Obesity, Weight Loss & Urinary Incontinence
By, Robert A. Wascher, MD, FACS
Last Updated: 02/01/2009
The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.
OBESITY AND THE COMPLICATIONS OF DIVERTICULOSIS (DIVERTICULITIS & BLEEDING)
Diverticulosis is an acquired condition that results in the formation of small pouches along the wall of the colon with advancing age. Diverticulosis is known to be much more common among populations that consume western diets, which generally lack significant daily fiber intake. In less developed countries where highly processed and refined foods are not frequently consumed, and where a large percent of the diet is in the form of fresh fruits and vegetables, diverticulosis of the colon is far less common. Most patients with diverticulosis will have no symptoms of this condition. However, there are two potentially life-threatening complications that can occur when diverticulosis is present.
Diverticulosis can result in significant bleeding from the colon within a diverticulum (the small colonic pouch that causes diverticulosis). In severe cases of diverticular bleeding, blood transfusions, and even emergency surgery, may be required (in some cases, radiologists may be able to identify the site of bleeding using angiography, and may also be able to inject material into the offending artery to stop the bleeding).
A second serious complication of diverticulosis is inflammation of a diverticulum, also known as diverticulitis. Mild cases of diverticulosis frequently respond to a 10 to 14 day course of oral antibiotics, while more severe cases of diverticulitis may cause perforation of the colon and abscess formation, or even diffuse peritonitis.
As previously mentioned, a low-fiber diet is thought to be the most important mechanism underlying the formation of diverticuli in the colon (and, most commonly, in the left side of the colon). However, other risk factors may also be involved in the development of diverticulosis, as well as the complications of diverticulosis.
A new prospective clinical study, just published in the journal Gastroenterology, evaluated more than 47,000 adult male physicians between the ages of 40 and 75 years, and followed them for an average of 18 years, making this a very high-powered study. The patient volunteers in this very large prospective clinical study were closely followed through detailed health surveys that were conducted every two years. During these biennial surveys, waste circumference, hip circumference, and body weight were measured and recorded.
In this very large cohort of study volunteers, there were 801 cases of diverticulitis and 383 cases of diverticular bleeding documented during the nearly 20 year duration of this study. After evaluating the resulting clinical data, the researchers found that being obese (BMI ≥ 30 kg/meter-squared) was associated with nearly twice the risk of developing diverticulitis as was observed among men who were of normal weight (BMI ≤ 21 kg/meter-squared). Similarly, the obese men in this enormous study population experienced more than 3 times the risk of diverticular bleeding when compared to the men who were of normal weight.
When the researchers looked at waist-to-hip circumference ratio, the resulting findings were similar. Men with a high waist-to-hip ratio (or, so-called “central obesity”) were approximately twice as likely to develop diverticulitis or diverticular bleeding when compared to men with a very low waist-to-hip ratio. Even simple measurements of waist circumference revealed the same findings, as men with larger waists were found to be about twice as likely to experience diverticular bleeding and diverticulitis when compared to their counterparts with narrower waists.
As if there weren’t already enough reasons to maintain your weight within a healthy range, this huge prospective clinical study strongly suggests that obesity (as measured by BMI, weight, waist-to-hip ratio, or waist circumference) is a significant risk factor for diverticulosis and its two major complications. Although this type of study was not designed to identify the mechanism(s) whereby obesity increases the risk of diverticular complications, it is very likely that the highly-refined, high-energy diets favored by obese people plays an important role in the development of diverticulosis (and its complications) in overweight people.
So, in addition to protecting your cardiovascular system and your joints (as well as reducing your risk of cancer), maintaining a healthy weight, and eating a diet rich in fruits and vegetables and whole grains, will probably do your colon a lot of good as well!
OBESITY, WEIGHT LOSS & URINARY INCONTINENCE
Urinary incontinence is a common affliction, particularly in older women. Urinary incontinence causes varying degrees of unintended urine leakage, especially when coughing or otherwise straining. Patients with urinary incontinence often must wear special water-proof undergarments to contain leaking urine. Hysterectomy and menopause are both well-known risk factors for urinary incontinence, which explains why this condition is much more common in women than in men. Obesity has long been known to increase the risk of developing urinary incontinence as well, most likely as a result of the increased pressures that arise within the abdomen with increasing levels of obesity. However, there has been very little prospective clinical research data available to suggest that losing excess weight can, in turn, reduce the severity of urinary incontinence symptoms in women.
Now, a new study published in the current issue of the New England Journal of Medicine provides compelling evidence that weight loss in overweight and obese women can indeed significantly reduce the severity of bothersome and often embarrassing urinary incontinence symptoms.
In this prospective randomized clinical research study, 338 middle-aged overweight and obese women were randomly assigned to either an intensive 6-month weight loss program (including diet, exercise, and behavior modification) or to a structured weight loss education program. Weekly measurements of body mass index (BMI) and the number of incontinence events were then recorded for all study participants over the course of 6 months.
The women who were assigned to the intensive 6-month weight loss program lost an average of 17 pounds (or about 8 percent of their initial body weight), while the women who were randomized to the weight loss education program only lost an average of about 3 pounds (or 1.6 percent of their initial body weight). Among the women who were assigned to the intensive exercise program, there was an impressive 47 percent reduction in the number of weekly incontinence episodes! However, even the women in the diet education group, despite their rather modest weight loss, appeared to benefit, and experienced a 28 percent decrease in weekly incontinence episodes.
While the significant decline in the number of weekly incontinence episodes reported by the women randomized to diet education classes suggests that there might be a placebo effect, or other factors not directly related to weight loss, involved in the improvements observed in this study, the women who participated in the intensive exercise program, and who lost 8 percent of their initial body weight, experienced a 68 percent greater reduction in the number of incontinence episodes when compared to the “education-only” group of women.
So… keeping one’s weight in a healthy range not only reduces the risk of cardiovascular disease, arthritis, cancer, and both benign and malignant diseases of the colon, but it may also sharply reduce the distressing symptoms of urinary incontinence as well!
Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and the Physician-in-Chief for Surgical Oncology at the Kaiser Permanente healthcare system in Orange County, California
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Robert A. Wascher, MD, FACS
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