONS
  Obese women had worse questionnaire results, but while showing a higher incidence of UI, they did not experience anorectal function worsening. After bariatric surgery, there was a slight improvement in PFD symptoms related to UI, but anorectal function did not change significantly and flatus incontinence increased.
authors.affiliation: Department of Surgical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126, Turin, Italy.
authors.forename: Gitana
authors.initials: G
authors.lastname: Scozzari
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Rebecchi
authors.forename: Claudio
authors.initials: C
authors.lastname: Giaccone
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiaro
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mistrangelo
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology*; D050110:Bariatric Surgery; D015992:Body Mass Index; D005242:Fecal Incontinence / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005414:Flatulence / Q000453:epidemiology / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D017773:Pelvic Floor / Q000503:physiopathology*; D011184:Postoperative Period; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000503:physiopathology*; D015431:Weight Loss