Prog Urol. 2023 Mar;33(4):207-216. doi: 10.1016/j.purol.2022.10.005. Epub 2022 Nov 29.

A Postillon ¹, C Buisset ², A Parvanescu ³, F Bihain ⁴, D Quilliot ⁵, L Brunaud ⁴

Author information

¹Department of Gastrointestinal, Metabolic and Surgical Oncology, University Hospital of Nancy, rue du Morvan, Vandoeuvre-les-Nancy, France. Electronic address: agathe.postillon@gmail.com.

²Department of Digestive, Endocrine and Metabolic Surgery, UNEOS groupe hospitalier associatif, hôpital Robert-Schuman, rue du Champ Montoy, Metz, France.

³Department of Digestive Surgery, hôpital Saint-Joseph, rue Raymond-Losserand, Paris, France.

⁴Department of Gastrointestinal, Metabolic and Surgical Oncology, University Hospital of Nancy, rue du Morvan, Vandoeuvre-les-Nancy, France.

⁵Department of Diabetology, Endocrinology and Nutrition, University Hospital of Nancy, rue du Morvan, Vandoeuvre-les-Nancy, France.

Abstract

Introduction: Anal incontinence (AI) prevalence in general population is estimate to range from 1.4 to 19.5% (Wexner ≥ 1). Obesity could be an AI risk factor. However, AI prevalence in patients with obesity is not clearly established. The main objective of this study was to assess the prevalence of AI in patients with extreme obesity prior to bariatric surgery and to identify specific AI risk factors in this subset of patients.

Material: A cross-sectional study, in a tertiary referral center in obesity was performed during one year. Patients who presented criteria for bariatric surgery (BMI>40 or BMI > 35 with co-morbidities) were asked to fill in preoperative self-questionnaires. A Wexner score ≥ 3 was used to define AI to identified patients who had a clinic impact of AI, by frequency of symptoms or alteration of quality of life.

Results: Two hundred and fifty patients were included. Corresponded to, 196 women (78.4%) and 54 men (21.6%). Median BMI was 44.53kg/m². AI was diagnosed in 41 patients (prevalence 16.4%, 95CI 0.59). Constipation, urinary incontinence and the history of pregnancy (P = 0.03, OR 2.79; P = 0.01, OR 3.53 and P=0.02, OR 4.71, respectively) were significantly associated with AI.

Conclusion: AI is frequently observed in patients with extreme obesity scheduled for bariatric surgery and should be routinely evaluated. Modifiable risk factors as constipation should be manage before surgery as well as the specific management of AI, to prevent AI exacerbation after surgery. The choice of bariatric surgical procedure should be discussed and evaluated for the treatment of patients with obesity and AI.

Level of evidence: Moderate.