Bariatric Surgery Versus Pelvic Floor Muscle Training: Which is Superior for Managing Urinary Incontinence?

Severe obesity substantially aggravates stress urinary incontinence (SUI) in older women. While both bariatric surgery and pelvic floor muscle exercise (PFME) are used to alleviate symptoms, their comparative effectiveness in elderly populations remains unclear. This retrospective study aimed to compare the continence outcomes of laparoscopic sleeve gastrectomy (SG) and structured PFME in women aged ≥ 60 years with obesity-related SUI and to explore the impact of early postoperative gastrointestinal symptoms.

We conducted a retrospective propensity score-matched cohort study including women aged ≥ 60 years with SUI treated with SG, PFME, or no continence-directed intervention. Surgical patients were matched 1:2 to PFME participants and untreated controls based on age, body mass index, baseline International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, incontinence subtype, parity, and menopausal duration. The primary outcome was continence improvement at 12 months, defined as an ICIQ-SF score ≤ 7. Secondary outcomes included absolute change in ICIQ-SF score, complete continence recovery, sleep quality, and postoperative gastrointestinal symptoms.

At 12 months, both SG and PFME were associated with significant improvements in urinary incontinence compared with no treatment (p < 0.001). PFME achieved the highest rate of symptom remission (ICIQ-SF ≤ 7) at one year (56.5%), exceeding that observed after SG (34.8%) and in untreated controls (8.7%). Among patients undergoing SG, most improvements occurred within the moderate symptom range (ICIQ-SF 7-14). Multivariable analysis identified early postoperative diarrhea as an independent factor associated with reduced continence improvement after SG (adjusted OR 1.65, 95% CI 1.21-1.95).

In older women with obesity-related SUI, both sleeve gastrectomy and structured PFME improve continence outcomes, with PFME demonstrating superior effectiveness as a standalone intervention at one year. Early postoperative diarrhea significantly attenuates the continence benefits of bariatric surgery and represents a potentially modifiable factor.