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The association of diet and other lifestyle factors with overactive bladder and stress incontinence: A longitudinal study in women
Abstract
To investigate the role of diet and other lifestyle factors in the incidence of overactive bladder and stress incontinence in women. Studies have suggested relationships between different aspects of lifestyle and symptoms of urinary incontinence, but there is a lack of firm evidence about their role in its cause.
A random sample of women aged >or= 40 years living at home took part in a prospective cohort study. Baseline data on urinary symptoms, diet and lifestyle were collected from 7046 women using a postal survey and food-frequency questionnaire. Follow-up data on urinary symptoms were collected from 6424 of the women in a postal survey 1 year later. Logistic regression was used to investigate the association of food and drink consumption and other lifestyle factors with the incidence of overactive bladder and stress incontinence.
In the multivariate model for the onset of an overactive bladder, there were significantly increased risks associated with obesity, smoking and consumption of carbonated drinks, and reduced risks with higher consumption of vegetables, bread and chicken. Obesity and carbonated drinks were also significant risk factors for the onset of stress incontinence, while consumption of bread was associated with a reduced risk.
Causal associations with obesity, smoking and carbonated drinks are confirmed for bladder disorders associated with incontinence, and additional associations with diet are suggested. Behavioural modification of lifestyle may be important for preventing and treating these disorders.
... Factors commonly associated with poor PFH in women often relate to childbirth [3][4][5] . However, non-sexspecific causal factors for poor PFH have also been proposed, for instance obesity, compromised cognition, poor nutrition, sedentary lifestyles, polypharmacy, and regular smoking and alcohol consumption [12][13][14][15][16][17][18] . Although poor PFH is not a simple topic to address in a public health sense, some proposed associated factors could be addressed via public health better lifestyle campaigns, health promotion, education and individual pharmaceutical and non-pharmaceutical approaches [2][3][4][5][12][13][14][15][16][17][18] . ...
... However, non-sexspecific causal factors for poor PFH have also been proposed, for instance obesity, compromised cognition, poor nutrition, sedentary lifestyles, polypharmacy, and regular smoking and alcohol consumption [12][13][14][15][16][17][18] . Although poor PFH is not a simple topic to address in a public health sense, some proposed associated factors could be addressed via public health better lifestyle campaigns, health promotion, education and individual pharmaceutical and non-pharmaceutical approaches [2][3][4][5][12][13][14][15][16][17][18] . This paper reports data from a cross-sectional observational study 11,19 to identify factors associated with bladder health in community dwelling adults aged 40-75 years. ...
... Increasing age was associated with decreasing bladder health for both men and women, with women reporting significantly more problems than men in each age group. Regular physical activity has been reported as being associated with good physical and mental health [12][13][14][15][16][17][18] , and it is not surprising that we found that good physical health indicators were related to good bladder health. Walking speed is an indicator of physical fitness, and slower walking speeds were related to poor bladder health. ...
... However, there is increasing evidence that diet may play a significant role in the development of OAB symptoms. Dallosso et al. [21] collected data from 7,046 women over the age of 40 to investigate the role of diet and life-style in OAB and urinary incontinence. Information about the onset of OAB symptoms, diet, and lifestyle was obtained by a postal questionnaire. ...
... Significant relationships were observed between OAB symptoms and obesity, smoking, and carbonated drink consumption. The risk of OAB symptoms was reduced with higher consumption of vegetables, bread, and chicken [21]. In our study, adults of both sexes participated. ...
... Of the 500 initially recruited patients, 174 were excluded from the study based on a detailed medical history in outpatient clinics and the results of urinalysis. Chronic diseases and urinary tract infec- [21] based on an evaluation of food consumption in various patient groups. In our study, the cumulative effect of foods was highlighted by evaluating the MeDAS. ...
Purpose:
The relationship between nutrition and overactive bladder (OAB) has yet to be elucidated. Therefore, this study investigated the relationship between the Mediterranean diet and OAB.
Methods:
The 14-item Mediterranean Diet Adherence Screener (MeDAS) and Overactive Bladder-Validated 8-question Screener (OAB-V8), validated in Turkish, were administered to 500 patients over the age of 18 who presented to outpatient clinics other than urology outpatient clinics. Of those patients, 174 with chronic diseases and urinary tract infections (based on urinalysis and a detailed medical history) were excluded. Therefore, 326 patients' data were analyzed.
Results:
There was a negative correlation between the MeDAS and OAB-V8 scores. High OAB-V8 scores were associated with obesity (body mass index ≥30 kg/m2), being single, and a low education level.
Conclusion:
Dietary patterns represent a broader perspective on food and nutrient consumption and may therefore be more predictive of disease risk. The Mediterranean type should be recommended in the first-line treatment of patients with OAB symptoms. It is easily possible to determine the compliance of patients with this diet by using the 14-item MeDAS.
