We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Urinary Incontinence Before and After Bariatric Surgery

Leslee L. Subak, MD1,2,3,4; Wendy C. King, PhD5; Steven H. Belle, PhD, MScHyg5,6; Jia-Yuh Chen, MS6; Anita P. Courcoulas, MD, MPH7; Faith E. Ebel, RD, MS, MPH8; David R. Flum, MD, MPH9; Saurabh Khandelwal, MD9; John R. Pender, MD10; Sheila K. Pierson, BS7; Walter J. Pories, MD10; Kristine J. Steffen, PharmD, PhD11; Gladys W. Strain, PhD8; Bruce M. Wolfe, MD12; Alison J. Huang, MD, MAS13
[+] Author Affiliations
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
2Department of Epidemiology and Biostatistics, University of California, San Francisco
3Department of Urology, University of California, San Francisco
4San Francisco Veterans Affairs Medical Center, San Francisco, California
5Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
6Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
7Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
8GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, New York
9Department of Surgery, University of Washington, Seattle
10Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
11Department of Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Grand Forks
12Department of Surgery, Oregon Health & Science University, Portland
13Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2015;175(8):1378-1387. doi:10.1001/jamainternmed.2015.2609.
Text Size: A A A
Published online

Importance  Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery–induced weight loss is lacking.

Objectives  To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.

Design, Setting, and Participants  The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).

Intervention  Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter.

Main Outcomes and Measures  The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up.

Results  Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.

Conclusions and Relevance  Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?


Place holder to copy figure label and caption
Figure 1.
Study Participant Flow Diagram
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Modeled Frequency of Urinary Incontinence Episodes and Prevalence of Any-Type, Stress-Type, and Urgency-Type Urinary Incontinence Before and After Bariatric Surgery

Each follow-up time point was compared with baseline. Bars indicate 95% CIs.

aThe overall P value for a time effect of change in prevalence of stress urinary incontinence among men was 0.31 so pairwise comparisons were not made.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

4 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles