Effect of body mass index on the risk of anal incontinence and defecatory dysfunction in women.
ABSTRACT The primary objective was to estimate the effect of body mass index on the risk of anal incontinence and defecatory dysfunction in a tertiary referral urogynecologic population.
This was a cross-sectional study, including 519 new patients. Exposure was defined as body mass index. The primary outcome was any reported anal incontinence. The secondary outcome was any defecatory dysfunction. We used multiple logistic regression to estimate odds ratios and 95% confidence intervals for the effect of body mass index on anal incontinence and defecatory dysfunction.
After adjusting for confounders, every 5 unit increase in body mass index was associated with a significantly increased odds of anal incontinence (odds ratio 1.25; 95% confidence interval, 1.09 to 1.44) and a trend toward an increased odds of defecatory dysfunction (odds ratio 1.13; 95% confidence interval, 0.98 to 1.31), although this was not statistically significant.
Increasing body mass index is significantly associated with anal incontinence, but not defecatory dysfunction in women.
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ABSTRACT: Sobrepeso e obesidade são relatados como importantes fatores de risco para desenvolvimento de disfunções do assoalho pélvico (AP) feminino. Assim, objetivou-se averiguar o índice de massa corporal (IMC) de mulheres com disfunções do AP que procuraram tratamento fisioterapêutico, e comparar com as estatísticas nacionais. Trata-se de um estudo observacional. Foram avaliados os prontuários de mulheres com disfunções do AP atendidas pelo Setor de Fisioterapia no período de 2004 à 2010, e incluídas todas as mulheres com a presença de algum sintoma de disfunção do AP. Calculou-se o IMC de 312 mulheres com disfunção do AP. A média de IMC foi de 28,1 kg/m2. Dessas mulheres, cerca de 70% apresentavam sobrepeso ou obesidade, resultado maior do que o índice nacional de 59%. A base fisiopatológica da relação entre obesidade e disfunções do AP está na correlação entre o IMC e a pressão intra-abdominal. A identificação do sobrepeso e da obesidade deve fazer parte dos programas de reabilitação do AP, uma vez que a redução do peso corporal pode contribuir para redução da severidade da disfunção. Com o presente estudo observa-se que as mulheres que procuram tratamento fisioterapêutico para disfunções do AP apresentam índice de obesidade maior do que a população feminina nacional.Fisioterapia e Pesquisa. 12/2012; 19(4):309-313.
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ABSTRACT: Objectives To determine the specificity of the management of urogynecologic disorders in obese women. Patients and methods Review of the literature: obesity, genital prolapse, pelvic organ prolapse, urinary incontinence, anal incontinence. Results The relative risk of urinary incontinence (UI) for morbidly obese women (BMI > 40 kg/m2) is five times greater than a normal weight woman. A 10% weight loss reduced the frequency of urinary leakage by 50%. Beyond a BMI of 35 kg/m2, the success rate of suburethral sling decreased to 50% with an increased risk of de novo urgenturies. Within this population of morbidly obese women, bariatric surgery was as successful as or more than surgery for incontinence. Patients with morbid obesity are three times as likely to experience anal incontinence, with a prevalence reaching 32%. The treatment of anal incontinence in obese patients is not clearly codified. The association between obesity and prolapse is very controversial according to the methodology used in the studies. Treatment of genital prolapse in obese women is little studied in the literature. Only sacrocolpopexy by laparotomy was studied. No more complications were found in this population. Conclusion Now we have specific data concerning urogynecology in obese women to better manage these patients.Progrès en Urologie 07/2012; 22(8):445–453. · 0.77 Impact Factor
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ABSTRACT: The aetiology of bowel incontinence in middle-aged women is multifactorial and the contribution of birth-related factors later in life is still poorly defined. The aim was to assess prevalence, risk factors and severity of faecal (FI, defined as the involuntary loss of faeces-solid or liquid) and anal incontinence (AI, includes FI as well as the involuntary loss of flatus) 20 years after one vaginal (VD) or one caesarean section (CS). This was a registry-based national cohort study of primiparae giving birth in 1985-1988 and having no further births (n = 5,236). Data from the Swedish Medical Birth Register were linked to information from a pelvic floor disorder questionnaire in 2008 (response rate 65.2 %). Analysis of variance and multivariate analysis were used to obtain adjusted prevalence and odds ratios (adj-OR). Overall prevalences of FI and AI were 13.6 and 47.0 %. FI prevalence was higher after VD compared with CS [14.5 versus 10.6 %, adj-OR 1.43, 95 % confidence interval (CI) 1.16-1.77] but was not increased after acute versus elective CS. Perineal tear (≥second degree) increased the prevalence and risk of FI compared with no tear (22.8 versus 13.9 %, adj-OR 1.95, 95 % CI 1.33-2.85). The prevalence of FI was lower after VD with an episiotomy (11.1 %) and similar to that after CS (10.6 %). With each unit increase of current body mass index the odds of FI increased by 6 % (OR 1.06, 95 % CI 1.04-1.08). Late FI and AI prevalences were higher after VD compared with CS. Perineal tear (≥second degree) versus no tear doubled the prevalence of FI. FI prevalence was similar after a CS and a VD combined with episiotomy.International Urogynecology Journal 05/2014; 25(10). · 2.17 Impact Factor