... Previous studies have identified the following factors affecting OAB incidence: age [1,8,9,[12][13][14], education level [1], employment [1], prior disease [6,9,10,15,16], parity [1,11], mode of delivery during birth [1,11], high body mass index (BMI) [6,7,9,11,13], racial or ethnic identity [6], geographical region [1], dietary habits [1,14,17], and environmental stimuli [14,18]. By contrast, one study found that sex, educational level, parity, vaginal delivery, race, menopause, marital status, smoking and alcohol consumption were not associated with OAB [13]. ...
... However, one study revealed that environmental cues, such as another person mentioning going to the bathroom, may constitute Pavlovian-conditioned stimuli that affect OAB symptoms [18]. Studies have revealed that the environmental factors, including dietary habits [1,14,17] and alcohol consumption [1,14], with each is associated with OAB [1,14,17], OAB dry [1], or OAB wet [1]. In this study, all partners lived together and thus shared a living environment, which may have influenced their respective health and health behaviors [22]. ...
... However, one study revealed that environmental cues, such as another person mentioning going to the bathroom, may constitute Pavlovian-conditioned stimuli that affect OAB symptoms [18]. Studies have revealed that the environmental factors, including dietary habits [1,14,17] and alcohol consumption [1,14], with each is associated with OAB [1,14,17], OAB dry [1], or OAB wet [1]. In this study, all partners lived together and thus shared a living environment, which may have influenced their respective health and health behaviors [22]. ...
Background and Objectives: The living environment can manifest physiological responses in humans, with cohabiting couples often having similar health statuses. The aim of this study was to (1) examine the prevalence of the overactive bladder (OAB) with or without incontinence and (2) identify associated factors for OAB with and without incontinence (including environmental factors, such as living with a partner who has OAB) in middle-aged women. Materials and Methods: In this cross-sectional study, the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OBA) was administered to 970 couples. Data were analyzed using descriptive statistics, chi-square analyses, and multivariate logistic regression. Results: Responses to the ICIQ-OBA among middle-aged women generated a higher prevalence of OAB with incontinence (OABwet; 41%) than OAB without incontinence (OABdry; 26%; p < 0.001). The factors associated with OABwet were as follows: being age ≥ 55 years (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.02–1.95), having a body mass index (BMI) ≥ 27 kg/m2 (OR, 1.50; 95% CI, 1.03–2.17), having vaginitis (OR, 1.89; 95% CI, 1.28–2.80), and having partners with OABwet (OR, 2.35; 95% CI, 1.74–3.19). Having partners with OABdry (OR, 1.81; 95% CI, 1.34–2.44) was an associated factor for OABdry. Conclusions: This study identified the associated factors for OAB subtypes (OABwet and OABdry) in middle-aged women. These findings can support treatment and preventive strategies for health providers who care for patients with OAB. As part of the treatment and preventative strategies, the risk that partners may introduce to the development of OAB in women should also be considered.
... However, there is increasing evidence that diet may play a significant role in the development of OAB symptoms. Dallosso et al. [21] collected data from 7,046 women over the age of 40 to investigate the role of diet and life-style in OAB and urinary incontinence. Information about the onset of OAB symptoms, diet, and lifestyle was obtained by a postal questionnaire. ...
... Significant relationships were observed between OAB symptoms and obesity, smoking, and carbonated drink consumption. The risk of OAB symptoms was reduced with higher consumption of vegetables, bread, and chicken [21]. In our study, adults of both sexes participated. ...
... Of the 500 initially recruited patients, 174 were excluded from the study based on a detailed medical history in outpatient clinics and the results of urinalysis. Chronic diseases and urinary tract infec- [21] based on an evaluation of food consumption in various patient groups. In our study, the cumulative effect of foods was highlighted by evaluating the MeDAS. ...
Aims The relationship between nutrition and overactive bladder (OAB) is known. This study investigates the relationship between Mediterranean type diet and OAB. Methods 14-Item Mediterranean Diet Adherence Screener(MeDAS) and OAB-V8 Bladder Inquiry Form, validated in Turkish, were presented to 500 patients over the age of 18 who applied to outpatient clinics other than urology outpatient clinics. Those with chronic diseases and urinary tract infections (by urinalysis and detailed medical history) were excluded. Results There was a negative correlation between the MeDAS and OAB-V8 scores. High OAB-V8 scoring was associated with obesity (BMI ≥ 30), being single and low education level. Conclusions Dietary patterns represent a broader perspective of food and nutrient consumption and may therefore be more predictive of disease risk. Mediterranean type diet should be recommended in the first-line treatment of patients with OAB symptoms. It is easily possible to determine the compliance of patients with this diet by using 14-Item MeDAS. Keywords: Mediterranean Diet , Overactive bladder, Nutrition
... BMI over 30 reported as an independent risk factor for OAB and DOA in some studies (13)(14)(15)(16). In a study relationship between central and general obesity in terms of OAB and incontinance eavulated. ...
... All these studies concluded that excessive weight gain may increase the pressure on the pelvic floor muscles. This may lead to weakeness of the urethral sphincter structure and cause urinary incontinence (14,15). Excessive visceral fat tissue may cause bladder inflammation, possibly due to changes in neuroendocrine processes that can occur as urinary frequency and urgency. ...
