(Poster 82) The Impact of Bariatric Surgery on Pelvic Floor Dysfunction: A Systematic Review

Objectives: This systematic review aims to assess the impact of bariatric surgery (BS) on pelvic floor dysfunction (PFD), particularly urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI) in obese women.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Scielo databases to identify relevant studies from inception to September 2024. Studies eligible for inclusion were prospective cohorts that evaluated women with morbid obesity and reported the prevalence of PFDs before and after BS. A total of 1532 studies were retrieved, and 28 were subjected to full analysis. After applying exclusion criteria, 20 studies involving 3,684 patients were included in the final review. The primary outcomes analyzed were changes in the prevalence of UI, POP, and FI. Additionally, changes in body mass index (BMI) and quality of life were assessed using standardized questionnaires such as the International Consultation on Incontinence-Short Form (ICIQ-SF), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and Pelvic Floor Distress Inventory-20 (PFDI-20).

Results: The most common surgical procedures performed for BS were roux n y gastric bypass ( 15 studies) followed by sleeve gastrectomy and laparoscopic gastric banding. Majority of the studies included various types of surgery and average follow up time was 15.2 months.
Bariatric surgery was associated with a significant reduction in BMI, with a mean decrease of 12.03 kg/m². The pooled analysis of 19 studies demonstrated a relative risk reduction of 50.8% for UI (OR = 2.01, 95% CI 1.73–2.34, p < 0.01) , SUI (OR = 2.15, 95% CI 1.75–2.65, p < 0.01) and Urge UI (OR = 2.02, 95% CI 1.57–2.60, p < 0.01). However, the reduction in POP prevalence was 38.3% (OR = 1.62, 95% CI 1.16–2.25, p < 0.01), and the reduction in FI prevalence was 20% but was not statistically significant (OR = 1.20, 95% CI 0.81–1.77, p = 0.69). Questionnaire analyses showed that BS significantly reduced scores on the PFDI-20 , ICIQ-SF but not with PFIQ-7.

Conclusions: Bariatric surgery had a significant positive impact on UI, with a robust reduction in prevalence post-surgery. This result is consistent with previous studies linking weight loss to improved pelvic floor function, likely due to reduced intra-abdominal pressure. However, the effects of BS on POP were to a lesser degree and FI did not show statistically significant reduction, possibly due to the lower prevalence of FI, multifactorial etiologies of FI, and the heterogeneity of the studies included. The reduction in PFD symptoms, as reflected by patient-reported outcomes in questionnaires, suggests that bariatric surgery may offer improvements in quality of life related to pelvic floor health. Nonetheless, larger studies with longer follow-up periods are needed to confirm these findings, especially for POP and FI.Bariatric surgery leads to a significant reduction in UI and to a certain degree in POP among obese women but shows limited impact on FI. These findings suggest that while BS is beneficial for certain PFDs, further research is required to evaluate its full effects on the pelvic floor.