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Outcomes Research
Obesity Linked to Pelvic Organ Prolapse Recurrence, Mesh Complications
Severe obesity will be the most common BMI category among women by 2030, research suggests. For urogynecologist Danielle Antosh, MD, this projection is a major concern when it comes to pelvic floor health.
An Associate Professor of Obstetrics and Gynecology, Antosh and colleagues conducted a systematic review and meta-analysis of 31 peer-reviewed articles to explore the effects of obesity on pelvic organ prolapse (POP) surgery. The study, published in Obstetrics & Gynecology, revealed an increased likelihood of prolapse recurrence and mesh complications after POP repair from all surgical approaches.
Danielle Antosh, MD
“Obesity is a risk factor for POP and it’s recurrence because it chronically increases intra-abdominal pressure, putting more weight on pelvic organs, such as the vagina and the bladder,” Antosh explained. “That excess pressure can cause those organs to drop or prolapse, resulting in symptoms such as bladder, bowel and sexual dysfunction.”
While the association between obesity and prolapse recurrence was weak, Antosh attributes this to the lack of studies that include women with severe obesity.
“There's not a lot of studies out there that examine severe or extreme obesity in relation to POP, and it’s common for patients of those BMI classes to be excluded from studies,” she explained. “I think if these patients were included more, we would see a stronger association.”
Nevertheless, study results provide synthesized evidence of obesity’s role in surgical outcomes after all surgical routes analyzed together—a knowledge gap in the field. The study results can help patients and surgeon make evidence-based treatment decisions through a shared decision-making process.
It's important for patients to understand obesity’s role in surgical outcomes so they can make an informed treatment decision.
Danielle Antosh, MD
Associate Professor, Obstetrics and Gynecology
“It's important for patients to understand obesity’s role in surgical outcomes so they can make an informed treatment decision,” Antosh said. She added that risk awareness may also serve as motivation to lose weight prior to surgical treatment, which is sometimes recommended to improve outcomes and alleviate symptoms in the meantime.
Often attributed to pregnancy and vaginal childbirth, POP can impact both physical and mental health. Many women think they’re the only ones struggling, but a quarter of women in their 40s and a third of women in their 60s will experience the condition. Unfortunately, social stigmas and embarrassment can keep women from seeking treatment until symptoms affect their quality of life.
“With obesity on the rise, we're going to see more patients with POP and prolapse recurrence,” Antosh noted. “We need to be prepared to treat this patient population while continuing to be sensitive to the stigmas associated with both POP and obesity."
Nancy E. Ringel, MD, MS, Stacy M. Lenger, MD, Rachel High, MD, Alexandriah Alas, MD, Sara Houlihan, MD, Olivia H. Chang, MD, MPH, Jon Pennycuff, MD, Ruchira Singh, MD, Amanda White, MD, Lioudmila Lipitskaia, MD, Sadikah Behbehani, MD, David Sheyn, MD, Bela Kudish, MD, Mikio Nihira, MD, MPH, Ambereen Sleemi, MD, Cara Grimes, MD, MAS, Ankita Gupta, MD, MPH, Ethan M. Balk, MD, MPH, and Danielle D. Antosh, MD
Callie Rainosek Wren, MS
May 2025
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