There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients.

We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI ≥ 33 kg/m2 were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent laparoscopic surgery: gastric sleeve, bypass or banding, performed by four surgeons in our hospital. The type of incontinence was not assessed at the initial visit done by the surgeon. All patients who declared being incontinent were referred to the urologist where they received the ICIQ – UI -SF questionnaire before their bariatric surgery and during follow up visits. The sum of points obtained at questions 3,4 and 5 was used to evaluate the severity of incontinence as well as the impact on the quality of life. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and way of deliveries, concomitant conditions and medications. The type of incontinence was assessed by the urologist before bariatric surgery, as urge, stress or mixed incontinence. At follow up visits, the patients were also asked to fill in a 10 point VAS questionnaire evaluating their perception on the improvement of incontinence symptoms. Data was analyzed using the t-test statistical analysis. Our objective defined change in incontinence as cure, improved, no change and worse.

Our study included 54 women in which initial data and at least 18 months of follow up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13,31±5,18 before to 8,30±4,49 points after surgery (p<0.0001). Before surgery, 38 patients (70%) described severe incontinence, compared to only 20 patients (37%) after surgery. 16 women (31%) report complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire shows improvement in 46 cases (85%). Pad usage improved from 7,04±2,79 to 3,42±2,77 (p<0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence doesn’t seem to be relevant, but our sample size was too small to lead to statistically significant results. There is no impact on the outcome of incontinence of number/type of delivery, age or BMI.

Some studies suggest that urge incontinence worsens after bariatric surgery. Urodynamics before bariatric surgery is futile.

Our data shows that bariatric surgery is able to cure urinary incontinence in one of three obese women. Significant improvement is obtained in more than two thirds of the patients, regardless the type of incontinence. For an obese female with urinary incontinence, the treatment for obesity should prevail and incontinence should be treated only if symptoms remain.