Beyond Leakage: The Hidden Burden of Pelvic Floor Dysfunction in Women with Urinary Incontinence Undergoing Sling Surgery.

INTRODUCTION AND HYPOTHESIS: We aimed to study the burden of symptoms beyond urinary incontinence (UI) and evaluate their prevalence in women before sling surgery. We also compared the prevalence of bothersome symptoms other than UI in normal-weight, overweight, and obese women. METHODS: This cross-sectional study included 539 women with UI scheduled for sling surgery. Women with POP stage ≥ 2 according to POP-Q were excluded. Patient-reported outcomes were assessed using PFDI-20, P-QoL, HADS, and a visual analogue scale (VAS) for low back and lower abdominal pain. RESULTS: The mean age was 52.6 (10.9) years. In the total sample, there were 35.8% overweight women and 34.7% of women with obesity. A significant proportion of women reported bothersome symptoms not directly related with urinary leakage, in particular, pelvic pressure (29.7%), pelvic heaviness (25.6%), incomplete bladder emptying (22.9%), bowel dysfunction (29.3-34.7%), and loss of gas (41.7%). Moderate-to-severe low back and lower abdominal pain were reported by 32.4% and 9.8% of women, respectively. Ten symptoms of the P-QoL not related to UI were observed as bothersome by more than 10% of patients. Anxiety and depression were present in 35% and 18% of patients, respectively. Women across all BMI experienced bothersome symptoms beyond urine leakage. There were more overweight and obese women with bothersome symptoms other than UI compared to normal-weight women. CONCLUSIONS: Women with UI undergoing sling surgery report a substantial burden of symptoms other than those of UI. More women with obesity and overweight than those with normal weight experience bothersome symptoms other than urinary leakage.