The long-term effects of bariatric surgery on female urinary incontinence

Obesity has been shown to negatively impact pelvic floor support and associated urinary incontinence (UI), however little is known regarding the long-term effect of bariatric surgery on urinary incontinence.

The aim of this study is to determine the impact of bariatric surgery on female UI at twelve months post-operatively.

A prospective cohort study was performed of all patients undergoing bariatric surgery who reported UI between January 2008 to January 2017.

Three hundred and sixty-six women undergoing bariatric surgery and filled out the ICIQ-UI SF questionnaire. Of these 44% (151/366) had UI pre-operatively, and of these 40% (61/151) completed the questionnaire at one year post-operatively. The mean pre-operative weight and body mass index (BMI) were 136 (21.3)kg and 51 (7.1) kg/m² respectively. The percentage excess weight loss was 74%. Sixty-six percent underwent laparoscopic gastric bypass, and the remainder underwent sleeve gastrectomy. Thirty-four percent reported stress incontinence (SUI), 21% reported overactive bladder (OAB), and 44% reported mixed incontinence. The cure rates post-operatively for SUI, OAB and mixed incontinence, were 41%, 38% and 48% respectively, and there was a 40% improvement in UI when assessing pad use (p < 0.001). Using the ICIQ-UI SF, the mean score was reduced by 4.8 (5), from 9.3 (4) pre-operatively to 4.5 (5) post-operatively.

Bariatric surgery results in a clinically significant long-term improvement in UI, with a significant cure rate at one year post bariatric surgery. The improvement in severity score, based on the Incontinence Questionnaire used, did not correlate with reduction in post-operative BMI.