She described her prior 'normal' habits of urinary stress incontinence with straining, exercise, lifting groceries, or laughing / coughing / sneezing. She admitted an average of 5-7 times per week the utter embarrassment of such events, as well as the ever-present anticipatory dread, that such events could occur at the most inopportune of times.
She was down in weight only 30# from her start weight (pre op), yet recounted a diminution in events now only 1-2 x per month now. Talk about quality-of-life improvement. This was a woman in her early 50s, obviously was morbidly obese, and the mom of 2 prior NSVDs.
As luck would have it, I just so happened to come across a study reported recently that was done at the University of California San Francisco School of Medicine, by Dr. Leslee Subak, professor of obstetrics, gynecology, and reproductive sciences there.
She led a team that looked at the rates of incontinence in a specific bariatric surgery patient population, and the resolution of those urinary tract symptoms in that same group.
She found that nearly 50% of the women in her study group, namely 775 of 1500, reported episodes of urinary incontinence at least 1 time per week preoperatively.
71% of those patients had Gastric Bypass, the remainder had Gastric Banding.
Demographically, the average age was 46 y/o, most were caucasian, and most lost at least 30% of their body weight by one year and maintained that through 3 years from their surgery date.
The findings from the completed annual questionnaires?
From an average of 11 instances of incontinence per week, the frequency dropped to only 4 per week at two and three years post-surgery. Further, the remission rate — less than 1 weekly episode over the past 3 months — was about 61 percent after 3 years. And 25 percent of the women had had no episodes in the previous 3 months, they reported at 3-year post-surgery.
Obesity and stress incontinence certainly do have a causal relationship. Not only can the long term pressure on the pelvic floor cause muscular and sphincteric laxity and dyscoordination, the effects of often comorbid Diabetes can further complicate the issue by adding neuromuscular dysfunction.
While incontinence is not one of the major players in the comorbidity strata, especially in terms of insurance reimbursement for surgery approval with a BMI of the 35 - 40 range patient, I am sure if you asked a patient how much negative lifestyle impact it has, you might be a little surprised. (Especially if you do not 'know' about the entity personally.)
So, there you go: Another reported / studied benefit of weight loss surgery, something to be mindful of, or mention to a patient when considering someone who would be a good candidate for surgery.
It's not too hard to remember the BIG benefits of mortality reduction and improvements in HTN, DM2, Lipids, and DJD / joint pain, as well as OSA improvements among others - disease processes all mentioned numerous times throughout the history of this Blog.
And, despite no one likely ever dying directly of incontinence, that doesn't mean that a patient with that affliction hasn't wished at one or more times they had - when that inopportune moment struck...
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| From Flickr.com |
