Effect of Weight Change on Natural History of Pelvic Organ Prolapse

Abstract

OBJECTIVE To evaluate the relationship between change in weight and pelvic organ prolapse (POP) progression/regression in women during a 5-year period. METHODS Postmenopausal women with uteri (N=16,608), ages 50 to 79, who were enrolled in the Women's Health Initiative (WHI) Estrogen plus Progestin Clinical Trial between 1993 and 1998 were included in this secondary analysis. Baseline pelvic examination, repeated annually, assessed uterine prolapse, cystocele, and rectocele using the WHI Prolapse Classification System. Statistical analyses included univariate and multiple logistic regression methods. RESULTS During the 5-year time period, the majority of women (9,251, 55.7%) gained weight (mean 4.43 kg, ± 5.95 kg), and the overall rate of prolapse (WHI Prolapse Classification System: grades 1-3) increased from 40.9% at baseline to 43.8% at year 5 of evaluation. Controlling for age, parity, race, and other health/physical variables, being overweight (body mass index [BMI] between 25 and 29.9) or obese (BMI of at least 30) at baseline was associated with progression in cystocele, rectocele, and uterine prolapse compared with women with healthy BMIs (BMI is calculated as weight (kg)/[height (m)]2). Specifically, the risk of prolapse progression in overweight and obese women as compared with the participants with healthy BMIs increased by 32% and 48% for cystocele, by 37% and 58% for rectocele, and by 43% and 69% for uterine prolapse, respectively. Adjusting for women with prolapse at baseline and baseline BMI, a 10% weight change was associated with minimal change in overall POP. Specifically, a 10% weight loss was associated with a borderline worsening of uterine prolapse (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88-0.97) and a minimal regression of cystocele (OR 1.03, 95% CI 1.00-1.05) and rectocele (OR 1.04, 95% CI 1.01-1.07). CONCLUSION Being overweight or obese is associated with progression of POP. Weight loss does not appear to be significantly associated with regression of POP, suggesting that damage to the pelvic floor related to weight gain might be irreversible.

Qual o índice de massa corporal de mulheres com disfunções dos músculos do assoalho pélvico que procuram tratamento fisioterapêutico?

“…Estudos demonstram que a redução do peso leva a significante diminuição dos episódios de IU, da noctúria, melhora na qualidade de vida e decréscimo da pressão intravesical 11 11,[33][34][35] suportam a perda de peso como opção de tratamento para mulheres com sobrepeso ou obesas e incontinentes, pois a redução dos episó-dios semanais de IU de 50 a 60% com a perda de peso é comparável com a melhora observada em estudos com terapias comportamentais e com terapias farmacológi-cas 35 . Porém, Kudish et al 7 observaram que a redução de peso não parece estar associada à regressão significativa do prolapso de órgãos pélvicos, sugerindo que o dano no assoalho pélvico, relacionado ao ganho de peso, pode demorar mais tempo para regredir ou ser irreversível.…”

“…A incontinência urinária de esforço (IUE) estaria ligada ao aumento da pressão no AP, enquanto a hiperatividade da bexiga parece estar associada a respostas inflamatórias e químicas na bexiga urinária 5 . Além disso, obesidade vem sendo sugerida como fator de risco estabelecido para o prolapso de órgãos pélvicos 6 , bem como para sua progressão 7 . Recentemente, a identificação do excesso de peso e da obesidade é sugerida como parte integrante dos programas de reabilitação do AP 8 .…”

Factores de riesgo en el fracaso de la reparación quirúrgica del prolapso de suelo pelviano

“…Otro estudio 19 prospectivo, con 16.608 mujeres posmenopáusicas entre 50 y 79 años, en el que se siguió a pacientes con POP durante 5 años y se modificó la variable peso, observó que las pacientes obesas tenían una progresión notoria del prolapso, a diferencia de las que perdían peso, que si bien no mejoraba el grado de prolapso, al menos no progresaba.…”

Existe alteração na função dos músculos do assoalho pélvico e abdominais de primigestas no segundo e terceiro trimestre gestacional?

“…Despite all the pregnant women in this study having normal pre-pregnancy BMI 9 , it may be noted that, during pregnancy, 15.8% were overweight and 15.8% were obese. This becomes important, since obesity can increase the pressure on the PF 24 , causing chronic stress and weakening of muscles and nerves, and may trigger PF dysfunctions 22,23 , such as urinary incontinence. However, even keeping values above 5 μV -considered the upper limit of the tonus at rest -in the third trimester, women had a basal tone less than in the first two trimesters.…”