Obesity Surgery

, Volume 26, Issue 7, pp 1471–1478 | Cite as

The Effect of Bariatric Surgery on Urinary Incontinence in Women

  • C. J. O’BoyleEmail author
  • O. E. O’Sullivan
  • H. Shabana
  • M. Boyce
  • B. A. O’Reilly
Original Contributions



Little is known regarding the effect of bariatric surgery on urinary incontinence.


Between September 2008 and November 2014, 240 female patients underwent bariatric surgery.


The prevalence of urinary incontinence preoperatively was 45 % (108). Eighty-two (76 %) completed urinary function questionnaires pre-operatively and post-operatively. Fifty-seven (70 %) underwent laparoscopic gastric bypass, twenty-four (29 %) underwent sleeve gastrectomy and one underwent a banding procedure. Thirty-one (38 %) reported leaking on sneezing or coughing—stress urinary incontinence (SUI). Thirteen (16 %) complained of leaking before reaching the toilet—overactive bladder syndrome (OAB). The remaining thirty-eight (46 %) reported mixed symptoms. The mean pre-operative weight and BMI were 133 (18) kg and 50 (SD = 6.2) kg/m2 respectively. The mean post-operative BMI drop was 16 (SD = 5.2) kg/m2. Preoperatively, 61 (75 %) reported moderate to very severe urinary incontinence compared to 30 (37 %) post-operatively (χ 2 = 3.24.67, p = 0.050). Twenty-seven (33 %) patients reported complete resolution of their urinary incontinence. Fifty-one (62 %) patients required incontinence pads on a daily basis pre-operatively, compared to 35 (43 %) post-operatively (χ 2 = 22.211.6, p = 0.00). The mean International Consultation on Incontinence Questionnaire- Urinary Incontinence short form (ICIQ-UI SF) score was 9.3 (SD = 4.4) pre-operatively compared to 4.9 (SD = 5.3) post-operatively (t = 7.2, p = 0.000). The improvement score post-operatively was 8 (SD = 3). A significant difference in the ICIQ-UI SF was identified between OAB and SUI groups when adjusting for age, number of children, type of delivery and pre-op BMI (t = 1.98, p = 0.05).


Bariatric surgery results in a clinically significant improvement in urinary incontinence. However, this is not proportional to pre-operative BMI, weight loss, age, parity and mode of delivery.


Bariatric surgery Stress urinary incontinence Urge urinary incontinence Morbid Obesity 



Catriona O’Sullivan provided invaluable secretarial support for this project.

Compliance with Ethical Standards

Conflict of Interest

CJ O’Boyle, OE O’Sullivan, H Shabana and M Boyce have no conflict of interest.

BA O’Reilly received educational funding from Astellas and Pfizer.


