Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders?

Area of Science:

• Urogynecology
• Bariatric Surgery
• Pelvic Floor Disorders

Background:

• Obesity is a significant risk factor for pelvic floor disorders (PFDs), including urinary incontinence, fecal incontinence, and pelvic organ prolapse.
• Weight loss achieved through bariatric surgery has shown to improve existing PFD symptoms.
• The impact of bariatric surgery on pelvic floor anatomy and function in women without pre-existing PFDs, and its potential as a prophylactic tool, remains under-researched.

Purpose of the Study:

• To investigate the influence of bariatric surgery on pelvic floor anatomy and function in women without prior PFDs.
• To evaluate the potential of bariatric surgery as a tool for PFD prophylaxis.

Main Methods:

• A prospective, non-randomized case-control study was conducted from January 2014 to September 2017.
• Pelvic floor ultrasound examinations, including bladder neck position assessment at rest, during levator ani tension, and Valsalva maneuver, were performed before and 12-18 months after bariatric surgery.
• Exclusion criteria included POPQ stage >2 and existing PFD complaints.

Main Results:

• Fifty-nine women underwent bariatric surgery (57 sleeve gastrectomy, 2 gastric bypass), with a significant BMI reduction (43.8 to 29 kg/m²).
• A statistically significant improvement in bladder neck position was observed at rest, during tension, and Valsalva maneuver post-surgery (p < 0.05).
• No significant differences were found in bladder neck mobility or levator ani muscle function after weight loss.

Conclusions:

• Bariatric surgery is associated with improved bladder neck position in women without pre-existing PFDs.
• The findings suggest that bariatric surgery could potentially serve as a preventive strategy for pelvic floor disorders.
• The surgery does not appear to negatively impact levator ani function or bladder neck mobility, indicating no adverse effect on pre-existing pelvic dysfunction.