TY - JOUR
T1 - Obesity and stress urinary incontinence in women
T2 - compromised continence mechanism or excess bladder pressure during cough?
AU - Swenson, Carolyn W.
AU - Kolenic, Giselle E.
AU - Trowbridge, Elisa R.
AU - Berger, Mitchell B.
AU - Lewicky-Gaupp, Christina
AU - Margulies, Rebecca U.
AU - Morgan, Daniel M.
AU - Fenner, Dee E.
AU - DeLancey, John O.
N1 - Funding Information:
Acknowledgements This research was supported by the National Institutes of Health Office of Research on Women’s Health (grant P50 HD044406). Investigator support for C.W.S. was provided by the National Institute of Child Health and Human Development Women’s Reproductive Health Research Career Development Award K12 HD065257.
Publisher Copyright:
© 2017, The International Urogynecological Association.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Introduction and hypothesis: We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. Methods: A secondary analysis was performed using data from a case–control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5–24.9 kg/m2); overweight (25.0–29.9 kg/m2); and obese (≥30 kg/m2). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. Results: The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410). Conclusions: Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.
AB - Introduction and hypothesis: We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. Methods: A secondary analysis was performed using data from a case–control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5–24.9 kg/m2); overweight (25.0–29.9 kg/m2); and obese (≥30 kg/m2). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. Results: The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410). Conclusions: Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.
KW - Obesity
KW - Pelvic floor disorders
KW - Urinary stress incontinence
KW - Urodynamics
UR - http://www.scopus.com/inward/record.url?scp=85011298711&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85011298711&partnerID=8YFLogxK
U2 - 10.1007/s00192-017-3279-6
DO - 10.1007/s00192-017-3279-6
M3 - Article
C2 - 28150033
AN - SCOPUS:85011298711
SN - 0937-3462
VL - 28
SP - 1377
EP - 1385
JO - International Urogynecology Journal
JF - International Urogynecology Journal
IS - 9
ER -
