How a Surgery Could Help Plug Urinary Leaks

Weight reduction after bariatric surgery may improve urinary incontinence

(RxWiki News) Losing weight can often ease the symptoms of urinary incontinence. And a surgery that helps with weight loss could also help.

A new study from the University of California, San Francisco, found that bariatric, or weight loss, surgery might improve urinary incontinence.

Tiffany Jackson, MD, medical director of robotic surgery at Baylor Medical Center at Garland, TX, who was not involved with this study, told dailyRx that, "Weight loss will alleviate some of the pressure that is placed on the bladder and can help with urinary frequency as well as urinary leakage with activity. I would not recommend that a patient pursue bariatric surgery solely for the improvement of urinary incontinence, however improvement of troublesome urinary incontinence should serve as yet another motivator for patients to commit to their weight loss goals."

Past anecdotal reports indicated that both men and women reported less urinary incontinence after bariatric surgery. However, the findings had not been confirmed with a clinical trial.

Urinary incontinence is urinary leakage or a loss of bladder control. It tends to occur in older people. Women may also develop the problem after giving birth.

Obesity can increase the pressure on the muscles that control the bladder and the bladder itself. In bariatric surgery, the surgeon reduces the stomach size or places a band around the stomach to make it smaller and help the patient lose weight.

Leslee L. Subak, MD, of the Department of Obstetrics, Gynecology and Reproductive Sciences at UCSF, led the research team, which studied more than 2,000 men and women.

Study patients answered a survey within the 30 days before they had weight loss surgery. They answered the same survey each year after that.

This survey asked how often the patients experienced incontinence. They also asked what activities brought on the problem (such as coughing or sneezing). Finally, the patients indicated whether they had received any kind of treatment for their incontinence.

Patients ranged in age from 18 to 78. Most of the patients in this study were female.

Women reported more problems with urinary incontinence than men, Dr. Subak and team found. Almost half of the women in this study reported the problem.

Dr. Subak and team found that, after weight loss surgery, both men and women reported improvements in urinary incontinence.

In women, urinary incontinence dropped from 49.3 percent of the patients to 18.3 percent. In men, incontinence dropped from 27 percent to 9.8 percent.

After three years, the rate of incontinence had risen slightly in both men and women. It was still lower than before surgery, Dr. Subak and colleagues found.

Patients who regained some or all of the weight they lost after their surgeries had an increased risk of incontinence, Dr. Subak and team found.

In an editorial about this study, Deborah L. Myers, MD, of the Warren Alpert Medical School at Brown University, wrote, “[This study] is the most rigorous and comprehensive study to date on the effects of bariatric surgery on urinary incontinence. The study clearly establishes that improvements in urinary inconstancy can be an important outcome of bariatric surgery.”

Dr. Jackson added, "We often hear about patients having their diabetes or blood pressure improved by their bariatric surgery, but I have also had patients report improvement of their urinary incontinence with weight loss surgery. With the obesity epidemic present, the relationship between obesity and urinary incontinence should not be ignored."

The study and editorial were published in the June issue of JAMA Internal Medicine.

The study was funded by multiple sources, such as the National Institute of Diabetes and Digestive and Kidney Diseases, Columbia University Medical Center, Cornell University Medical Center, and Oregon Health and Science University.

Dr. Subak received funding from Astellas Scientific and Medical Affairs, Inc. Study authors Drs. Courcoulas, Flum, Pender, Pories, Wolfe and Huang received funding from companies that make drugs or equipment used to treat obesity. Among these were Allergan, Pfizer, Johnson & Johnson, Nutrisystem, GlaxoSmithKline, Ethicon and Medtronics.


Review Date: 
June 21, 2015