... Sigara içiminin üriner inkontinansı arttırdığına dair çalışmalar mevcuttur. [39,40] Histerektominin üriner inkontinans oranını arttırıp arttırmadığına dair yapılan çalışmalar tutarsızdır ve daha çok subjektif verilere dayanmaktadır. [41] SINIFLANDIRMA 1-Stres İnkontinans: ...
... Only one study, published in 2021, investigated urinary incontinence (UI) in nulliparous university students in Turkey and concluded that the prevalence of UI is 18% in this age group [6]. The association between lower urinary tract symptoms (LUTS) and dietary factors, and nondietary behavioral factors such as cigarette smoking, alcohol, and physical activity has been assessed in many studies [5,[7][8][9]. Kawahara et al. recently published a large-scale study to determine a correlation between cigarette smoking and OAB in nonhospitalized participants [10]. The authors found a 30% prevalence of OAB in women in their third decade. ...
Introduction and hypothesisThe objective was to assess the prevalence of symptoms of overactive bladder syndrome (OAB) among healthy nulliparous female university students, and to evaluate the correlation of these symptoms with a variety of factors, including waterpipe (WP) smoking.Methods
This is a cross-sectional study. A questionnaire was administered to evaluate symptoms of OAB in healthy nulliparous female university students. Variables assessed included body mass index (BMI), cigarette smoking, WP smoking, consumption of alcohol, coffee, and tea with and without artificial sweeteners, soft drinks, and energy drinks. Adjusted odds ratio were calculated to determine the correlation of these variables with OAB symptoms.ResultsA total of 767 out of 2,900 females responded to the questionnaire. Bothersome frequency was reported in 32.3%, and nocturia in 47.5% of the women. Urgency and urgency urinary incontinence (UUI) were present in 25.5 and 24.7% of the study participants respectively. Urgency was associated with WP smoking (p value 0.048). Bothersome frequency was associated with artificial sweeteners used with coffee and tea (p value 0.013). UUI was associated with cigarette smoking (p value 0.034) and elevated BMI (p value < 0.001). OAB symptoms were not found to be significantly associated with soft drink and energy drink consumption. A lower prevalence of nocturia (p value 0.009) and urgency was associated with alcohol consumption (p value 0.017). More than two-thirds (69.2%) of WP smokers expressed readiness to decrease WP smoking if this would improve their lower urinary tract symptoms (LUTS).Conclusion
Overactive bladder is common in healthy young nulliparous women and is associated with multiple risk factors, including WP smoking.
... for obese women [6]. In a study of 6,424 women with overweight and obesity in the United Kingdom multivariate analysis revealed significantly increased risks associated with BMI for the onset of stress incontinence (odds ratio [OR], 1.4 and 2.3) and overactive bladder (OR, 1.3 and 1.2, respectively) [7]. ...
Objectives:
This study aims to examine the clinical outcomes of women who underwent a midurethral sling surgery for stress urinary incontinence and compare postoperative urinary symptoms among different body mass index (BMI) groups.
Methods:
A retrospective cohort study on results after midurethral sling surgery according to BMI was conducted at the institution of the current study from January 2010 to December 2019. The study population was classified into three groups according to patients' BMI (in kg/m²) during surgery: normal weight (BMI < 23.0 kg/m²), overweight (BMI, 23.0-24.9 kg/m²), and obese (BMI ≥ 25.0 kg/m²). The primary outcome was the recurrence of urinary symptoms after surgery. The secondary outcomes were operation time, estimated blood loss, length of hospital stay, and postoperative complications.
Results:
This study included 376 patients (normal weight, 148; overweight, 74; and obese women, 154) who underwent midurethral sling surgery. No significant difference was noted in urinary symptom recurrence after midurethral sling surgery. Of the patients, 6.8% (n = 10), 9.5% (n = 7), and 7.8% (n = 12) were normal weight, overweight, and obese women, respectively (P = 0.775). Moreover, operation time (P = 0.589), blood loss (P = 0.138), and complication rate (P = 0.865) showed no significant difference.
Conclusions:
Midurethral sling surgery is effective regardless of BMI. Even when midurethral sling surgery was performed as a concomitant surgery, no significant difference in urinary symptom recurrence, operation time, intraoperative blood loss, and complication rate was noted among different BMI groups.
... The decisions that are made that affect bladder health include what to eat, how many fluids to drink, and daily voiding frequency. Dietary decisions affect bladder health in that obesity has been linked to urinary incontinence symptoms, as well as poor diet and consumption of carbonated beverages (Dallosso, McGrother, Matthews, & Donaldson, 2003). Voiding frequency has been found to average around every three to four hours each day (Lukacz, Whitcomb, Lawrence, Nager, & Luber, 2009). ...
