Obesity and Pelvic Floor Dysfunction: Battling the Bulge

IMPORTANCEPelvic floor disorders (PFDs) comprise a broad spectrum of clinical conditions, including urinary incontinence, pelvic organ prolapse, fecal incontinence, and defecatory dysfunction. These disorders are common conditions that generate significant medical, emotional, social, and economic issues for many women. Obese women are disproportionately affected compared with their normal-weight peers, with more than half of women with a body mass index of greater than 35 kg/m reporting a PFD, compared with only 32% in women with a normal body mass index. Despite this prevalence, little research is available to help guide and tailor treatment in obese populations. OBJECTIVEThis review outlines current knowledge regarding the relative contribution of obesity to PFDs, as well as its effect on treatment implications. EVIDENCE ACQUISITIONLiterature relating to the incidence and treatment of PFDs in obese populations was reviewed. RESULTSBoth nonsurgical and surgical weight loss improves all PFDs. Obese women benefit from pelvic floor training, biofeedback, and pharmacologic treatments of urinary and fecal incontinence. Surgical treatments of stress urinary incontinence note increased operative times and perhaps slightly lower cure rates, but overall good treatment success in obese women. No increased risks of complications or treatment failure were noted in obese women treated for prolapse surgically, and pessaries work well for both prolapse and stress urinary incontinence in obese women. CONCLUSIONS/RELEVANCEAlthough literature regarding treatment of PFDs in obese women is limited, the available evidence demonstrates good treatment outcomes in obese populations. Further research into how to best counsel and optimize treatment of obese patients is essential as the obesity epidemic continues. TARGET AUDIENCEObstetricians and gynecologists, family physicians LEARNING OBJECTIVESAfter completing this activity, the learner should be better able to understand how obesity may contribute to the etiology of PFDs including urinary incontinence, pelvic organ prolapse, and fecal incontinence; describe the behavioral, medical, and surgical interventions available for treatment of PFDs; and understand how obesity may influence the success of behavioral, medical, and surgical interventions for treatment of PFDs.