Pelvic floor disoders after bariatric surgery

Pelvic floor disorders (PFD), principally understood as pelvic organs prolapse (POP), faecal incontinence (FI) and urinary incontinence (UI), involve a group of pathologies which, even though benign, are extremely disabling. Moreover, their treatment is burdened by a significant percentage of functional failures since the physiopathology of these disorders is complex and still partially unknown. Therefore, it is important to evaluate the real impact of risk factors which, unlike age, ethnic group, pregnancy and delivery, can be modified. The relationship between the excess of fat mass and urinary disorders is that which has been the most investigated. In fact, studies have demonstrated how, with an increase in the body mass index (BMI), there is an increase in the prevalence and severity of UI. Furthermore, as a confirmation of the role of obesity, it has been demonstrated that weight loss determines a significant improvement and, in some cases, complete remission of the urinary symptomology. Instead, the relationship of obesity with FI and the morpho-functional alterations of the pelvic compartment have been studied less systematically. However, the prevalence of FI in obese patients seems to be greater than that in the general population, and weight loss, obtained after bariatric surgery, seems to result in improvement of FI and POP symptoms, as well as their impact on the Qol. Therefore, weight loss should be considered as the primary treatment for PFD in obese women.