One in three women will experience urinary incontinence in their lifespan, and withholding urine has been shown to increase risk. Adolescents pose significant risk for withholding behaviors due to psychosocial developmental stage and fear of negative peer interaction. Little is known about adolescent women’s feelings and experiences with high school bathrooms that might influence use, such as fear of bullying, environmental considerations, and school policies. The purpose of this dissertation research is to explore adolescent women’s experiences with high school bathroom use to better understand early lifespan behaviors that may lead to future development of urinary incontinence. To guide this endeavor, the Optimal Bladder Health (OBH) Model was used, as well as variables of psychosocial developmental stage, school policies, privacy, bathroom cleanliness, and peer interaction. This dissertation 1) identified factors that influences school bathroom behaviors in adolescent women, 2) explored knowledge related to bladder health, including voiding frequency, beverage intake, societal attitudes, and experiences with incontinence, and explored strategies adolescent women use to avoid or delay bathroom use, and 3) used these findings to inform the Optimal Bladder Health Model. A constructivist grounded theory approach was used to conduct individual interviews with adolescent women between the ages of 14-18 years and who attend high schools in the Midwest United States. Interviews were audio recorded and verbatim transcripts were made. Grounded theory’s constant comparison method of analysis was used to identify emerging themes, and descriptive statistics were used to describe the sample. One-on-one interviews were conducted with 30 adolescent women from 14 high schools, 11 (79%) of which were public schools. Adolescent women described difficulty in navigating through the many barriers to bathroom use in the high school setting. Themes that emerged were amount of time to use the bathroom, bathroom environment, privacy, school policies, and school bathrooms as a safe space. Bullying was not a factor in bathroom avoidance, but rather bathrooms served as a safe space to receive support from peers. Adolescent women preferred teacher policies supporting autonomy to leave the classroom for bathroom use, as well as clean, private, and well-stocked environments. Knowledge of bladder health was limited due to lack of having received any education, and three types of strategies to avoid or delay bathroom use were employed: physical, mental, and behavioral. Factors added to the Optimal Bladder Health Model included access to toilets at school, safe environment, general bathroom environment, social support, and peer interaction, resulting in the Adapted Optimal Bladder Health Model for Adolescent Women (Adapted OBH Model). This model may be used to guide future research concerning adolescent women and bladder health. Opportunities to improve the school bathroom experience include providing clean, private, and well-supplied bathrooms. Nurses and other health care providers may aid in increasing school bathroom use through providing education about the importance of not withholding urine. In addition to this, restructuring school policies to better support autonomy to use the bathroom with biologic cues may potentially reduce school bathroom avoidance.
... Based on previous reports [13][14][15][16][17][18] and expert opinion, we will initially include in the mode the following candidate predictors variables which were measured at baseline; demographic variables (age, body mass index [BMI], delivery, menopause, smoking status, alcohol habit, walking habit), history of comorbidities (hypertension, hyperlipidemia, diabetes, ischemic heart disease, stroke, kidney disease, cancer, depression, sleep disturbance, obstructive sleep apnea [OSA], benign prostate disease and prostate cancer [PCa]), questionnaires specific to OAB (OABSS question 1, question 2, question 3 and question 4) and blood test (HbA1c, B-type natriuretic peptide [BNP], the estimated glomerular filtration rate [eGFR]) and prostate specific antigen [PSA]). Trained physicians and research assistants administered the standardized questionnaire in which participants provided clinical background information, such as lifestyle and medical history. ...
Background
An accurate prediction model could identify high-risk subjects of incident Overactive bladder (OAB) among the general population and enable early prevention which may save on the related medical costs. However, no efficient model has been developed for predicting incident OAB. In this study, we will develop a model for predicting the onset of OAB at 5-year in the general population setting.
Methods
Data will be obtained from the Nagahama Cohort Project, a longitudinal, general population cohort study. The baseline characteristics were measured between Nov 28, 2008 and Nov 28, 2010, and follow-up was performed every 5 years. From the total of 9,764 participants (male: 3,208, female: 6,556) at baseline, we will exclude participants who could not attend the follow-up assessment and those who were defined as having OAB at baseline. The outcome will be incident OAB defined using the Overactive Bladder Symptom Score (OABSS) at follow-up assessment. Baseline questionnaires (demographic, health behavior, comorbidities and OABSS) and blood test data will be included as predictors. We will develop a logistic regression model utilizing shrinkage methods (LASSO penalization method). Model performance will be evaluated by discrimination and calibration. Net benefit will be evaluated by decision curve analysis. We will perform an internal validation and a temporal validation of the model. We will develop a web-based application to visualize the prediction model and facilitate its use in clinical practice.
Discussion
This will be the first study to develop a model to predict the incidence of OAB.
... 59 Both carbonated drinks and caffeinated beverages are considered to be bladder irritants. 60,61 Following bariatric surgery, patients are advised to avoid bladder irritants and drinking fluids with meals. 62 In a similar way, the dietary changes promoted in behavioural studies involve reduced calorie intake, which is likely to be associated with reduced fluid intake. ...
Women with obesity are at risk of pelvic floor dysfunction with a three-fold increased incidence of urgency urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index 30kg/m2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI).
Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence.
Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]).
This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomised control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study’s findings.
... Many recent studies have shown that MetS and lifestyle-related diseases are closely associated with OAB. [3][4][5] Likewise, many researchers have also reported that obesity-related, excessive fat accumulation in the body is strongly associated with the occurrence of LUTS, including those associated with OAB. 6,7 Interestingly, an increase in abdominal visceral fat induces abnormal secretion of adipocytokines, promotes excessive production of various inflammatory cytokines and further leads to chronic systemic inflammation. ...
