Are Obese Patients at an Increased Risk of Pelvic Floor Dysfunction Compared to Non-obese Patients?

• Published in: Obesity surgery Vol. 27; no. 7; pp. 1822 - 1827
• Main Authors: Neto, Isaac José Felippe Corrêa, Pinto, Rodrigo Ambar, Jorge, José Marcio Neves, Santo, Marco Aurélio, Bustamante-Lopez, Leonardo Alfonso, Cecconello, Ivan, Nahas, Sérgio Carlos
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2017; Springer Nature B.V
• Subjects: Adult; Anal Canal - physiopathology; Bariatric Surgery; Case-Control Studies; Comparative studies; Constipation - etiology; Fecal incontinence; Fecal Incontinence - etiology; Fecal Incontinence - physiopathology; Female; Humans; Male; Manometry; Medicine; Medicine & Public Health; Middle Aged; Obesity; Obesity, Morbid - complications; Obesity, Morbid - physiopathology; Obesity, Morbid - surgery; Original Contributions; Pelvic Floor - physiopathology; Pelvic Floor Disorders - etiology; Pelvic Floor Disorders - physiopathology; Pressure; Prospective Studies; Surgery; Surveys and Questionnaires; Obesity; Fecal incontinence; Defecation frequency; Anorectal manometry
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-017-2559-z

Purpose
Factors associated with increased intra-abdominal pressure such as chronic cough, morbid obesity, and constipation may be related to pelvic floor dysfunction. In this study, we compared anorectal manometry values and clinical data of class II and III morbidly obese patients referred to bariatric surgery with that of non-obese patients.
Methods
We performed a case-matched study between obese patients referred to bariatric surgery and non-obese patients without anorectal complaints. The groups were matched by age and gender. Men and nulliparous women with no history of abdominal or anorectal surgery were included in the study. Anorectal manometry was performed by the stationary technique, and clinical evaluation was based on validated questionnaires.
Results
Mean age was 44.8 ± 12.5 years (mean ± SD) in the obese group and 44.1 ± 11.8 years in the non-obese group (
p
 = 0.829). In the obese group, 65.4% of patients had some degree of fecal incontinence. Mean squeeze pressure was significantly lower in obese than in non-obese patients (155.6 ± 64.1 vs. 210.1 ± 75.9 mmHg,
p
 = 0.004), and there was no significant difference regarding mean rest pressure in obese patients compared to non-obese ones (63.7 ± 23.1 vs. 74.1 ± 21.8 mmHg,
p
 = 0.051). There were no significant differences in anorectal manometry values between continent and incontinent obese patients.
Conclusions
The prevalence of fecal incontinence among obese patients was high regardless of age, gender, and body mass index. Anal squeeze pressure was significantly lower in obese patients compared to non-obese controls.