Incontinence and pelvic organ prolapse in the obese woman

Abstract Urinary incontinence (UI) and pelvic organ prolapse are common conditions with a profound impact upon the quality of life. Observational and experimental data demonstrate that obesity is associated with higher abdominal pressure that predisposes to stress incontinence. Large epidemiological studies have shown that obesity carries an approximately twofold increased risk of UI, both stress incontinence and overactive bladder symptoms (urgency, frequency, and urge incontinence). Fecal incontinence and prolapse symptoms are subject to similar increased risk in the obese woman. Weight loss has a profound effect upon urinary, anal, and prolapse symptoms: achieving a target weight loss of 5%–10% of baseline body weight is associated with 30%–70% cure of urinary leakage, around 65% improvement of anal symptoms, and 75% resolution of prolapse symptoms. Weight loss should be recommended as first-line intervention for obese incontinent women. Surgery for incontinence carries a slightly lower cure rate in obese women but no higher risk of complications. Data on prolapse cure are not available.