Incontinence: An Underappreciated Problem in Obesity and Bariatric Surgery
- Adil E. Bharucha
- … show all 1 hide
Driven by the obesity epidemic, the number of bariatric operations performed in the United States has increased markedly, by one estimate from ~20,000 in 1998 to 140,000 in 2004, and plateaued thereafter . While diarrhea is a recognized consequence of intestinal bypass procedures, Roberson and colleagues in this issue of the journal highlight, for the first time, that fecal incontinence (FI) may begin or worsen after bariatric surgery . Of note, 48% of women and 42% of men reported FI for liquid stools while 21% of women and 30% of men reported solid FI after surgery. Moreover, 55% of women and 31% of men reported their symptoms were worse after surgery. While these figures may be affected by response rates (48%) or, since surveys were only conducted after surgery, by recall bias, they draw attention for the first time to an underappreciated and significant problem since FI can be a devastating symptom which can substantially impair quality of life [3, 4].
Consistent with studies ...
- Kohn GP, Galanko JA, Overby DW, Farrell TM. Recent trends in bariatric surgery case volume in the United States. Surgery. 2009;146:375–380. CrossRef
- Roberson EN, Gould JC, Wald A. Urinary and fecal incontinence after bariatric surgery. Dig Dis Sci. 2010. doi:10.1007/s10620-010-1190-9.
- Norton NJ. The perspective of the patient. Gastroenterology. 2004;126:S175–S179. CrossRef
- Bharucha AE, Zinsmeister AR, Locke GR, Schleck C, McKeon K, Melton LJ. Symptoms and quality of life in community women with fecal incontinence. Clin Gastroenterol Hepatol. 2006;4:1004–1009. CrossRef
- Bharucha AE, Zinsmeister AR, Locke GR, et al. Risk factors for fecal incontinence: a population-based study in women. Am J Gastroenterol. 2006;101:1305–1312. CrossRef
- Whitehead WE, Borrud L, Goode PS, et al. Pelvic floor disorders network. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137:512–517. CrossRef
- Fox M, Schwizer W, Menne D, Stutz B, Fried M, Thumshirn M. The physical properties of rectal contents have effects on anorectal continence: insights from a study into the cause of fecal spotting on orlistat. Dis Colon Rectum. 2004;47:2147–2156. CrossRef
- Zhang H, DiBaise JK, Zuccolo A, et al. Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci USA. 2009;106:2365–2370. CrossRef
- Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008;27:749–757. CrossRef
- Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481–490. CrossRef
- Wasserberg N, Haney M, Petrone P, et al. Fecal incontinence among morbid obese women seeking for weight loss surgery: an underappreciated association with adverse impact on quality of life. Int J Colorectal Dis. 2008;23:493–497. CrossRef
- Altman D, Falconer C, Rossner S, Melin I. The risk of anal incontinence in obese women. Int Urogynecol J. 2007;18:1283–1289. CrossRef
- Bharucha AE, Melton LJ, Schleck C, Zinsmeister AR. A population-based case-control study of fecal incontinence (FI). Gastroenterology. 2010;138:S-99.
- Delgado-Aros S, Locke GR 3rd, Camilleri M, et al. Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study. Am J Gastroenterol. 2004;99:1801–1806. CrossRef
- Bharucha AE, Seide B, Guan Z, Andrews CN, Zinsmeister AR. Effect of tolterodine on gastrointestinal transit and bowel habits in healthy subjects. Neurogastroenterol Motil. 2008;20:643–648. CrossRef
- De Keulenaer BL, De Waele JJ, Powell B, Malbrain MLNG. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med. 2009;35:969–976. CrossRef
- Mishra GD, Hardy R, Cardozo L, Kuh D. Body weight through adult life and risk of urinary incontinence in middle-aged women: results from a British prospective cohort. Int J Obes. 2008;32:1415–1422. CrossRef
- Leigh RJ, Turnberg LA. Faecal incontinence: the unvoiced symptom. Lancet. 1982;1:1349–1351. CrossRef
- Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology. 2005;129:42–49. CrossRef
- Wald A. Con: Anorectal manometry and imaging are not necessary in patients with fecal incontinence. Am J Gastroenterol. 2006;101:2681–2683. CrossRef
- Bharucha AE. Pro: Anorectal testing is useful in fecal incontinence. Am J Gastroenterol. 2006;101:2679–2681. CrossRef
- Fox M, Stutz B, Menne D, Fried M, Schwizer W, Thumshirn M. The effects of loperamide on continence problems and anorectal function in obese subjects taking orlistat. Dig Dis Sci. 2005;50:1576–1583. CrossRef
- Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr Res. 2008;28:293–298. CrossRef
- Machado JDC, Campos CS, Lopes Dah Silva C, et al. Intestinal bacterial overgrowth after Roux-en-Y gastric bypass. Obes Surg. 2008;18:139–143. CrossRef
- Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman DA, Whitehead W. Randomized controlled trial shows biofeedback to be superior to alternative treatments for fecal incontinence. Dis Colon Rectum. 2009;52:1730–1737.
- Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Sys Rev. 2009;1.
- Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–632 (discussion 632–625).
- Longitudinal Assessment of Bariatric Surgery C, Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–454.
- Incontinence: An Underappreciated Problem in Obesity and Bariatric Surgery
Digestive Diseases and Sciences
Volume 55, Issue 9 , pp 2428-2430
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Adil E. Bharucha (1)
- Author Affiliations
- 1. Clinical Enteric Neuroscience Translational and Epidemiological Research Program (C.E.N.T.E.R.), Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, 200 First St. S.W., Rochester, MN, 55905, USA