Einfluss der Adipositas in der Urogynäkologie

Zusammenfassung

Beckenbodenfunktionsstörungen wie Genitaldeszensus, Belastungsinkontinenz, überaktive Blase und Stuhlinkontinenz zählen zu den häufigsten urogynäkologischen Krankheitsbildern. Die postmenopausale Prävalenz liegt bei ca. 40%. Hauptursachen sind Geburten, fortschreitendes Alter und Hormonmangel in der Menopause. Chronischer Druck auf den Beckenboden durch Übergewicht und Adipositas, oft in Verbindung mit Diabetes mellitus, sind weitere Risikofaktoren. Studien zeigen, dass Übergewicht die Häufigkeit von Beckenbodenfunktionsstörungen erhöht, wobei ein höherer BMI mit einer höheren Prävalenz von Harn- und Stuhlinkontinenz sowie Genitaldeszensus korreliert. Eine Gewichtsabnahme kann die urogynäkologischen Symptome verbessern, bei 5–10% Gewichtsreduktion wird ein Rückgang der Inkontinenzepisoden bis zu 60% beschrieben. Jedoch sind die langfristigen Erfolge oft begrenzt. Hier stellen die medikamentöse Therapie der Adipositas und die bariatrische Chirurgie eine Therapieoption dar. Daher sollte die Beratung adipöser Frauen nicht nur die möglichen urogynäkologischen Folgen thematisieren, sondern auch gezielt zur Gewichtsreduktion motivieren. Bei Schwangeren kann Übergewicht das Risiko für postpartale Beckenbodenstörungen deutlich erhöhen. Daher sind prä- und postpartale Maßnahmen zur Beckenbodengesundheit besonders wichtig.

Abstract

Pelvic floor dysfunction such as genital prolapse, stress incontinence, overactive bladder and fecal incontinence are among the most common urogynecological diseases. The postmenopausal prevalence is around 40%. The main causes are childbirth, advancing age and hormone deficiency during menopause. Chronic pressure on the pelvic floor caused by overweight and obesity, often associated with diabetes mellitus, are further risk factors. Studies show that obesity increases the incidence of pelvic floor dysfunction, with higher BMI correlating with a higher prevalence of urinary and fecal incontinence and genital prolapse. Losing weight can improve urogynecological symptoms; with 5–10% weight loss, a reduction in incontinence episodes of up to 60% has been described. However, long-term success is often limited. Here, drug therapy for obesity and bariatric surgery represent a treatment option. Therefore, counseling for obese women should not only address the possible urogynecological consequences, but also specifically motivate them to lose weight. In pregnant women, being overweight can significantly increase the risk of postpartum pelvic floor disorders. Therefore, pre- and postpartum measures for pelvic floor health are particularly important.

Schlüsselwörter

Urogynäkologie - Genitaldeszensus - Inkontinenz - Adipositas

Keywords

urogynaecology - genital prolapse - incontinence - obesity

Publication History

Article published online:
13 December 2024

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