Objective
To assess the relationship between visceral fat accumulation and lower urinary tract symptoms in female patients.
Methods
In this single‐center study, we enrolled all women who underwent screening abdominal computed tomography 3 months before the study, irrespective of whether they experienced lower urinary tract symptoms. The Overactive Bladder Symptom Score was used to assess subjective symptoms. Uroflowmetry and ultrasound assessment of post‐void residual urine were carried out to assess objective signs. We analyzed the relationship between lower urinary tract symptoms and various body fat accumulation parameters, including visceral fat area, visceral fat volume and total abdominal fat volume, assessed using computed tomography scans.
Results
A total of 182 patients were divided into the overactive bladder (n = 71, 39.0%) and the non‐overactive bladder (n = 111, 61.0%) groups. The visceral fat area, visceral fat volume and visceral fat volume/total abdominal fat volume values were all significantly higher in the overactive bladder group than in the non‐overactive bladder group (P < 0.001). Of these parameters, the visceral fat volume/total abdominal fat volume ratio showed the strongest correlation with the total Overactive Bladder Symptom Score (r = 0.394, P < 0.001). The maximum urine flow rate correlated negatively with the visceral fat volume/total abdominal fat volume value (visceral fat volume/total abdominal fat volume r = –0.289, P < 0.001). Subsequent multivariate analysis showed that a high visceral fat volume/total abdominal fat volume value, age and metabolic syndrome‐related diseases were independent risk factors for the presence of overactive bladder.
Conclusions
Excessive accumulation of visceral fat is independently associated with overactive bladder in females.
... Modest weight reduction has been shown to decrease SUI in women, though it is unknown whether the same holds true for men [56,57]. The literature has mixed results on the association between fluid intake and UI [58,59]. Though some older adults may limit fluid intake hoping to decrease UI, more concentrated urine acts as a bladder irritant and can worsen UI and constipation [46]. ...
Risk of urinary incontinence (UI) increases with age and can have detrimental effects on patients and caregivers. UI should not be considered a normal part of aging and warrants a comprehensive evaluation. Treatment of UI in the aging male requires special consideration, particularly when it comes to comorbid conditions and potential side effects of intervention. The aim of this review is to discuss the evaluation of, risk factors for, and management of UI in the aging male.
... It was observed that women who drank as little as one carbonated beverage per week had an elevated risk of stress incontinence (SI), and those who consumed a carbonated beverage daily had an almost 2X higher risk of SI than those who consumed daily. Consumption of carbonated beverages also increased risk of overactive bladder onset, although risk was not as high as that for SI [83]. Therefore, while carbonated beverages may be beneficial for hydration and by extension overall health, they may negatively affect certain individuals who should monitor consumption to minimize potential symptoms. ...
The Beverage Guidance System has established dietary recommendations for daily intake of commonly consumed beverages including water, tea, coffee, milk, non-calorically sweetened beverages, and calorically sweetened beverages. As obesity in America continues to be a growing problem, this guidance becomes of increasing importance due to many beverages’ potential links to Type 2 Diabetes Mellitus (T2DM), Cardiovascular disease (CVD), and numerous other harmful health effects. However, the growing popularity of “better for you” beverages is causing a shift in the market, with consumers pushing for healthier beverage alternatives. Beverages simultaneously present advantages while posing concerns that need to be evaluated and considered. In this review, health effects of nonalcoholic beverages are discussed including various aspects of consumption and current trends of the beverage market such as the novel Soft Seltzer category as an alternative to Hard Seltzer and various mashups. A variety of advisory boards and agencies responsible for dietary guidelines in various countries suggest drinking water as the preferred practice for hydration.
... 13,14 Although the detailed mechanism underlying the association between cigarette smoking and LUTS is still unknown, smoking is thought to be associated with functional abnormalities of LUTS. [15][16][17] The present study examined the correlation between a smoking habit and LUTS in a population-based study using a web-based questionnaire. ...
Objective:
To examine the correlation between smoking habit and lower urinary tract symptoms in women.
Methods:
We first screened 10 000 female patients to examine their smoking habit. A total of 7004 samples were successfully collected for further analysis through a urinary continence survey. The ratio of current smoking to non-smoking participants was set as 1:3 to allow thorough assessment of the impact of cigarette smoking on lower urinary tract symptoms.
Results:
A total of 4756 complete responses were obtained for the Overactive Bladder Symptom Score and International Consultation on Incontinence Questionnaire-Short Form questionnaire. The current smokers (2.54 ± 2.91, 2.48 ± 4.01) and ex-smokers (2.27 ± 2.50, 2.25 ± 3.50) showed significantly higher Overactive Bladder Symptom Score and International Consultation on Incontinence Questionnaire-Short Form scores than the non-smokers (1.70 ± 2.05, 1.49 ± 2.73) (P < 0.0001, P < 0.0001 and P < 0.0001, P < 0.0001, respectively). The prevalence of urgency was affected by the smoking status. Younger participants (aged 20-39 years) showed a stronger influence of their smoking habit than older participants (aged ≥40 years). Urgency urinary incontinence was also affected by the smoking status.
