Obesity represents a critical health issue and it is also a risk factor for pelvic floor disorders (PFD). It is important to screen patients for obesity to assess their quality of life (QOL) and reduce health care costs.
Methodsː
We evaluated the prevalence of PFD, such as urinary incontinence (UI), fecal incontinence (FI), constipation, rectal and female pelvic organ prolapse, and also the QOL of obese patients referred to our center.
Resultsː
The most prevalent PFD was constipation, affecting 18% (n = 71) of the patients, 11% for FI (n = 43), and 17% for UI (n = 67). The QOL, according to the Short Form-36 results, was worse in the obese group with PFD than the obese patients without PFD (p < 0.01). In only one subscale, mental health, the difference was not statistically different.
Conclusionsː
The prevalence of PFD was almost similar between the obese and the control group. However, obese patients with PFD present a lower QOL than obese patients without PFD. This aspect is essential to investigate on embarrassing health problems, often hidden by patients, to improve QOL.
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References
1.
Uustal FornellE, WingrenG, KjolhedeP. Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand, 2004; 83:383–389.
2.
Ul-HaqZ, MackayDF, FenwickE, PellJP. Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36. Obesity (Silver Spring), 2013; 21:E322–E327.
3.
FlegalKM, CarrollMD, KitBK, OgdenCL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA, 2012; 307:491–497.
4.
LuppinoFS, de WitLM, BouvyPF, StijnenT, CuijpersP, PenninxBWJH, et al.Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry, 2010; 67:220–229.
DeeA, KearnsK, O'NeillC, SharpL, StainesA, O'DwyerV, et al.The direct and indirect costs of both overweight and obesity: a systematic review. BMC Res Notes, 2014; 7:242.
7.
de Sam LazaroS, NardosR, CaugheyAB. Obesity and pelvic floor dysfunction: battling the bulge. Obstet Gynecol Surv, 2016; 71:114–125.
8.
NetoIJFC, PintoRA, JorgeJMN, SantoMA, Bustamante-LopezLA, CecconelloI, et al.Are obese patients at an increased risk of pelvic floor dysfunction compared to non-obese patients?. Obes Surg, 2017; 27:1822–1827.
9.
MerrellJ, BrethauerS, WindoverA, AshtonK, HeinbergL. Psychosocial correlates of pelvic floor disorders in women seeking bariatric surgery. Surg Obes Relat Dis, 2012; 8:792–796.
10.
MacLennanAH, TaylorAW, WilsonDH, WilsonD. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG An Int J Obstet Gynaecol, 2000; 107:1460–1470.
11.
KepenekciI, KeskinkilicB, AkinsuF, CakirP, ElhanAH, ErkekAB, et al.Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity. Dis Colon Rectum, 2011; 54:85–94.
12.
BruscianoL, LimongelliP, del GenioG, RossettiG, SansoneS, HealeyA, et al.Clinical and instrumental parameters in patients with constipation and incontinence: their potential implications in the functional aspects of these disorders. Int J Colorectal Dis, 2009; 24:961–967.
13.
GambardellaC, BruscianoL, Del GenioG, ToloneS, TerraccianoG, GualtieriG, et al.Predictive parameters to identify incontinent patients amenable for rehabilitation treatment: the muscular synergies evaluation. Arq Gastroenterol, 2019; 56:452–453.
14.
PomianA, LisikW, KosieradzkiM, BarczE. Obesity and pelvic floor disorders: a review of the literature. Med Sci Monit, 2016; 22:1880–1886.
15.
Durigon KellerK, La RosaVL, Marques CerentiniT, Machado de SouzaC, Langlois CostaF, Viana da RosaP, et al.. Quality of life and urinary incontinence symptoms in women undergoing bariatric surgery: a combined case-cohort study. Female Pelvic Med Reconstr Surg, 2019. [Epub ahead of print]; DOI: 10.1097/SPV.0000000000000757.
16.
TorellaM, De FranciscisP, RussoC, GalloP, GrimaldiA, AmbrosioD, et al.Stress urinary incontinence: usefulness of perineal ultrasound. Radiol Med, 2014; 119:189–194.
17.
Romero-TalamásH, UngerCA, AminianA, SchauerPR, BarberM, BrethauerS. Comprehensive evaluation of the effect of bariatric surgery on pelvic floor disorders. Surg Obes Relat Dis, 2016; 12:138–143.
18.
JantaratnotaiN, MosikanonK, LeeY, McIntyreRS. The interface of depression and obesity. Obes Res Clin Pract, 2017; 11:1–10.
19.
GargR, SaxenaSK, BashirS. Is obesity a risk to depression? A cross-sectional study. Ind Psychiatry J, 2019; 28:130–134.
20.
LaganàAS, La RosaVL, RapisardaAMC, VitaleSG. Pelvic organ prolapse: the impact on quality of life and psychological well-being. J Psychosom Obstet Gynaecol, 2018; 39:164–166.
21.
