title: Comprehensive evaluation of the effect of bariatric surgery on pelvic floor disorders.
abstract: BACKGROUND
  The association of pelvic floor disorders (PFD) with obesity is well documented. The spectrum of PFD includes stress urinary incontinence (SUI), urge urinary incontinence (UUI), pelvic organ prolapse (POP), and fecal incontinence (FI). Resolution or improvement of SUI after bariatric surgery has been previously reported. However, the data regarding UUI and other forms of PFD with objective testing are sparse.
  
  
  OBJECTIVE
  Prospectively evaluate the effects of bariatric surgery on the prevalence and severity of pelvic floor disorders.
  
  
  METHODS
  U.S. Academic Hospital.
  
  
  METHODS
  From December 2008 to December 2012, patients who screened positive on a screening questionnaire were asked to participate in the study. Participants completed 3 validated condition-specific questionnaires before surgery and 6-12 months after. A subgroup consented to gynecologic examination (Pelvic Organ Prolapse Quantification [POP-Q] test) and urodynamic testing at similar time points.
  
  
  RESULTS
  Seventy-two study patients underwent laparoscopic gastric bypass (n = 65), sleeve gastrectomy (n = 5), and gastric banding (n = 2). Mean BMI decreased from 47.5 to 32.7 kg/m(2) 1 year after surgery (P<.001). Based on questionnaires, the most prevalent PFD was SUI, identified in 60 (83.3%) patients at baseline and 32 (44.4%, P<.001) at follow-up. There was significant improvement in PFD-related symptoms, quality of life, POP, and sexual function at follow-up. Decrease in prevalence of SUI after surgery was also confirmed with urodynamic testing (from 76.9% to 30.8%, P = .01). There was no significant change in prevalence and severity of POP based on POP-Q exam.
  
  
  CONCLUSIONS
  Bariatric surgery is associated with a decrease in prevalence and severity of diverse forms of urinary incontinence as well as improvement in quality of life and sexual function of morbidly obese women.
authors.affiliation: Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Héctor
authors.initials: H
authors.lastname: Romero-Talamás
authors.affiliation: Department of Obstetrics & Gynecology, Women's Health Institute, Division of Female Pelvic Medicine & Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Cecile A
authors.initials: CA
authors.lastname: Unger
authors.affiliation: Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Department of Obstetrics & Gynecology, Women's Health Institute, Division of Female Pelvic Medicine & Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Barber
authors.affiliation: Digestive Disease Institute, Section of Bariatric and Metabolic Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: brethas@ccf.org.
authors.forename: Stacy
authors.initials: S
authors.lastname: Brethauer
mesh_terms: D050110:Bariatric Surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000523:psychology / Q000601:surgery; D009820:Ohio / Q000453:epidemiology; D059952:Pelvic Floor Disorders / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Bariatric surgery; Pelvic floor disorders; Pelvic organ prolapse; Urinary incontinence