OBJECTIVE -We examined associations between obesity and diabetes and female pelvic floor disorders (PFDs), stress urinary incontinence (SUI), overactive bladder (OAB), and anal incontinence (AI) in community-dwelling women.RESEARCH DESIGN AND METHODS -Women were screened for PFD using a validated mailed survey. Diabetes status, glycemic control, and diabetes treatment were extracted from clinical databases, while other risk factors for PFDs were obtained through self-report. Women were categorized hierarchically as nonobese/nondiabetic (reference), nonobese/ diabetic, obese/nondiabetic, and obese/diabetic. CONCLUSIONS -Given the impaired quality of life experienced by women with PFDs, health care providers should counsel women that obesity and diabetes may be independent modifiable risk factors for PFDs.
RESULTS
Diabetes Care 30:2536-2541, 2007D iabetes, obesity, and incontinence are all common health problems for women in the U.S. It has been estimated that 9.7 million, or 8.8%, of all women aged Ն20 years had diabetes in 2005 (1), while almost 50% may experience urinary incontinence in their lifetime (2). In [2003][2004]28.6% of women were overweight and 33.2% were obese (3). Urinary incontinence alone accounts for the expenditure of up to 19.5 billion dollars annually in the U.S. (4) and can have a significant impact on the quality of womens' lives (5).Studies (6 -12) have demonstrated the association between urinary incontinence and diabetes, and some (11,12) have found that women who used insulin were more likely to be incontinent than women with diabetes who did not require insulin, but the mechanisms are unclear. It has been suggested that the most likely reason for the increase in risk is microvascular compromise, leading to damage to the urethral sphincter mechanism and bladder sensitivity, and that stricter glycemic control may reduce the risk or severity of urinary incontinence (13). Studies (14,15) of the relationship between anal incontinence and diabetes have had conflicting results.Strong associations between obesity and both urinary and fecal incontinence have been reported (16 -24). The pathophysiologic basis posited for this relationship lies in the significant correlation between BMI and intra-abdominal pressure, suggesting that obesity may stress the pelvic floor secondary to a chronic state of increased pressure (25). Weight loss has been shown to improve incontinence in obese women (26 -28).In this secondary analysis of data from the KP CARES (Kaiser Permanente Continence Associated Risk Epidemiology Study) study, we examined associations between female pelvic floor disorders (PFDs) (stress urinary incontinence [SUI], overactive bladder [OAB], and anal incontinence [AI]) and diabetes and obesity. Pelvic organ prolapse was excluded from these analyses due to insufficient power to assess the associations of interest for this condition. We sought to evaluate the relative importance of the associations between diabetes and obesity in their contributions to PFDs.
RESEARCH DESIGN AND METHODS -Kai...