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Pelvic Floor Disorders, Diabetes, and Obesity in Women

Findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study

¹ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
² Women’s Pelvic Medicine Center, University of California San Diego, San Diego, California
³ Department of Female Pelvic Medicine, Kaiser Permanente San Diego Medical Center, San Diego, California

Address correspondence and reprint requests to Jean M. Lawrence, ScD, MPH, MSSA, Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena CA 91101. E-mail: jean.m.lawrence{at}kp.org

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.

RESULTS—Of 3,962 women, 393 (10%) had diabetes. In unadjusted analyses, women with diabetes and women who were obese had greater odds of having PFDs. Among women with diabetes, being obese was associated with SUI and OAB. After adjusting for confounders, we found that obese/diabetic women were at the highest likelihood of having SUI (odds ratio 3.67 [95% CI 2.48–5.43]) and AI (2.09 [1.48–2.97]). The odds of having OAB among obese women was the same for obese/diabetic women (2.97 [2.08–4.36]) and obese/nondiabetic women (2.93 [2.33–3.68]). Nonobese/diabetic women had higher odds of SUI (1.90 [1.15–3.11]) but did not differ significantly in their OAB (1.45 [0.88–2.38]) and AI (1.33 [0.89–2.00]) prevalence from nonobese/nondiabetic women.

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.

Abbreviations: AI, anal incontinence • EPIQ, Epidemiology of Prolapse and Incontinence Questionnaire • KPSC, Kaiser Permanente Southern California • PFD, pelvic floor disorder • SUI, stress urinary incontinence • OAB, overactive bladder

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