Conclusions:
The prevalence of urgency and urgency urinary incontinence is correlated with age and smoking habit, and both current and ex-smokers show an increased prevalence of urgency and urgency urinary incontinence compared with non-smokers, especially younger women.
... Smoking is known to be a risk factor for lower urinary tract symptoms including urgency [49], frequency [49], and overactive bladder [50]. However, the association with incontinence is less clear. ...
Purpose of review:
Despite available treatments for urinary incontinence, the data regarding prevention is less established. This review sought to identify prevention measures and discuss their underlying evidence base with an attempt to include the most recent updates in the field.
Recent findings:
Urinary incontinence is a prevalent issue among women, particularly surrounding pregnancy and menopause. Interventions regarding pregnancy include not only general health promotion but also potentially interventions such as pelvic floor muscle training and decisions regarding method of delivery. With regard to menopause, the literature suggests avoiding treatments that have adverse effects on continence. Lastly, promoting healthy life style and reducing effects of co-morbid conditions can impact a woman's continence. The literature indicates that preventative strategies exist for urinary incontinence, though the data is limited in this area. Further work is needed to determine the impact of prevention measures and how best to implement them.
... Nevertheless, the most common type of physical activity among older people is endurance exercises. Dallosso et al. (2003) [12] evaluated the daily activities carried out by 507 people between 65 and 74 years old and 537 people of 75 years or more. Most of the exercises that they performed involved maintenance of the house and the garden, as well as leisure activities, such as swimming and cycling, but by far the most practiced activity was walking. ...
Background:
Ageing is associated with changes of physical and physiological parameters, but there is evidence that regular physical activity could minimize these effects. Additionally, the older population presents a great risk of suboptimal nutrition. Therefore, the purpose of this study was to review the evidence of nutritional strategies and endurance exercises in the older population.
Methods:
A systematic review was performed based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. The search was carried out in three different databases: PubMed, Web of Science, and SPORTDiscus.
Results:
Eight studies were included in the present review. The use of caffeine and beta-alanine supplementation with proteins have been found to be beneficial in both sexes. In older women, a balanced diet, an increase in protein, supplementation with beta hydroxy methyl butyrate, and supplementation with sodium bicarbonate have been favorable. However, no benefit has been seen in older men with sodium bicarbonate or ubiquinone supplementation. Nevertheless, the use of supplements should be prescribed according to individual characteristics and physical activity.
Conclusions:
Caffeine and high protein supplement with beta-alanine may provide positive effects in the older population. In addition, in older women, bicarbonate supplementation and beta-hydroxyethyl butyrate (HMB), lysine, and arginine supplementation have shown positive effects on exercise performance.
... There are several studies that show reducing caffeine intake also can alleviate OAB symptoms 6,7,8 , and one study reported improvements after reducing intake of saccharine and carbonated beverages. 9 Although alcohol intake is commonly thought to increase OAB symptoms 10 , there is no evidence that removing it from diet reduces urge incontinence. 11 There is, however, evidence that alcohol acts as a diuretic. ...
Purpose:
The aim of this study was to evaluate patient compliance to individualized recommendations for self-management of fluid intake, bladder irritants, and timing of fluid consumption.
Design:
Single-group, before-after pilot study.
Subjects and setting:
The sample comprised 22 patients (17 male and 5 females, mean age 62 years, age range 27-84 years). The study setting was the uroflow clinic at Southmead Hospital, Bristol, UK, a tertiary level referral hospital for complex evaluation and treatment of urological patients.
Methods:
Patients were given a bladder diary to complete after 2 weeks, which was compared with the bladder diary they had originally brought to clinic, to see whether the advice was followed. The bladder diary used required the patient to document the times and volumes of urination over a period of 3 days, magnitude of urinary urgency felt at the time, along with fluid intake timing, amount, and type of beverage. The study was not designed to measure changes in symptoms, but observed changes recorded in the bladder diaries are reported.
Results:
All 6 of the 22 participants who were advised to increase the volume of fluid intake complied, with an increased average intake of a mean of 520 mL (range 100-1450 mL). Similarly, one participant advised to reduce fluid intake decreased their fluid intake by 1800 mL per day. Thirteen out of 16 patients (81%) who were advised to remove caffeine, alcohol, or artificial sweeteners from their diet complied, indicated by no bladder irritant being recorded on their bladder diary. Nine out of 12 patients (75%) advised to reduce fluid intake in the evenings complied, decreased fluid intake after 6 PM by an average of 240 mL (range 100-550 mL less).
Conclusions:
A majority of participants given fluid intake advice that is specific to their symptoms and lifestyle complied with recommendations. Simple guidance could usefully be given to patients before they are referred to specialist urological care or undergo urodynamic testing.
... In addition, a high intake of caffeine was linked to detrusor instability when compared with moderate consumption [40][41][42]. Similarly, alcohol and carbonated beverages promote OAB symptoms [43,44]. For example, a population-based study has shown a threefold increase in symptom development in women consuming more than one alcoholic drink. ...
