Obesity is a significant and increasing health problem for older adults, their care partners and healthcare. Obesity is an established risk factor for pelvic floor disorders including urinary and fecal incontinence, the symptoms of which adversely affect self esteem and the quality of social, family and sexual lives. Incontinence affects 30 - 40% of people living with obesity (1). The odds ratio for the presence of urinary incontinence is 1.6 per 5-unit increase in BMI, and the prevalence of UI in women in the ‘morbidly obese’ category seeking weight-loss surgery is as high as 67%. The role of weight loss, either moderate, associated with diet, or surgical for those people in the morbidly obese category, has been established in reducing or ameliorating urinary incontinence (2,3). Apart from a single study which considers continence care for obese nursing home residents, there is a gap in the literature regarding the day-to-day experience of people living with obesity in caring for their incontinence, problems related to the maintenance of continence and toileting and difficulties with caring for incontinence associated adverse events. This study aimed to investigate these factors from the perspective of women living with obesity and incontinence.

Community dwelling participants, 18 years of age and over, who had a diagnosis of UI, FI or both and a BMI over 30 were recruited from a continence and a bariatric surgical clinic. Following initiation of contact, and receipt of informed consent to participate, the was study explained and, a time and date arranged to conduct a one on one semi structured interview.  Interviews took place either in person or virtually, depending on the preference of the participant, at a convenient time (place).  Interviews explored the nature of the incontinence suffered by the person, the current methods of care, the use of aids and appliances, associated health problems (skin problem etc) toileting difficulty, experiences of care (either independent or assisted. The interview was audio recorded for transcription and de-identified at that point. Interviews continued until saturation of information was reached.  All qualitative data were analyzed using content analysis by two researchers, who independently coded the first two transcripts from each participant, compared codes and developed an initial coding framework. The initial coding framework was used to code three transcripts, review and revise the coding framework which was then used for all interviews. Data for each code was consolidated on a code/data form, reviewed and collapsed into categories and themes. To ensure rigor in the approach and trustworthiness of findings, team members collecting data familiarized themselves with the context. For dependability and confirmability, an audit trail of data was maintained. Each interviewer kept field notes to allow reflection and consideration of the topic. Quantitative data on age, sex, medical history, comorbidities and functional abilities will be gathered in order to describe the population of interview participants

The participants (n=9) ranged from 66 to 90 years of age and all were females. Interviews lasted no more than 60 minutes. Coding revealed 7 categories and 3 themes (Table) “Health Issues”, “Self Management and Personal Adaptations”, and “Experiences with Medical Management. Compounding health issues and particularly mobility impairment posed difficulties in the management of incontinence. Participants reported alterations to lifestyle, containment products and changed daily habits as management strategies. Varied success with medical management and frustration in navigating management or treatment for incontinence were commonly reported.  Participants reported some stigma regarding their incontinence, felt by some clinicians as being because of their obesity. Skin complications did not arise as a problem in this sample.

Discussion: In this sample of women living with obesity, there were unique elements in managing incontinence and in the methods used for the management of incontinence. Mobility impairment and the unavailability of suitable products and aids for continence appeared to be major factors in daily management. Issues with containment products and experiences with medical management and care received are shared between those with and without obesity, however. Due to the complexity of both conditions and their bidirectional interactions, healthcare providers must be aware of these differences when considering management strategies. This study is limited by the recruitment of English only speakers and the lack of any male voice.  The study also set out to interview care partner dyads of people living with obesity, but none were prepared to participate in separate interviews. Both will be the focus of future work.

Women living with both obesity and incontinence faced unique challenges related to their management of incontinence, related to mobility and the lack of adapted aids to continence management.  Given the increasing prevalence of the problem, greater attention needs to be paid to these coexisitng conditions

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Continence 12S (2024) 101615
DOI: 10.1016/j.cont.2024.101615