Gastric Bypass and Bowel Incontinence

Gastric bypass surgery is a life-changing surgery. Gastric bypass includes the creation of a small stomach pouch and the construction of bypasses of the duodenum and other segments of the small intestine to limit the amount of absorption of calories from food. Most of the stomach is closed off with staples.

Gastric banding is another type of bariatric surgery wherein food intake is restricted by making a small pouch at the top of the stomach where food enters from the esophagus. The pouch is very small at first (holds 1 oz. of food) but expands with time.

With both surgeries, the stomach is made to be much smaller. The way your body handles food is completely changed. You have to eat less food, and you will not absorb all the nutrition and calories from the food you do eat. After surgery, there are also risks of complications and health issues. But for many people who are morbidly obese or who have tried everything and are unable to lose weight, this surgery is the best option. The Longitudinal Assessment of Bariatric Surgery (LABS) estimated that in 2008, over 220,000 Americans had weight loss surgery.

The health risks associated with having weight loss surgery include:

• The pouch stretching over time thus reversing the surgery
• The staples or band coming out
• Anemia, due to vitamin deficiency
• Osteoporosis or bone disease, due to calcium deficiency
• Gallstones
• Diarrhea
• Hypoglycemia
• Dumping syndrome

Benefits of Gastric Bypass Surgery

There are a multitude of benefits of the surgery that include weight loss, reduced cholesterol levels, reduced symptoms or complete disappearance of type 2 diabetes, reduced or complete disappearance of sleep apnea, lower blood pressure and better overall mental health. Since morbid obesity can put extra pressure on the bladder, one other benefit is reduced stress urinary incontinence. Once enough weight has been lost, the pressure decreases. However, though urinary incontinence is markedly improved following weight loss surgery, there is a possibility that bowel incontinence can happen post-surgery.

A study in Digestive Diseases and Science, and published by the National Institute of Health, found that while diarrhea is a recognized consequence of intestinal bypass procedures, Roberson and colleagues in this issue of the journal highlight found that fecal incontinence (FI) may begin or worsen after bariatric surgery.

The main takeaways from the study are:

• Reinforcing the need to manage obese patients by an integrated team.
• Be sure to have a gastroenterologist and record any incontinence symptoms following surgery.
• Patients undergoing bariatric surgery should be asked by their physician if they have bowel incontinence before and after surgery.
• The study found that a majority of patients with fecal incontinence will not disclose the symptom to their physician unless asked.

The Impact of Bariatric Surgery on Urinary and Fecal incontinence

Another study by the same medical team, conducted at University of Wisconsin, had a similar outcome. The study was conducted with the cooperation of over 400 men and women who underwent bariatric surgery. The study found that prior to weight loss surgery, 72% of women suffered from urinary incontinence. After surgery, 39% of the women said their urinary incontinence symptoms improved. Prior to surgery, 48% of women and 42% of the men reported bowel incontinence. Following surgery, 55% of the women in that group, and 31% of the men said their bowel symptoms worsened. The study concluded that incontinence and weight loss surgery are linked, and symptoms of bowel incontinence seem to worsen after surgery.