Purpose of Review
Overactive bladder (OAB) is a widely prevalent urinary condition affecting women of all ages, with increasing incidence in advancing age. A primary care provider is likely to encounter a significant proportion of women experiencing lower urinary tract symptoms (LUTS). This review serves primary care physicians as a thorough reference for a common condition causing LUTS in women.
Recent Findings
Most emerging data addressing overactive bladder relates to the different treatment modalities available. The side effect profile of antimuscarinic drugs remains an ongoing concern among OAB patients, especially with recent data linking the use of this class of drugs with Alzheimer’s and future development of dementia. In addition, it was recently demonstrated that individuals taking medications of medium-to-high anticholinergic activity had reduced brain glucose metabolism and increased brain atrophy. Combination treatments seem to be more efficacious than monotherapies, as has been proven when using mirabegron with antimuscarinics. Many studies have also validated the use of neuromodulation as a safe and effective treatment for OAB.
Summary
Overactive bladder is a widely prevalent urinary condition affecting women of all ages. It is regarded as multifactorial with several proposed theories to explain its occurrence. Several tests are available to aid in diagnosing OAB. Symptom severity and patient-related factors including patient preferences drive treatment.
... 12 The higher-thanexpected prevalence of MI could be due to SI and UI episodes occurring at separate times but being linked by a common predisposing factor. 13,14 Clinical practice guidelines recommend individualized pelvic floor muscle (PFM) training as a first-line treatment for stress or mixed UI in women, although the lack of personnel and financial resources has limited the delivery of this modality. 11 Alternatively, or in parallel with any type of surgical or pharmacological intervention, a physical rehabilitation approach, known as pelvic re-education, is based on the possibility of urging and accustoming the patient to self-management of muscular contractions. ...
Dysfunctions of the pelvic floor related to mixed urinary incontinence in women are pathologies extremely limiting for patients bodily and psychosocial conditions, altering their quality of life. The aim of this study was to determine the effects of focal mechanical vibrations in mixed urinary incontinence. In this retrospective observational case–control study, 65 patients were randomized and divided into 2 groups: treatment group by focal mechanical vibrations (VISS-10 sessions) (N = 33) and a control group in waiting list (N = 32). Also, both groups received home-based postural ergonomic instructions to reinforce pelvic floor. Data were collected at T0 (baseline), T1 (end of treatment), and T2 (follow-up = after 1 month): rheological muscle parameters were assessed by MyotonPRO respect to evaluate the gluteus maximus muscle. Then, to measure the general disability of the pelvic floor and the impact of urogenital problems on daily activities the Pelvic Floor Disability Index (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were used. Groups were matched perfectly before treatment for age (58.20 ± 4.37 vs. 58.73 ± 5.19) and BMI (26.15 ± 2.22 vs. 25.85 ± 2.11); for the two-way ANOVA analysis, a difference in gluteus variables over time and between groups except for GMDR (group p-value = 0.60) was showed. The two-way ANOVA shows statistically significant effects of treatment and time for PDFI-20 and PFIQ-7 (p-value <0.001). An improvement in incontinence symptoms and quality of life in the PDFI-20 and PFIQ-7 scores were reported and VISS may favor muscles stiffness for exercises by improving the normalization of basal tone. Our results were encouraging and suggested the use of focal mechanical vibration as a novel tool for treating mix urinary incontinence in women to complete and help the rehabilitative therapeutic protocol.
... Functional disability and mobility problems often accompany gross obesity and are further risk factors for UI. 20 Waetjen et al 21 noted that a BMI increase of 5 kg/m 2 increased SUI by 30% and UUI by 15%. Also in elderly women, obesity is reported as an incontinence predictor and BMI had a specific effect on mixed urinary incontinence prediction. ...
Aims:
To evaluate the relationship between obesity and urinary incontinence (UI) and to determine the effect of weight reduction on the severity of incontinence.
Methods:
This is a consensus report of the proceedings of a Research Proposal from the annual International Consultation on Incontinence-Research Society, 14 June to 16 June, 2018 (Bristol, UK): "What are the relationships between obesity and UI, and the effects of successful bariatric surgery?"
Results:
Obesity is an increasing problem worldwide and is associated with many adverse effects on health and quality of life. From both translational and clinical studies, there is a strong relationship between obesity and the occurrence of UI. Both mechanical and metabolic factors seem to play an important role including systemic inflammation and oxidative stress due to the release of cytokines in visceral adipose tissue. The success rate of anti-incontinence surgery does not seem to be greatly affected by body mass index (BMI), although reliable data and long-term follow-up are currently lacking. Both weight reduction programs and bariatric surgery can result in amelioration of UI. Various studies have shown that weight loss (particularly that associated with bariatric surgery) can reduce incontinence, and the degree of weight loss is positively correlated with improvement in symptoms.
Conclusions:
Obesity is strongly associated with an increased prevalence of both stress and urgency UI. The treatment outcome does not seem to be highly dependent on BMI. Weight reduction is positively correlated with improvement of incontinence symptoms and therefore should be advocated in the management.