LianW, ZhengY, HuangH, ChenL, CaoB. Effects of bariatric surgery on pelvic floor disorders in obese women: a meta-analysis. Arch Gynecol Obstet, 2017; 296:181–189.
22.
BruscianoL, LimongelliP, del GenioG, SansoneS, RossettiG, MaffettoneV, et al.Useful parameters helping proctologists to identify patients with defaecatory disorders that may be treated with pelvic floor rehabilitation. Tech Coloproctol, 2007; 11:45–50.
23.
BruscianoL, ToloneS, Del GenioG, GrossiU, SchiattarellaA, PiccoloFP, et al.Middle-term outcomes of Gatekeeper implantation for fecal incontinence. Dis Colon Rectum, 2020; 63:514–519.
24.
NygaardI, BradleyC, BrandtD, Women's HealthInitiative. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol, 2004; 104:489–497.
25.
AgachanF, ChenT, PfeiferJ, ReissmanP, WexnerSD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum, 1996; 39:681–685.
26.
JorgeMJN, WexnerSD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993; 36:77–97.
27.
SandvikH, HunskaarS, SeimA, HermstadR, VanvikA, BrattH. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health, 1993; 47:497–499.
WareJEJ, SherbourneCD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 1992; 30:473–483.
30.
von ElmE, AltmanDG, EggerM, PocockSJ, GøtzschePC, VandenbrouckeJP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet, 2007; 370:1453–1457.
31.
BruscianoL, GambardellaC, ToloneS, Del GenioG, TerraccianoG, GualtieriG, et al.An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the same whole in the harmonic functioning of the pelvic floor. Tech Coloproctol, 2019; 23:603–605.
32.
De FranciscisP, ColacurciN, RiemmaG, ConteA, PittanaE, GuidaM, et al.A nutraceutical approach to menopausal complaints. Medicina (Kaunas), 2019; 55:544.
33.
Al-SafiZA, PolotskyAJ. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol, 2015; 29:548–553.
34.
SeravalleG, GrassiG. Obesity and hypertension. Pharmacol Res, 2017; 122:1–7.
35.
StehouwerCDA. Microvascular dysfunction and hyperglycemia: a vicious cycle with widespread consequences. Diabetes, 2018; 67:1729–1741.
36.
PolskyS, EllisSL. Obesity, insulin resistance, and type 1 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes, 2015; 22:277–282.
GuerraS, SherrillDL, BobadillaA, MartinezFD, BarbeeRA. The relation of body mass index to asthma, chronic bronchitis, and emphysema. Chest, 2002; 122:1256–1263.
40.
RodrigoGJ, PlazaV. Body mass index and response to emergency department treatment in adults with severe asthma exacerbations. Chest, 2007; 132:1513–1519.
41.
ChenCCG, GatmaitanP, KoeppS, BarberMD, ChandB, SchauerPR, et al.Obesity is associated with increased prevalence and severity of pelvic floor disorders in women considering bariatric surgery. Surg Obes Relat Dis, 2017; 5:411–415.
42.
BrownJS, SeeleyDG, FongJ, BlackDM, EnsrudKE, GradyD. Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol, 1996; 87:715–721.
43.
Ait SaidK, LerouxY, MenahemB, DoerflerA, AlvesA, TillouX. Effect of bariatric surgery on urinary and fecal incontinence: prospective analysis with 1-year follow-up. Surg Obes Relat Dis, 2017; 13:305–312.
44.
KatsareliEA, Dedoussis GV. Biomarkers in the field of obesity and its related comorbidities. Expert Opin Ther Targets, 2014; 18:385–401.
45.
FujiokaK. Current and emerging medications for overweight or obesity in people with comorbidities. Diabetes Obes Metab, 2015; 17:1021–1032.
46.
SarwerDB, SpitzerJC, WaddenTA, RosenRC, MitchellJE, LancasterK, et al.Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and nonsurgical weight loss. Surg Obes Relat Dis, 2013; 9:997–1007.
47.
VergeldtTFM, WeemhoffM, IntHoutJ, KluiversKB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J, 2015; 26:1559–1573.
48.
YenielAO, ErgenogluAM, AskarN, ItilIM, MeseriR. How do delivery mode and parity affect pelvic organ prolapse?. Acta Obstet Gynecol Scand, 2013; 92:847–851.
49.
SmithIE, ShneersonJM. Is the SF 36 sensitive to sleep disruption? A study in subjects with sleep apnoea. J Sleep Res, 1995; 4:183–188.
50.
MavroudiM, PapakostaD, KontakiotisT, DomvriK, KalamarasG, ZarogoulidouV, et al.Sleep disorders and health-related quality of life in patients with interstitial lung disease. Sleep Breath, 2018; 22:393–400.
51.
OgilvieRP, PatelSR. The epidemiology of sleep and obesity. Sleep Health, 2017; 3:383–388.
52.
St-OngeM-P. Sleep-obesity relation: underlying mechanisms and consequences for treatment. Obes Rev, 2017; 18:34–39.
