title: Are Obese Patients at an Increased Risk of Pelvic Floor Dysfunction Compared to Non-obese Patients?
abstract: Factors associated with increased intra-abdominal pressure such as chronic cough, morbid obesity, and constipation may be related to pelvic floor dysfunction. In this study, we compared anorectal manometry values and clinical data of class II and III morbidly obese patients referred to bariatric surgery with that of non-obese patients.
  
  
  
  We performed a case-matched study between obese patients referred to bariatric surgery and non-obese patients without anorectal complaints. The groups were matched by age and gender. Men and nulliparous women with no history of abdominal or anorectal surgery were included in the study. Anorectal manometry was performed by the stationary technique, and clinical evaluation was based on validated questionnaires.
  
  
  
  Mean age was 44.8 ± 12.5 years (mean ± SD) in the obese group and 44.1 ± 11.8 years in the non-obese group (p = 0.829). In the obese group, 65.4% of patients had some degree of fecal incontinence. Mean squeeze pressure was significantly lower in obese than in non-obese patients (155.6 ± 64.1 vs. 210.1 ± 75.9 mmHg, p = 0.004), and there was no significant difference regarding mean rest pressure in obese patients compared to non-obese ones (63.7 ± 23.1 vs. 74.1 ± 21.8 mmHg, p = 0.051). There were no significant differences in anorectal manometry values between continent and incontinent obese patients.
  
  
  
  The prevalence of fecal incontinence among obese patients was high regardless of age, gender, and body mass index. Anal squeeze pressure was significantly lower in obese patients compared to non-obese controls.
authors.affiliation: Department of Gastroenterology, Colorectal Surgery Service, Obesity and Metabolic Surgery Service, School of Medicine, Hospital das Clínicas of University of São Paulo, 31, Fabia Street #101, São Paulo, SP, 05051-030, Brazil. isaacneto@hotmail.com.
authors.forename: Isaac José Felippe Corrêa
authors.initials: IJFC
authors.lastname: Neto
authors.affiliation: Department of Gastroenterology, Colorectal Surgery Service, Obesity and Metabolic Surgery Service, School of Medicine, Hospital das Clínicas of University of São Paulo, 31, Fabia Street #101, São Paulo, SP, 05051-030, Brazil.
authors.forename: Rodrigo Ambar
authors.initials: RA
authors.lastname: Pinto
authors.affiliation: Department of Gastroenterology, Colorectal Surgery Service, Obesity and Metabolic Surgery Service, School of Medicine, Hospital das Clínicas of University of São Paulo, 31, Fabia Street #101, São Paulo, SP, 05051-030, Brazil.
authors.forename: José Marcio Neves
authors.initials: JMN
authors.lastname: Jorge
authors.affiliation: Department of Gastroenterology, Colorectal Surgery Service, Obesity and Metabolic Surgery Service, School of Medicine, Hospital das Clínicas of University of São Paulo, 31, Fabia Street #101, São Paulo, SP, 05051-030, Brazil.
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Santo
authors.affiliation: Department of Gastroenterology, Colorectal Surgery Service, Obesity and Metabolic Surgery Service, School of Medicine, Hospital das Clínicas of University of São Paulo, 31, Fabia Street #101, São Paulo, SP, 05051-030, Brazil.
authors.forename: Leonardo Alfonso
authors.initials: LA
authors.lastname: Bustamante-Lopez
authors.affiliation: Department of Gastroenterology, Colorectal Surgery Service, Obesity and Metabolic Surgery Service, School of Medicine, Hospital das Clínicas of University of São Paulo, 31, Fabia Street #101, São Paulo, SP, 05051-030, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.affiliation: Department of Gastroenterology, Colorectal Surgery Service, Obesity and Metabolic Surgery Service, School of Medicine, Hospital das Clínicas of University of São Paulo, 31, Fabia Street #101, São Paulo, SP, 05051-030, Brazil.
authors.forename: Sérgio Carlos
authors.initials: SC
authors.lastname: Nahas
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology*; D050110:Bariatric Surgery; D016022:Case-Control Studies; D003248:Constipation / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D017773:Pelvic Floor / Q000503:physiopathology; D059952:Pelvic Floor Disorders / Q000209:etiology / Q000503:physiopathology*; D011312:Pressure; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Anorectal manometry; Defecation frequency; Fecal incontinence; Obesity