Pelvic Floor Dysfunction, Diabetes, and Obesity

Urinary incontinence and fecal incontinence adversely affect quality of life and add to healthcare costs. In a secondary analysis of data from a large Kaiser Permanente (KP) continence study, researchers examined the association of three pelvic floor disorders (PFDs) with diabetes and obesity (alone or combined). Validated surveys to assess the presence and nature of PFD symptoms were mailed to women (age range, 25–94) served by KP. Respondents’ information was linked through the database to that of health plan members with probable diabetes. BMI was calculated from self-reported height and weight; women were categorized as nonobese (BMI <30) or obese (BMI ≥30).

Of the 3962 eligible respondents (median age, 57), 62% were white, 19% Hispanic, 10% black, and 8% Asian/Pacific Islanders. The 393 diabetic women were more likely to be older, black or Hispanic, obese, parous, and postmenopausal than were nondiabetic women. Overall PFD prevalence was 15% for stress urinary incontinence (SUI), 13% for overactive bladder (OAB), 25% for anal incontinence (AI; flatal, solid, or liquid), and 35% for any PFD. In adjusted analyses, compared with nonobese nondiabetic women, obese diabetic women were more likely to have SUI (odds ratio, 3.67), OAB (OR, 2.97), AI (OR, 2.09), or any PFD (OR, 2.62). Obese nondiabetic women had the next highest incidence of SUI (OR, 2.62), OAB (OR, 2.93), AI (OR, 1.45), or any PFD (OR, 1.83). Nonobese diabetic women had no significant increase in occurrence of OAB, AI, or any PFD but were more likely to have SUI (OR, 1.81) than were nonobese nondiabetic women.