Evaluating the influence of metabolic bariatric surgery on urinary and fecal incontinence outcomes: a one-year postoperative analysis

The most prevalent conditions affecting the pelvic floor include fecal incontinence (FI) and urinary incontinence (UI), both of which are particularly common among women with obesity. Although the effect of metabolic bariatric surgery (MBS) on FI remains a topic of ongoing discussion, the present study seeks to assess the impact of effective bariatric surgery on UI and FI in women with obesity. An observational prospective study was conducted at the Tours University Hospital, involving 212 women who underwent MBS. Participants completed pre-operative and post-operative questionnaires to evaluate UI and FI one-year after surgery. Additionally, urinary symptom profile (USP) and Wexner score (WS) were utilized for the assessment of UI and FI, respectively. Of the 212 patients, 148 achieved a weight loss of more than 20% of their weight one-year after surgery, and of these 40 (27.0%) completed all questionnaires. The median pre-surgical BMI was found to be 41.8 kg/m², which reduced to 29.1 kg/m² one-year post-surgery. A significant improvement was observed in stress urinary incontinence (SUI), which decreased from 32.5% pre-operatively to 22.5% post-operatively (p < 0.0001). FI showed slight exacerbation, with an increase in moderate FI (from 5.0% to 10.0%), frequency of liquid stool per week (from 2.5% to 5.0%), and gas-related symptoms (from 0 to 2.5%). The findings of this study indicate that MBS significantly improves SUI in women with obesity, yet has minimal impact on FI one-year postoperatively. Further studies are required to more accurately assess the impact of metabolic bariatric surgery on postoperative FI.