Prevalence and degree of bother from pelvic floor disorders in obese women

  • Emily L. Whitcomb
  • Emily S. Lukacz
  • Jean M. Lawrence
  • Charles W. Nager
  • Karl M. Luber
Original Article

Abstract

We aimed to determine the prevalence and bother from pelvic floor disorders (PFD) by obesity severity, hypothesizing that both would increase with higher degrees of obesity. We performed a secondary analysis of 1,155 females enrolled in an epidemiologic study that used a validated questionnaire to identify PFD. Prevalence and degree of bother were compared across three obesity groups. Logistic regression assessed the contribution of degree of obesity to the odds of having PFD. Prevalence of any PFD was highest in morbidly (57%) and severely (53%) obese compared to obese women (44%). Regression models demonstrated higher prevalence of pelvic organ prolapse, overactive bladder, stress urinary incontinence, and any PFD in morbidly compared to obese women and higher prevalence of stress urinary incontinence in severely obese compared to obese women. Degree of bother did not vary by degree of obesity. Prevalence of PFD increases with higher degrees of obesity.

Keywords

Obesity Pelvic floor disorders 

Abbreviations

POP

pelvic organ prolapse

SUI

stress urinary incontinence

OAB

overactive bladder

AI

anal incontinence

PFD

pelvic floor disorders

BMI

body mass index

KP CARES

Kaiser Permanente Continence-Associated Risk Epidemiology Study

EPIQ

Epidemiology of Prolapse and Incontinence Questionnaire

VAS

visual analog scale

Notes

Funding

NICHD #R01 HD4113-01A1

Conflicts of interest

None.

