Now, researchers have found that the severity of fecal incontinence worsens for a majority of patients after the procedure, although the reason is not known.
“This is important because it’s an underappreciated problem,” said principal investigator Erica N. Roberson, MD, women’s health fellow at the University of Wisconsin in Madison. “Nobody really talks enough about incontinence among these patients.” More than half of patients who have the problem do not even mention it to their physicians, Dr. Roberson added, and physicians tend not to ask about the condition.
Recent studies have documented a high prevalence of urinary incontinence and fecal incontinence (67% and 32%, respectively) in women considering bariatric surgery and improvement of urinary incontinence after the procedure (Obstet Gynecol 2005. 106:1272-1277. NIH Consens State Sci Statements, 2007;24).
Dr. Roberson and her team mailed questionnaires to all patients who underwent bariatric surgery at the University of Wisconsin–Madison over a four-year span. The survey covered background information, type of surgery, weight change, symptoms of bowel and bladder disorders, and perceived effects of surgery on those symptoms.
Of 194 patients who responded (82% female), 51.2% who had liquid fecal incontinence prior to surgery said their conditions worsened afterward, compared with only 9.3% who reported improvement after surgery. Of the patients with solid fecal incontinence, 44.1% reported worsening diarrhea and 11.8% reported improvement of diarrhea after surgery. Of those patients with solid fecal incontinence prior to surgery, 54% said it worsened after surgery, and 11.8% reported an improvement. Urinary incontinence was reported by 73.4% of the respondents, although most reported either improvement or no change after surgery.
What’s the connection between bariatric surgery and incontinence? “We don’t have a good answer,” said Dr. Roberson. She offered some possibilities, including a change in diet or an anatomic change of the gastrointestinal tract. Diarrhea is known to occur frequently following bariatric surgery, and may relate to changes in diet after the procedure. Many patients change their diets drastically after surgery. Dr. Roberson hopes to address issues of causation in future studies.
Mark DeLegge, professor of medicine in the Department of Gastroenterology and Hepatology at the Medical University of South Carolina, Charleston, acknowledged that he had not realized that the problem of worsening incontinence was so prevalent in post–bariatric surgery patients.
“I see a lot of these patients and most have never mentioned this to me,” Dr. DeLegge said. In what he calls a “very unscientific evaluation” of a small number of his own patients, Dr. DeLegge found that some patients experienced somewhat worse fecal incontinence after the surgery, although they had not volunteered the information.
Dr. DeLegge speculated that fecal incontinence becomes a problem because many patients become more physically active after bariatric surgery. “I don’t think it’s a result of the surgery itself,” he said.
Source: General Surgery News