Bariatric surgery as a possible choice for therapy and prevention of pelvic floor dysfunctions

Abstract

In our country, 10% of the population is obese; probably 20% of these subjects are affected by severe obesity (BMI >40) or by obesity complicated by diseases able to reduce life expectancy and to worsen quality of daily living. So these patients will be considered chronically ill. The rapid increase of obesity in the incoming years foresees a percentage of obese people suffering from other chronic diseases much higher than nowadays. Bariatric surgery is an effective remedy to treat those obese who have had no benefit from previous medical and nutritional treatments. Such complex surgery involves doctors of different disciplines, and requires dedicated resources. In particular, for patients (women and men) with pelvic floor diseases, there can be a significant improvement after bariatric surgery in terms of bladder and rectal function, with reduction of problems connected with continence. It is known that urinary and fecal incontinence is more prevalent in obese subjects than in non-obese population. Patients with severe obesity have an increased incidence of pelvic organ prolapsed, stress incontinence, pelvic floor disorders, difficulty with complete bladder emptying, excessive filling incontinence, and bladder irritation symptoms. On the other hand, pathological obesity can be considered an independent risk factor for urinary incontinence and bladder symptoms, but it is really a modifiable factor in case a proper weight loss can be obtained. KEY WORDS obesity; bariatric surgery; urinary incontinence; fecal incontinence