Hypothesis / aims of study
Obesity is a major modifiable risk factor linked to extensive comorbidities and a substantial reduction in women’s quality of life (QOL), including urinary incontinence (UI) and sexual dysfunction. With 40% of adult women worldwide being overweight and 15% classified as obese, the burden of obesity-related pelvic floor disorders is substantial. Obesity contributes to UI through increased intra-abdominal pressure, metabolic dysfunction, and hormonal disturbances. Given that obese women experience poorer outcomes after incontinence surgery than women with normal BMI, identifying conservative strategies such as weight reduction is clinically relevant.
The primary aim of this study was to evaluate the impact of bariatric surgery on UI symptoms and UI-related QOL in morbidly obese female patients undergoing laparoscopic weight-loss surgery. The hypothesis was that weight reduction, through bariatric procedures such as laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric banding (LGB), results in measurable improvement or resolution of UI at 12-month follow-up.
Study design, materials and methods
This prospective observational study included 56 consecutively referred morbidly obese women scheduled to undergo LSG or LGB at our hospital bariatric clinic. Ethical approval was obtained, and informed consent secured. Participants completed an anonymous questionnaire addressing UI, its severity, and its effect on QOL. The validated ICIQ-UI-SF questionnaire was administered preoperatively and again 12 months postoperatively.
Collected demographic data included age, BMI, smoking status, parity, menopausal status, and menstrual irregularities. Obstetric and gynaecological history, as well as obesity-related comorbid conditions such as type 2 diabetes and hypertension, were recorded. Exclusion criteria included previous pelvic surgery for incontinence or prolapse and the presence of neurological diseases.
Of the initial 56 women recruited, 52 returned fully completed questionnaires and were included in the final analysis. Thirty women underwent LSG and 22 underwent LGB. Statistical analysis evaluated changes in BMI, UI symptoms, cure rates across UI subtypes (stress, urge, mixed), and QOL domains.
Results
The mean participant age was 42.4 years, and baseline BMI ranged from 38.6 to 55.8 kg/m², with a mean of 46.2 kg/m². A majority (70%) were parous, and 77% reported menstrual irregularities. Comorbidities linked to metabolic syndrome were highly prevalent, affecting 85% of participants, while 28.8% were smokers.
At 12 months post-surgery, all participants demonstrated significant weight loss, with mean BMI reduced to 32.4 kg/m² (p < 0.0001). UI was prevalent in 79% of participants preoperatively. Postoperatively, 17 women (41.5%) reported complete resolution of UI symptoms. Improvement rates varied by UI subtype: 60% for stress UI, 37% for urge UI, and 28% for mixed UI.
Incontinence-specific QOL improved by 17% at follow-up. No statistically significant differences were identified between parous and nulliparous women in either UI cure rates or QOL outcomes. Additionally, participants noted improvements in metabolic conditions, including reduced hypertension, improved glycaemic control, and improved menstrual regularity.
Interpretation of results
The study supports the strong association between obesity and UI and demonstrates that substantial weight loss from bariatric surgery significantly improves both UI symptoms and related QOL. The reductions in intra-abdominal and visceral fat following surgery are likely to decrease intra-abdominal pressure, lowering the mechanical strain on pelvic floor structures and improving continence. However, the observed improvements are likely multifactorial. Enhanced metabolic health, normalization of sex hormone levels, reduction in obesity-related pelvic organ prolapse, improved cardiovascular status, and reduced medication use may all contribute to symptom improvement. These findings align with existing international research, reinforcing the beneficial role of bariatric surgery in managing obesity-related UI.