Urinary and fecal incontinence after bariatric surgery.

BACKGROUND: Morbidly obese women have markedly high rates of urinary and fecal incontinence. Weight loss reduces prevalence and severity of urinary incontinence; however, the effect of weight loss on fecal incontinence is unknown. AIMS: The aim of this study was to document the prevalence of urinary and fecal incontinence in subjects who underwent bariatric surgery and associated weight loss. METHODS: We mailed a detailed survey to all 404 adults who underwent bariatric surgery at the University of Wisconsin prior to May 2006. Type and severity of urinary and fecal incontinence was obtained using previously validated questionnaires. Perceived effect of surgery on bowel and bladder function was also assessed. RESULTS: Forty-eight percent (193) of the surveys were returned. Urinary incontinence was reported in 72% of the women, 39% of whom perceived improvement after surgery. Only 21% of the men reported urinary incontinence. In contrast, fecal incontinence was common in both men and women; 48% of the women and 42% of the men reported liquid stool incontinence and 21% of the women and 30% of the men reported solid stool incontinence. Fifty-five percent of the women and 31% of the men with fecal incontinence perceived worsening after surgery. Women with diarrhea were four times more likely to report fecal incontinence (P<0.0001). Furthermore, women who perceived worsening of diarrhea after surgery were significantly more likely to have fecal incontinence (P=0.003). CONCLUSIONS: Both fecal and urinary incontinence were common after bariatric surgery. Risk factors for fecal incontinence in women after bariatric surgery include diarrhea and worsening of diarrhea; we suggest that such surgery may uncover prior weaknesses in the continence mechanism.

Pilot study using PET/CT as a novel, noninvasive assessment of disease activity in inflammatory bowel disease.

BACKGROUND: A pilot study was performed investigating the possibility that positron emission tomography (PET) activity using 18-fluorodeoxyglucose (FDG) with nearly simultaneous computerized tomography (CT) for anatomic accuracy would identify regions of active inflammation in both ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Prospective clinical data was collected in 12 patients experiencing an exacerbation of their inflammatory bowel disease; 7 with CD and 5 with UC. A PET/CT scan (GE Discovery LS PET/CT scanner) was performed in all patients. Twenty patients undergoing PET/CT because of solitary pulmonary nodules served as controls. We graded the small bowel and 4 colon regions (ascending, transverse, descending, and rectosigmoid) with PET activity scores assigned to each region based on the amount of FDG uptake using the liver as the reference organ. RESULTS: In UC patients, PET activity was seen in 13 of 24 (52%) regions. There was high (23 of 24; 95.8%) correlation between PET activity and disease activity as determined by colonoscopy, disease activity indices, and radiology. In patients with CD, PET activity was seen in 19 of 32 (59.4%) regions. Again, there was a high (26 of 32; 81.3%) correlation between PET activity and clinical disease activity. Of the 20 controls, significant PET activity (Grades 2 and 3) was seen in only 2 of 100 regions (2%). CONCLUSIONS: We found that PET activity correlated well with active inflammation in both UC and CD, suggesting that this may be a noninvasive method of identifying disease activity in patients with inflammatory bowel disease.