Research shows that overweight women who lose as little as 5 percent of their body weight can lessen or prevent pelvic floor disorders, including incontinence and prolapse
It’s no secret, maintaining a healthy BMI (body mass index) positively affects just about every aspect of your personal health. And even though Colorado has been dubbed one of the nation’s thinnest states, I still have patients who could benefit from significant weight loss.
Obesity, defined as a BMI over 30, affects nearly 60 million Americans, and rates have steadily increased over the last 50 years. BMI is an estimate of body fat based on a person’s weight to height ratio. A high BMI indicates that a person’s weight is above the healthy range. While carrying a little extra weight may not seem like a major concern, the medical conditions associated with obesity can have a profound negative impact on a person’s health and quality of life.
Obese as well as overweight patients (BMI 25-29.9) are more likely to develop a range of health conditions, including pelvic floor disorders such as pelvic organ prolapse, loss of bladder control and stool leakage.
While there are a wide variety of treatments for these conditions, I always recommend that my obese and overweight patients lose weight as part of their treatment plan. This first step can often significantly reduce symptoms and prevent progressive or recurrent symptoms. Moreover, it can have far-reaching positive effects in other parts of their lives. Even if a person is obese or overweight and does not experience symptoms like incontinence, weight loss is recommended since it may lessen the risk of developing these conditions in the future.
Below I outline more specifically the relationship between weight and pelvic floor disorders, and how you can get started on a path toward a healthier self.
Obesity & pelvic organ prolapse
Excess weight is a clear risk factor for pelvic organ prolapse. Prolapse occurs when the tissues that support the pelvic organs (such as the bladder or uterus) are stretched and damaged. The organs they support may then drop down and press against the wall of the vagina, causing a bulge that will sometimes stick out through the vagina’s opening. Several studies have shown that women who are obese and overweight are at higher risk for prolapse. Therefore, I encourage weight management for all of my patients.
In a recent study, we also showed that women who began pregnancy at higher BMIs are more likely to have prolapse than those who began pregnancies at lower weights. In a follow-up study, we also showed that BMI one year after delivery was associated with higher odds of having pelvic organ prolapse at one year postpartum. Obviously, no one wants to experience prolapse. So, I recommend that women with higher BMIs who are considering having a baby, and those who have recently delivered, meet with their obstetrician or primary care provider to determine the best tactics for getting fit ASAP.
Obesity & incontinence
Obese and overweight women are at higher risk for developing lower urinary tract symptoms such as overactive bladder and urinary incontinence. Women with stress incontinence lose urine when they cough, sneeze, laugh, walk, exercise, lift or get up from a seated or lying position. This is due to poor support of the urethra normally provided by the underlying muscle and connective tissue of the vagina. Stress incontinence is more commonly seen in women who are obese and overweight while overactive bladder, a condition in which people feel like they always have to use the bathroom, is more common in women who are obese.
The good news is that women who lose as little as 5 percent of their body weight, may improve urinary incontinence symptoms without any medication or surgery whatsoever.
In addition to urinary incontinence, chances of bowel incontinence, defined as an involuntary loss of liquid or solid stool, can be increased in obese and overweight women. Recent studies have also specifically linked obesity to increased symptoms of bowel incontinence. Weight loss strategies that encourage high fiber intake often work best to control bowel incontinence, while helping individuals achieve their desired weight reduction.
So, what can you do?
The research clearly demonstrates that as overweight or obese women lose weight, their pelvic floor disorders improve. But many women who want to start losing weight can understandably find it challenging to know how to start.
The first step is for them to recognize their excess weight as a medical condition that needs to be treated and to overcome their fear of failure. Just like addressing any other problem, commitment and determination will often lead to success. I often recommend that my overweight or obese patients start by admitting their problem to their primary care provider. These providers often help my patients establish a safe and realistic plan and they also serve as an excellent resource for identifying strategies that help my patients achieve their goals.
Whether or not my patients are ready to admit their problem to their doctor, I strongly encourage then to admit it to someone – anyone – and ideally join a weight loss group or find a weight loss partner to help keep them on track. Many of them benefit from the structure and support these weight loss programs provide.
In fact, one of the best studies published looking at group versus individual weight loss programs showed that women in groups were eight times more likely to achieve a 5 percent weight reduction and nearly nine times more likely to achieve a 10 percent reduction in weight when compared with participants who opted for self-directed weight loss.
One common dieting tactic I do not recommend, however, is crash diets and diets that replace food with liquids. These diets are often difficult to maintain and may not result in sustained weight loss. Many patients, in turn, will come into our office saying they drink more than 120 ounces of fluid every day, which may not be within a safe or healthy range.
Finally, I encourage my patients to look for ways to incorporate exercise into their daily routine and to find activities they enjoy, so they’ll stick with them even after they’ve achieved their weight loss goal. This is particularly important for keeping the weight off. Taking small steps to exercise more regularly, such as enjoying a 30-minute walk every day or routinely bypassing the elevator and using the stairs, can often have profound long-term effects on mental and physical wellness.
What about surgical weight loss?
Bariatric surgery for the management of morbid obesity is becoming increasingly popular and has proven effective in achieving weight loss. Along with weight loss, a large number of women also experience complete resolution of other medical conditions such as diabetes, hypertension and obstructive sleep apnea.
While data objectively demonstrating improvement of pelvic organ prolapse and fecal incontinence after surgical weight loss is limited, there is solid data showing that urinary incontinence and quality of life improve in women after surgical weight loss.
As you may suspect, surgical weight loss is not for everyone, and I strongly recommend that my patients first pursue weight loss through diet and exercise. But, all obese patients should keep bariatric surgery on the back burner; it may be the best solution for combating persistent obesity and alleviating some of the negative health impacts of excess weight for some women.
Just remember: Healthy habits lead to a healthy BMI
When my patients come to me frustrated and discouraged by the idea of trying to lose weight, I encourage them by reminding them that getting to and maintaining a healthy weight is just a series of choices. Initially it can feel challenging to consistently make these choices, but before long, it will feel routine.
If you’re starting a weight loss journey, know that not every day is going to be perfect. There will be times when trying to lose or keep weight off that you stray from your good habits. But if you have the expectation that living a healthy lifestyle is your routine, then you will always be able to get back on track.
So what are you waiting for? It’s time to make that resolution to come out of your shell, make a few new friends who support your goals and toast to a thinner, healthier new you.