  1. 1.
    Stevens GA et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metrics. 2012;10(1):22.CrossRefGoogle Scholar
  2. 2.
    Finucane MM et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Roth J et al. The obesity pandemic: where have we been and where are we going? Obes Res. 2004;12 Suppl 2:88S–101.CrossRefPubMedGoogle Scholar
  4. 4.
    Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3–21.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lim SS et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–60.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Prospective Studies C et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.CrossRefGoogle Scholar
  7. 7.
    Ng M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Elia G, Dye TD, Scariati PD. Body mass index and urinary symptoms in women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):366–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Kapoor DS et al. Pelvic floor dysfunction in morbidly obese women: pilot study. Obes Res. 2004;12(7):1104–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Uustal Fornell E, Wingren G, Kjolhede P. 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(4):383–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Richter HE et al. Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol. 2005;106(6):1272–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(1):41–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Nygaard I et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet. 2003;82(3):327–38.CrossRefPubMedGoogle Scholar
  15. 15.
    Lifford KL et al. The epidemiology of urinary incontinence in older women: incidence, progression, and remission. J Am Geriatr Soc. 2008;56(7):1191–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Kammerer-Doak D et al. Mixed urinary incontinence: international urogynecological association research and development committee opinion. Int Urogynecol J. 2014;25(10):1303–12.CrossRefPubMedGoogle Scholar
  17. 17.
    Haylen BT et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.CrossRefPubMedGoogle Scholar
  18. 18.
    Pories WJ et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. discussion 350–2.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sjostrom L et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000. 894: i-xii. 1–253.Google Scholar
  21. 21.
    Burgio KL et al. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110(5):1034–40.CrossRefPubMedGoogle Scholar
  22. 22.
    Deitel M et al. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988;7(2):147–53.CrossRefPubMedGoogle Scholar
  23. 23.
    Palleschi G et al. Laparoscopic sleeve gastrectomy effects on overactive bladder symptoms. J Surg Res. 2015;196(2):307–12.CrossRefPubMedGoogle Scholar
  24. 24.
    Albanopoulos K, et al. The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: the results of 3 years of follow-up. Surg Endosc. 2015.Google Scholar
  25. 25.
    Risstad H, et al. Changes in health-related quality of life after gastric bypass in patients with and without obesity-related disease. Obes Surg. 2015.Google Scholar
  26. 26.
    Melissas J. IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obes Surg. 2008;18(5):497–500.CrossRefPubMedGoogle Scholar
  27. 27.
    Espuna Pons M et al. Comparison between the “ICIQ-UI Short Form” Questionnaire and the “King’s Health Questionnaire” as assessment tools of urinary incontinence among women. Actas Urol Esp. 2007;31(5):502–10.CrossRefPubMedGoogle Scholar
  28. 28.
    Avery K et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.CrossRefPubMedGoogle Scholar
  29. 29.
    Herrmann V et al. Correlation of the International Consultation on Incontinence Questionaire: Urinary Incontinence/Short Form to Urodynamic diagnosis in women with urinary incontinence. Rev Bras Ginecol Obstet. 2013;35(1):16–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Espuna-Pons M et al. Analysis of the value of the ICIQ-UI SF questionnaire and stress test in the differential diagnosis of the type of urinary incontinence. Neurourol Urodyn. 2007;26(6):836–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Seckiner I et al. Correlations between the ICIQ-SF score and urodynamic findings. Neurourol Urodyn. 2007;26(4):492–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Klovning A et al. Comparison of two questionnaires for assessing the severity of urinary incontinence: the ICIQ-UI SF versus the incontinence severity index. Neurourol Urodyn. 2009;28(5):411–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Siddiqui NY et al. Perceptions about female urinary incontinence: a systematic review. Int Urogynecol J. 2014;25(7):863–71.CrossRefPubMedGoogle Scholar
  34. 34.
    Coyne KS et al. Economic burden of urgency urinary incontinence in the United States: a systematic review. J Manag Care Pharm. 2014;20(2):130–40.PubMedGoogle Scholar
  35. 35.
    Whitcomb EL, Subak LL. Effect of weight loss on urinary incontinence in women. Open Access J Urol. 2011;3:123–32.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Khullar V et al. The relationship between BMI and urinary incontinence subgroups: results from EpiLUTS. Neurourol Urodyn. 2014;33(4):392–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Wu SP et al. Outcome after conservative management for mixed urinary incontinence. J Obstet Gynaecol Res. 2015;41(2):269–76.CrossRefPubMedGoogle Scholar
  38. 38.
    Celiker Tosun O, et al. Does pelvic floor muscle training abolish symptoms of urinary incontinence? A randomized controlled trial. Clin Rehabil. 2014.Google Scholar
  39. 39.
    de Boer AG et al. Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res. 2004;13(2):311–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Bump RC et al. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol. 1992;167(2):392–7. discussion 397–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Frohme C et al. TOT approach in stress urinary incontinence (SUI)—outcome in obese female. BMC Urol. 2014;14:20.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Brennand E, et al. Twelve-month outcomes following midurethral sling procedures for stress incontinence: impact of obesity. BJOG. 2014.Google Scholar
  43. 43.
    Wesnes SL. Weight and urinary incontinence: the missing links. Int Urogynecol J. 2014;25(6):725–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Ranasinghe WK et al. Effects of bariatric surgery on urinary and sexual function. BJU Int. 2011;107(1):88–94.CrossRefPubMedGoogle Scholar
  45. 45.
    Shen J et al. In vivo effects of leptin on autonomic nerve activity and lipolysis in rats. Neurosci Lett. 2007;416(2):193–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Tong RS et al. Pelvic lipomatosis associated with proliferative cystitis occurring in two brothers. Urology. 2002;59(4):602.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • C. J. O’Boyle
    • 1
    Email author
  • O. E. O’Sullivan
    • 2
  • H. Shabana
    • 1
  • M. Boyce
    • 3
  • B. A. O’Reilly
    • 2
  1. 1.Department of Bariatric SurgeryBon Secours HospitalCorkIreland
  2. 2.Department of UrogynaecologyCork University Maternity HospitalCorkIreland
  3. 3.Department of Best PracticeBon Secours HospitalCorkIreland

Personalised recommendations