Weight-loss surgery may reduce incontinence

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The authors of a recently published study have found that bariatric surgery may provide a significant benefit beyond dramatic weight loss.

Bariatric weight-loss surgery significantly improved urinary incontinence in severely obese people over a 3-year period in a newly reported study.

The findings extend previous research showing weight-loss-associated reductions in incontinence over shorter periods of about a year.

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The observational cohort study investigated incontinence in 1,987 patients who underwent bariatric surgery between 2005 and 2009 at 10 hospitals nationwide. Using a validated questionnaire, researchers assessed frequency and type of incontinence episodes during the previous 3 months at baseline (before surgery), then annually for 3 years. They defined prevalent incontinence as episodes occurring at least once a week and remission as a decline between baseline and follow-up from prevalent incontinence to episodes less often than weekly.

Study participants, predominantly women (78.8%), ranged in age from 18 to 78 years with a median age of 47 years. Median body mass index at baseline was 47 kg/m². Researchers controlled for age, race, smoking status, and recent pregnancy. Before surgery, 49.3% of women and 21.8% of men reported experiencing incontinence at least once a week.

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At 1 year after surgery, women had lost a mean of 29.5% of body weight and men had lost 27%. The prevalence of incontinence had fallen markedly, to 18.3% among women and 9.8% among men. Three years after surgery, the prevalence was higher than at 1 year (24.8% for women, 12.2% for men) but still substantially below baseline.

The odds of improved incontinence increased with the amount of weight lost. The risk of relapse increased with each 10-pound weight gain. Younger age and absence of severe walking limitations were associated with greater improvement; recent pregnancy was associated with less improvement.

Although previous studies have shown reduced incontinence a year after weight loss by such methods as a low-calorie diet, behavioral modification, and bariatric surgery, “there wasn’t evidence on the longer-term effects of these changes,” said lead author Leslee L. Subak, MD, of the University of California, San Francisco. “Improvement in urinary incontinence may help motivate severely obese men and women with incontinence to undergo bariatric surgery or other weight-loss interventions and improve long-term weight maintenance,” he noted.

The study, which was published online in JAMA Internal Medicine (June 22, 2015), was supported by the Longitudinal Assessment of Bariatric Surgery 2, a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr. Subak has received a grant from the NIDDK.