Skip to main content

Advertisement

SpringerLink
Log in

The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

It has been suggested that weight reduction decreases the frequency of urinary incontinence (UI) episodes. However, it is not known if this improvement is associated with anatomical changes in the pelvis. The aim of this study was to investigate the effects of weight loss on UI episodes and pelvic floor anatomy.

Methods

Three hundred seventy-eight overweight/obese women were randomly allocated either to behavioral weight loss or to structured education programs. The patients were evaluated by voiding diary, Pelvic Floor Distress Inventory (PFDI), and Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and after 6 months.

Results

The women in the intervention group had a mean weight loss of 9.4 %, whereas the weight in the control group remained almost the same (P < 0.001). While there were no change in stress and urge incontinence episodes in the control group, the mean number of stress incontinence episodes per 3-day diary dropped from 7.96 episodes to 3.11, and the mean number of urge incontinence episodes per 3-day diary dropped from 2.85 episodes to 1.08 in the study group (P < 0.05). Regarding the POP-Q system, only genital hiatus, perineal body, and Ap measurements were significantly lower in the weight loss group than in the control group after 6 months.

Conclusions

Weight reduction provides improvement in episodes of UI, decreases the incidence of drops of urine leakage, and increases quality of life related to pelvic floor symptoms. However, there are little to no changes in the parameters of the POP-Q system with weight reduction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Elving LB, Foldspang A, Lam GW et al (1989) Descriptive epidemiology of urinary incontinence in 3,100 women age 30–59. Scand J Urol Nephrol Suppl 125:37–43

    CAS  PubMed  Google Scholar 

  2. Brown JS, Grady D, Ouslander JG et al (1999) Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. Obstet Gynecol 94:66–70

    Article  CAS  PubMed  Google Scholar 

  3. Ertunc D, Tok EC, Pata O, Dilek U, Ozdemir G, Dilek S (2004) Is stress urinary incontinence a familial condition? Acta Obstet Gynecol Scand 83:912–916

    Article  PubMed  Google Scholar 

  4. Subak LL, Richter HE, Hunskaar S (2009) Obesity and urinary incontinence: epidemiology and clinical research update. J Urol 182(6 Suppl):S2–S7

    Article  PubMed Central  PubMed  Google Scholar 

  5. Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D (1996) Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol 87(5 Pt 1):715–721

    Article  CAS  PubMed  Google Scholar 

  6. Wing RR, Creasman JM, West DS et al (2010) Improving urinary incontinence in overweight and obese women through modest weight loss. Obstet Gynecol 116(2 Pt 1):284–292

    Article  PubMed Central  PubMed  Google Scholar 

  7. Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS (2005) Weight loss: a novel and effective treatment for urinary incontinence. J Urol 174:190–195

    Article  PubMed Central  PubMed  Google Scholar 

  8. Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS (2007) Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol 110:1034–1040

    Article  PubMed  Google Scholar 

  9. Wing RR, West DS, Grady D et al (2010) Effect of weight loss on urinary incontinence in overweight and obese women: results at 12 and 18 months. J Urol 184:1005–1010

    Article  PubMed Central  PubMed  Google Scholar 

  10. Subak LL, Wing R, West DS et al (2009) Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 360:481–490

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Bump RC, Sugerman HJ, Fantl JA, McClish DK (1992) Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol 167:392–397

    Article  CAS  PubMed  Google Scholar 

  12. Noblett KL, Jensen JK, Ostergard DR (1997) The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct 8:323–326

    Article  CAS  PubMed  Google Scholar 

  13. Sugerman H, Windsor A, Bessos M, Kellum J, Reines H, DeMaria E (1998) Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity. Int J Obes Relat Metab Disord 22:230–235

    Article  CAS  PubMed  Google Scholar 

  14. Tok EC, Yasa O, Ertunc D, Savas A, Durukan H, Kanik A (2010) The effect of pelvic organ prolapse on sexual function in a general cohort of women. J Sex Med 7:3957–3962

    Article  PubMed  Google Scholar 

  15. Ryan DH, Espeland MA, Foster GD et al (2003) Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 24:610–628

    Article  PubMed  Google Scholar 

  16. Paffenbarger RS Jr, Wing AL, Hyde RT (1978) Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 108:161–175

    PubMed  Google Scholar 

  17. Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  CAS  PubMed  Google Scholar 

  18. Yarnell JW, Voyle GJ, Sweetnam PM, Milbank J, Richards CJ, Stephenson TP (1982) Factors associated with urinary incontinence in women. J Epidemiol Community Health 36:58–63

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Barber MD, Kuchibhatla MN, Pieper CF et al (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185:1388–1395

    Article  CAS  PubMed  Google Scholar 

  20. Toprak Celenay S, Akbayrak T, Kaya S, Ekici G, Beksac S (2012) Validity and reliability of the Turkish version of the Pelvic Floor Distress Inventory-20. Int Urogynecol J 23:1123–1127

    Article  PubMed  Google Scholar 

  21. Greer WJ, Richter HE, Bartolucci AA, Burgio KL (2008) Obesity and pelvic floor disorders: a systematic review. Obstet Gynecol 112(2 Pt 1):341–349

    Article  PubMed Central  PubMed  Google Scholar 

  22. Hendrix SL, Clark A, Nygaard I et al (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186:1160–1166

    Article  PubMed  Google Scholar 

  23. Kudish BI, Iglesia CB, Sokol RJ et al (2009) Effect of weight change on the natural history of pelvic organ prolapse. Obstet Gynecol 113:81–87

    Article  PubMed Central  PubMed  Google Scholar 

  24. Schaffer JI, Wai CY, Boreham MK (2005) Etiology of pelvic organ prolapse. Clin Obstet Gynecol 48:639–647

    Article  PubMed  Google Scholar 

  25. Marchionni M, Bracco GL, Checcucci V et al (1999) True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med 44:679–684

    CAS  PubMed  Google Scholar 

  26. Bradley CS, Zimmerman MB, Qi Y, Nygaard IE (2007) Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol 109:848–854

    Article  PubMed  Google Scholar 

  27. Washington BB, Erekson EA, Kassis NC, Myers DL (2010) The association between obesity and stage II or greater prolapse. Am J Obstet Gynecol 202:503.e1–503.e4

    Article  Google Scholar 

  28. Nygaard I, Bradley C, Brandt D, Women’s Health Initiative (2004) Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol 104:489–497

    Article  PubMed  Google Scholar 

  29. Chatoor DR, Taylor SJ, Cohen CR, Emmanuel AV (2007) Faecal incontinence. Br J Surg 94:134–144

    Article  CAS  PubMed  Google Scholar 

  30. Richter HE, Burgio KL, Clements RH, Goode PS, Redden DT, Varner RE (2005) Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol 106:1272–1277

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Mersin State Hospital, Mersin, Turkey

    Yavuz M. Gozukara

  2. Department of Obstetrics and Gynecology, Mersin University School of Medicine, Zeytinlibahce, Mersin, Turkey, 33079

    Gulcan Akalan, Ekrem C. Tok, Hakan Aytan & Devrim Ertunc

Authors
  1. Yavuz M. Gozukara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gulcan Akalan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ekrem C. Tok
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hakan Aytan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Devrim Ertunc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ekrem C. Tok.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gozukara, Y.M., Akalan, G., Tok, E.C. et al. The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy. Int Urogynecol J 25, 1219–1225 (2014). https://doi.org/10.1007/s00192-014-2368-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-014-2368-z

Keywords

Search

Navigation