According to a recent study published in JAMA Internal Medicine, in addition to bariatric surgery facilitating weight loss, the procedure can also reduce urinary incontinence. The study conducted by UC San Francisco researchers is the first to assess the longer-term impact of the procedure on incontinence three years following bariatric surgery.
“Our findings showing another important long-term benefit to bariatric surgery might help to motivate people who are severely overweight,” said first author Leslee L. Subak, M.D., a UCSF professor in the departments of obstetrics, gynecology & reproductive sciences, urology, and epidemiology/biostatistics.
“Research has previously shown that weight loss by several methods — low-calorie diet, behavioral weight reduction, and bariatric surgery — were all associated with improved incontinence in overweight people through the first year,” Subak said. “But there wasn’t evidence of the longer-term effect of these changes. We wanted to see whether incontinence could be improved three years after bariatric surgery and identify factors associated with improvement in incontinence.”
In the United States, urinary incontinence affects about 30 million adults, and accounts for $60 billion in annual medical costs. The condition can cause reduced quality of life, limitations in daily functioning and significant distress. Obesity is a known risk factor for urinary incontinence: each 5-unit increase in Body Mass Index (BMI) is associated with far higher rates of bladder control. Among severely obese women, the prevalence of incontinence is about 70% and 24% for severely obese men.
According to the American Society for Metabolic and Bariatric Surgery, bariatric surgery leads to weight loss by restricting the amount of food the stomach can hold. The standard procedures include sleeve gastrectomy, gastric bypass, biliopancreatic diversion with duodenal switch and adjustable gastric band.
To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery, the team of researchers conducted the Longitudinal Assessment of Bariatric Surgery 2, an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between 2005 and 2009.
Results showed that of the 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years, and the median body mass index was 46 kg/m2. Urinary incontinence was more prevalent among women (49.3%) than men (21.8%).
Following surgery and a large weight loss of 29% of body weight for women and 26% for men, substantial improvements in incontinence were observed, with a majority of women and men achieving remission three years post-surgery. The more weight lost, the higher the chances of improvement. While the risk of relapse rose with each gain of about 10 pounds, overall the researchers found substantial improvement for both women and men. People who were older, had severe walking limitations or were recently pregnant showed less improvement.