title: Obesity and Pelvic Floor Dysfunction: Battling the Bulge.
abstract: OBJECTIVE
  Pelvic floor disorders (PFDs) comprise a broad spectrum of clinical conditions, including urinary incontinence, pelvic organ prolapse, fecal incontinence, and defecatory dysfunction. These disorders are common conditions that generate significant medical, emotional, social, and economic issues for many women. Obese women are disproportionately affected compared with their normal-weight peers, with more than half of women with a body mass index of greater than 35 kg/m(2) reporting a PFD, compared with only 32% in women with a normal body mass index. Despite this prevalence, little research is available to help guide and tailor treatment in obese populations.
  
  
  OBJECTIVE
  This review outlines current knowledge regarding the relative contribution of obesity to PFDs, as well as its effect on treatment implications.
  
  
  METHODS
  Literature relating to the incidence and treatment of PFDs in obese populations was reviewed.
  
  
  RESULTS
  Both nonsurgical and surgical weight loss improves all PFDs. Obese women benefit from pelvic floor training, biofeedback, and pharmacologic treatments of urinary and fecal incontinence. Surgical treatments of stress urinary incontinence note increased operative times and perhaps slightly lower cure rates, but overall good treatment success in obese women. No increased risks of complications or treatment failure were noted in obese women treated for prolapse surgically, and pessaries work well for both prolapse and stress urinary incontinence in obese women.
  
  
  CONCLUSIONS
  Although literature regarding treatment of PFDs in obese women is limited, the available evidence demonstrates good treatment outcomes in obese populations. Further research into how to best counsel and optimize treatment of obese patients is essential as the obesity epidemic continues.
authors.affiliation: Associate Physician, Department of Obstetrics and Gynecology, Kaiser Permanente, Martinez, CA.
authors.forename: Shireen
authors.initials: S
authors.lastname: de Sam Lazaro
authors.affiliation: Assistant Professor.
authors.forename: Rahel
authors.initials: R
authors.lastname: Nardos
authors.affiliation: Professor and Chair, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D005242:Fecal Incontinence / Q000628:therapy; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications*; D059952:Pelvic Floor Disorders / Q000209:etiology / Q000628:therapy*; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000628:therapy; D014549:Urinary Incontinence / Q000628:therapy; D015431:Weight Loss