References

  1. 1.
    Subak LL, Brown JS, Kraus SR, Brubaker L, Lin F, Richter HE et al (2006) The “costs” of urinary incontinence for women. Obstet Gynecol 107:908–916PubMedGoogle Scholar
  2. 2.
    Grimby A, Milsom I, Molander U, Wiklund I, Ekelund P (1993) The influence of urinary incontinence on the quality of life of elderly women. Age Ageing 22:82–89PubMedCrossRefGoogle Scholar
  3. 3.
    Norton PA, MacDonald LD, Sedgwick PM, Stanton SL (1988) Distress and delay associated with urinary incontinence, frequency, and urgency in women. BMJ 297:1187–1189PubMedCrossRefGoogle Scholar
  4. 4.
    Varma MG, Brown JS, Creasman JM, Thom DH, Van Den Eeden SK, Beattie MS et al (2006) Fecal incontinence in females older than aged 40 years: who is at risk? Dis Colon Rectum 49:841–851PubMedCrossRefGoogle Scholar
  5. 5.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. Jama 295:1549–1555PubMedCrossRefGoogle Scholar
  6. 6.
    Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM (2008) Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol 111:678–685PubMedGoogle Scholar
  7. 7.
    Ogden CL, Carroll MD, McDowell MA, Flegal KM (2007) Obesity among adults in the United States-no change since 2003–2004. NCHS data brief no 1. National Center for Health Statistics, HyattsvilleGoogle Scholar
  8. 8.
    Richter HE, Burgio KL, Brubaker L, Moalli P, Markland AD, Mallet V et al (2005) Factors associated with incontinence frequency in a surgical cohort of stress incontinent women. Am J Obstet Gynecol 193:2088–2093PubMedCrossRefGoogle Scholar
  9. 9.
    Kapoor DS, Davila GW, Rosenthal RJ, Ghoniem GM (2004) Pelvic floor dysfunction in morbidly obese women: pilot study. Obes Res 12:1104–1107PubMedCrossRefGoogle Scholar
  10. 10.
    Uustal Fornell E, Wingren G, Kjolhede P (2004) Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand 83:383–389PubMedCrossRefGoogle Scholar
  11. 11.
    Dwyer PL, Lee ET, Hay DM (1988) Obesity and urinary incontinence in women. Br J Obstet Gynaecol 95:91–96PubMedGoogle Scholar
  12. 12.
    Roe B, Doll H (1999) Lifestyle factors and continence status: comparison of self-report data from a postal survey in England. J Wound Ostomy Continence Nurs 26:312–313 315–319PubMedGoogle Scholar
  13. 13.
    Yarnell JW, Voyle GJ, Sweetnam PM, Milbank J, Richards CJ, Stephenson TP (1982) Factors associated with urinary incontinence in women. J Epidemiol Community Health 36:58–63PubMedCrossRefGoogle Scholar
  14. 14.
    Richter HE, Burgio KL, Clements RH, Goode PS, Redden DT, Varner RE (2005) Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol 106:1272–1277PubMedGoogle Scholar
  15. 15.
    Lawrence JM, Lukacz ES, Liu IL, Nager CW, Luber KM (2007) Pelvic floor disorders, diabetes, and obesity in women: findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care 30:2536–2541PubMedCrossRefGoogle Scholar
  16. 16.
    Subak LL, Johnson C, Whitcomb E, Boban D, Saxton J, Brown JS (2002) Does weight loss improve incontinence in moderately obese women? Int Urogynecol J Pelvic Floor Dysfunct 13:40–43PubMedCrossRefGoogle Scholar
  17. 17.
    Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS (2005) Weight loss: a novel and effective treatment for urinary incontinence. J Urol 174:190–195PubMedCrossRefGoogle Scholar
  18. 18.
    Kuruba R, Almahmeed T, Martinez F, Torrella TA, Haines K, Nelson LG et al (2007) Bariatric surgery improves urinary incontinence in morbidly obese individuals. Surg Obes Relat Dis 3:586–590 discussion 590–591PubMedCrossRefGoogle Scholar
  19. 19.
    Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS (2007) Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol 110:1034–1040PubMedGoogle Scholar
  20. 20.
    Bump RC, Sugerman HJ, Fantl JA, McClish DK (1992) Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol 167:392–397 discussion 397–9PubMedGoogle Scholar
  21. 21.
    Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM (2006) Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol 107:1253–1260PubMedGoogle Scholar
  22. 22.
    Lukacz ES, Lawrence JM, Buckwalter JM, Burchette RJ, Nager CW, Luber KM (2005) Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct 16(4):272–284PubMedCrossRefGoogle Scholar
  23. 23.
    Lukacz ES, Lawrence JM, Burchette RJ, Luber KM, Nager CW, Buckwalter JM (2004) The use of visual analog scale in urogynecologic research: a psychometric evaluation. Am J Obstet Gynecol 191(1):165–170PubMedCrossRefGoogle Scholar
  24. 24.
    Foldspang A, Mommsen S (1995) Overweight and urinary incontinence in women. Ugeskr Laeger 157:5848–5851PubMedGoogle Scholar
  25. 25.
    Moller LM, Lose G, Jorgensen T (2001) Risk factors of lower urinary tract symptoms in women aged 40–60 years. Ugeskr Laeger 163:6598–6601PubMedGoogle Scholar
  26. 26.
    Wasserberg N, Haney M, Petrone P, Crookes P, Rosca J, Ritter M et al (2008) 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 23:493–497PubMedCrossRefGoogle Scholar
  27. 27.
    Gerten KA, Richter HE, Burgio KL, Wheeler TL, Goode PS, Redden DT (2007) Impact of urinary incontinence in morbidly obese women versus women seeking urogynecologic care. Urology 70:1082–1085PubMedCrossRefGoogle Scholar
  28. 28.
    Wasserberg N, Haney M, Petrone P, Ritter M, Emami C, Rosca J et al (2007) Morbid obesity adversely impacts pelvic floor function in females seeking attention for weight loss surgery. Dis Colon Rectum 50:2096–2103PubMedCrossRefGoogle Scholar
  29. 29.
    McAdams MA, Van Dam RM, Hu FB (2007) Comparison of self-reported and measured BMI as correlates of disease markers in US adults. Obesity (Silver Spring) 15:188–196CrossRefGoogle Scholar
  30. 30.
    Noblett KL, Jensen JK, Ostergard DR (1997) The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct 8:323–326PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2008

Authors and Affiliations

  • Emily L. Whitcomb
    • 1
    • 4
  • Emily S. Lukacz
    • 1
    • 4
  • Jean M. Lawrence
    • 2
  • Charles W. Nager
    • 1
    • 4
  • Karl M. Luber
    • 3
  1. 1.Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Reproductive MedicineUniversity of CaliforniaSan DiegoUSA
  2. 2.Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  3. 3.Department of Female Pelvic Medicine and Reconstructive SurgeryKaiser Permanente San Diego Medical CenterSan DiegoUSA
  4. 4.La JollaUSA

Personalised recommendations