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Pelvic Floor Dysfunction, Diabetes, and Obesity

Obese diabetic women were at highest risk for pelvic floor disorders.

Urinary incontinence and fecal incontinence adversely affect quality of life and add to healthcare costs. In a secondary analysis of data from a large Kaiser Permanente (KP) continence study, researchers examined the association of three pelvic floor disorders (PFDs) with diabetes and obesity (alone or combined). Validated surveys to assess the presence and nature of PFD symptoms were mailed to women (age range, 25–94) served by KP. Respondents’ information was linked through the database to that of health plan members with probable diabetes. BMI was calculated from self-reported height and weight; women were categorized as nonobese (BMI <30) or obese (BMI 30).

Of the 3962 eligible respondents (median age, 57), 62% were white, 19% Hispanic, 10% black, and 8% Asian/Pacific Islanders. The 393 diabetic women were more likely to be older, black or Hispanic, obese, parous, and postmenopausal than were nondiabetic women. Overall PFD prevalence was 15% for stress urinary incontinence (SUI), 13% for overactive bladder (OAB), 25% for anal incontinence (AI; flatal, solid, or liquid), and 35% for any PFD. In adjusted analyses, compared with nonobese nondiabetic women, obese diabetic women were more likely to have SUI (odds ratio, 3.67), OAB (OR, 2.97), AI (OR, 2.09), or any PFD (OR, 2.62). Obese nondiabetic women had the next highest incidence of SUI (OR, 2.62), OAB (OR, 2.93), AI (OR, 1.45), or any PFD (OR, 1.83). Nonobese diabetic women had no significant increase in occurrence of OAB, AI, or any PFD but were more likely to have SUI (OR, 1.81) than were nonobese nondiabetic women.

Comment: These findings confirm that pelvic floor disorders, including incontinence, are more common among obese women than among those with normal BMI. Furthermore, the authors were able to tease out the differences in PFD rates in obese versus nonobese diabetic women. Assisting obese diabetic women to lose weight through all appropriate strategies may improve both pelvic floor function and diabetes control. The high overall prevalence of PFDs, including anal incontinence, is a reminder for clinicians to ask about symptoms periodically.

— Diane E. Judge, APN/CNP

Published in Journal Watch Women's Health November 15, 2007

Citation(s):

Lawrence JM et al. Pelvic floor disorders, diabetes, and obesity in women: Findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care 2007 Oct; 30:2536.

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