Obesity and Stress Urinary Incontinence in Women

Abstract

The prevalence of obesity is increasing all over the world and in  our country. Obesity  is associated with many diseases. One of them is stress urinary incontinence in women. Obesity is a factor which can increase the severity of incontinence.  Researches are going on for determining the exact role of obesity on stress incontinence. Straining of pelvic muscles, stress and chronic irritation of pelvic nerves have been  reported  to play  roles in the aetiology. The first stage of treatment involves struggling with obesity, behavioural modalities and surgical treatment may be considered next. In this study, obesity and stress urinary incontinence in women will be discussed in the light of current literature.

Keywords

• Obesity, stress urinary incontinence, surgery

Obezite ve Kadınlarda Stres Üriner İnkontinans

Öz

Obezite tüm dünyada olduğu gibi ülkemizde de yükselen trendi ile büyük bir sağlık problemidir. Obezitenin günümüzde birçok hastalıkla ilişkisi belirlenmiştir. Bunlardan biride kadınlardaki stres üriner inkontinanstır. Obezite hem bu hastalığın nedenleri arasında, hem de inkontinansın şiddetini arttırabilen bir etken olarak rol oynamaktadır. Obezitenin stres inkontinanstaki rolü hakkın da halen araştırmalar devam etmektedir. Özellikle pelvik kaslarda ıkınma, gerilme, zayıflama yolu ile; sinirlerde de kronik irritasyonlara yol açarak etyolojide rol oynadığı bildirilmiştir. Yenileyin yapılan çalışmalarda obezitenin ve stres üriner inkontinansın ayrı ayrı ve birlikte hayat kalitesini azalttığına dair bilimsel yazılar literatürde yerini hızla almaktadır. Tedavi aşamasında ise öncelikle obezite ile mücadele, davranış modaliteleri ve gerektiğinde cerrahi tedavi gündeme gelebilir. Bu çalışmada kadınlarda obezite ve stres üriner inkontinans ilişkisinde güncel literatür eşliğinde bahsedilecektir.

Anahtar Kelimeler

• Obezite; stres üriner inkontinans; cerrahi.

References

1. World Health Organization(WHO). Obesity and overweight. Erişim: (http://www.who.int/mediacentre/factsheets/fs311/en/). (Erişim tarihi: 04/06/2014).
2. Hakan Gülmez. Metabolik Sendromu Olan Hastalarda Visseral Yağlanma Oranı Ve Boyun Çevresi Arasındaki İlişki. Uzmanlık tezi, Ankara; 2012.
3. Goran MI, Reynolds KD, Lindquist CH. Role of physical activity in the prevention of obesity in children. International Journal of Obesity 1999;23:18-33.
4. Ergül Ş, Kalkım A. A Major Chronic Disease: Obesity in Childhood and Adolescence. TAF Prev Med Bull 2011;10:223-30.
5. Bergman RN, Kim SP, Catalano KJ, Hsu IR, Chiu JD, Kabir M, Hucking K, Ader M. Why visceral fat is bad: mechanisms of the metabolic syndrome. Obesity 2006;14:16–9.
6. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311:806-14.
7. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186:1160–6.
8. Handa VL, Pierce CB, Muñoz A, Blomquist JL. Longitudinal changes in overactive bladder and stress incontinence among parous women. Neurourol Urodyn 2014 (doi: 10.1002/nau.22583).

9. Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Comorbidities and personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract 2013; 67:1015-33.
10. Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence: epidemiology and clinical research update. J Urol 2009; 182(6 Suppl):2-7.
11. Markland AD, Richter HE, Fwu CW, Eggers P, Kusek JW. Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. J Urol 2011; 186:589-93.
12. Chen CC, Gatmaitan P, Koepp S, Barber MD, Chand B, Schauer PR, Brethauer SA. Obesity is associated with increased prevalence and severity of pelvic floor disorders in women considering bariatric surgery. Surg Obes Relat Dis 2009; 5:411-5.
13. T.C. Sağlık Bakanlığı, Temel Sağlık Hizmetleri Genel Müdürlüğü, Beslenme ve Fiziksel Aktiviteler Daire Başkanlığı. Türkiye'de Obezitenin Görülme Sıklığı http://beslenme.gov.tr/content/files/yayinlar/kitaplar/diger_kitaplar/kalbimizi_koruyalim.pdf . (Erişim tarihi: 04/06/2014).
14. Altunkaynak BZ, Özbek E. Obezite: Nedenleri ve Tedavi Seçenekleri Van Tıp Dergisi 2006;13:138-42.
15. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol In Adults (Adult Tretment Panel III). JAMA 2001; 285:2486-97.
16. Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn 2008; 27:749-57.
17. Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg 2005;15:1225-32.
18. Richter HE, Creasman JM, Myers DL, Wheeler TL, Burgio KL, Subak LL; Program to Reduce Incontinence by Diet and Exercise (PRIDE) Research Group.Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial. Int Urogynecol J Pelvic Floor Dysfunct 2008;19(12):1653-8.
19. Kokino S, Özdemir F, Zateri C. Obesity and Physical Modalities. Trakya Univ Tip Fak Derg 2006; 23:47-54.
20. Bump RC, Sugerman HJ, Fantl JA, McClish DK. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol 1992;167:392-7.
21. Subak LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM, Richter HE, Myers D, Burgio KL, Gorin AA, Macer J, Kusek JW, Grady D; PRIDE Investigators. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009;360:481-90.
22. Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS. Weight loss: a novel and effective treatment for urinary incontinence. J Urol 2005;174:190-5.
23. Auwad W, Steggles P, Bombieri L, Waterfield M, Wilkin T, Freeman R. Moderate weight loss in obese women with urinary incontinence: a prospective longitudinal study. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:1251-9.
24. Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol 2007;110:1034-40.
25. Abrams P, Andersson KE, Birder L etal. Fourth international consultation on incontinence recommendations of the international scientific committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2010;29:213-40.
26. Keegan PE, Atiemo K, Cody J, McClinton S, Pickard R. Periurethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev 2007;3:CD003881.
27. Osborn DJ, Strain M, Gomelsky A, Rothschild J, Dmochowski R. Obesity and female stress urinary incontinence. Urology 2013;82:759-63.
28. Viecelli CF, dos Santos DC, Aguiar WW, Martins-Costa SH, Corleta Hv, Ramos JG. Obesity as a risk factor to Burch surgery failure. Rev Bras Ginecol Obstet 2009;31:182-8.
29. Zivkovic F, Tamussino K, Pieber D, Haas J. Body mass index and outcome of incontinence surgery. Obstet Gynecol 1999; 93(5 Pt 1):753-6.
30. Richter HE, Brubaker L, Stoddard AM et al. Urinary Incontinence Treatment Network.Patient related factors associated with long-term urinary continence after Burch colposuspension and pubovaginal fascial sling surgeries. J Urol 2012;188:485-9.
31. Meschia M, Rossi G, Bertini S et al. Single incision mid-urethral slings: impact of obesity on outcomes. Eur J Obstet Gynecol Reprod Biol 2013; 170: 571-4.
32. Hwang IS, Yu JH, Chung JY, Noh CH, Sung LH. One-year outcomes of mid-urethral sling procedures for stress urinary incontinence according to body mass index. Korean J Urol 2012; 53:171-7.
33. Moore RD, De Ridder D, Kennelly MJ. Two-year evaluation of the MiniArc in obese versus non-obese patients for treatment of stress urinary incontinence. Int J Urol 2013;20:434-40.
34. De Ridder D, Berkers J, Deprest J et al. Single incision mini-sling versus a transobturator sling: a comparative study on MiniArc and Monarc slings. Int Urogynecol J 2010;21:773–8.