Impact of bariatric surgery on pelvic floor dysfunction symptoms: a systematic review and meta-analysis of prospective Studies

Abstract

Pelvic floor dysfunction (PFD), including urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI), is highly prevalent among women and strongly linked to obesity. Given the mechanical and physiological effects of excess weight on pelvic floor support, weight loss via bariatric surgery may improve PFD symptoms. This systematic review and meta-analysis aimed to evaluate the impact of bariatric surgery on PFD outcomes, based on 32 prospective studies encompassing 5299 patients. Following surgery, the mean body mass index decreased by 12.26 kg/m². UI prevalence declined by 50%, with significant improvements in both stress and urge UI. POP symptoms also significantly improved, while FI outcomes remained unchanged. Quality of life measures such as Pelvic Floor Distress Inventory-20, Incontinence Questionnaire-Short Form, and Pelvic Floor Impact Questionnaire-7 showed notable improvement, though no significant change was observed in PISQ-12 scores. These findings underscore the beneficial effects of bariatric surgery on urinary and prolapse symptoms, supporting its role in the multidisciplinary management of obesity-related PFD.

Keywords: Bariatric surgery; Fecal incontinence; Obesity; Pelvic floor disorders; Pelvic organ prolapse; Urinary incontinence; Weight loss.