... Sigaranın içinde bulunan nikotin mesane kontraksiyonlarını artırmaktadır (24). Çalışmada sigara kullanmayan kız öğrencilerinde SÜİ yaşanmadığı bulunmuştur. ...
Aim: This study was aimed to investigate of the affecting factors and prevalence of Stress Urinary Incontinence in nursing students. Material-Method: This descriptive and cross-sectional study was conducted on 273 nursing students of the University Faculty of Health Sciences in March-April 2017. Data were collected by using a information form and UDI-6. Data were evaluated by descriptive statistics, Chi-square test, Mann-Whitney U test. Results: The average age and body mass index of students was 20.8±1.6; 23.9±3.1 respectively. When the characteristics of students related to stress urinary incontinence are examined; it was found that 15.5% were have stress urinary incontinence problems. 55.6% of those with stress urinary incontinence experienced urinary incontinence in the cases of upper and lower respiratory tract infections. There was a significant relationship between stress urinary incontinence status and body mass index, the use of smoking, alcohol, herbal tea and cola in the students. Urinary Distress Inventory-6 total score of students was 19.7±20.8. It was found that Urinary Distress Inventory-3 physical activity and urinary incontinence score was higher in stress urinary incontinence patients. Conclusion: The rate of stress urinary incontinence was 15.5% in nursing students and as the body mass index increases, stress uri-nary incontinence increases.
Amaç: Bu araştırmada, hemşirelik bölümü öğrencilerinde Stres Üriner İnkontinans görülme sıklığı ve etkileyen faktörleri incelemek amaçlanmıştır. Yöntem: Tanımlayıcı ve kesitsel tipteki bu çalışma Mart-Nisan 2017 tarihlerinde bir üniversitenin hemşirelik bölümünde 273 kız öğ-renci üzerinde yürütülmüştür. Araştırma verileri 'Anket Formu ve Urogenital Distres Envanteri /UDI-6 (Urinary Distress Inventory-6) ile toplanmıştır. Veriler tanımlayıcı istatistikler Ki-Kare Testi ve Mann-Whitney U testleri ile değerlendirilmiştir. Bulgular: Öğrencilerin yaş ortalaması 20,8±1,6, beden kitle indeksi ortalaması (BKİ) ortalaması 23,9±3,1'dir. Öğrencilerin stres üriner inkontinans ile ilgili özellikleri incelendiğinde; %15,5'i stres üriner inkontinans problemi olduğu, stres üriner inkontinans olanların %55,6'sının üst ve alt solunum yolu enfeksiyonları durumlarında inkontinans yaşadığı belirlenmiştir. Öğrencilerde stres üriner inkontinans durumu ile BKİ, sigara ve alkol kullanımı, bitki çayı ve kola tüketimi arasında anlamlı farklılık saptanmıştır. Öğrencilerin Urogenital Distres Envanteri /UDI-6 toplam puanı 19,7±20,8 ve stres üriner inkontinans olanlarda, Urogenital Distres Envanteri-3 fiziksel aktivite ile idrar kaçırma madde puan ortalamasının yüksek olduğu saptanmıştır. Sonuç: Hemşirelik bölümü kız öğrencilerinde stres üriner inkontinans görülme oranı %15,5 olup beden kitle indeksi arttıkça stres üriner inkontinans yaşanma durumu da artmaktadır. Ayrıca SÜİ mevcut öğrencilerde idrar kaçırma semptomlarında artış yaşanmaktadır.
... Em contrapartida estudos realizados por Dalosso et al. 28 Durante a coleta de dados para o estudo, observou-se a escassez de dados na anamnese do paciente, este que é de extrema importância para que se possa definir um diagnóstico preciso, além de dificultar a elaboração do perfil epidemiológico das mulheres atendidas na unidade de saúde do município de Araucária PR. ...
... With regard to subtypes of urinary incontinence, three studies (3610 cases, 68 175 participants) of BMI and frequent incontinence, [9][10][11] four studies (1463 cases, 69 270 participants) of severe incontinence, 10,11,16,18 eight studies of stress incontinence (>3906 cases, 85 576 participants), [9][10][11]16,18,19,37,38 seven studies of urge incontinence (>1567 cases, 77 953 participants), [9][10][11]14,16,18,19 and three studies of mixed incontinence (809 cases, 68 175 participants) [9][10][11] were included in the meta-analysis. The summary RR per 5 kg/m 2 was 1.45 (95% CI 1.25-1.68, ...
Background:
Adiposity has been associated with elevated risk of urinary incontinence in epidemiological studies, however, the strength of the association has differed between studies.
Objectives:
To conduct a systematic literature review and dose-response meta-analysis of prospective studies on adiposity and risk of urinary incontinence.
Search strategy:
We searched PubMed and Embase databases up to July 19th 2017.
Selection criteria:
Prospective cohort studies were included.
Data collection and analysis:
Data were extracted by one reviewer and checked for accuracy by a second reviewer. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models.
Main results:
Twenty four prospective studies were included. The summary RR per 5 kg/m2 increment in BMI was 1.20 (95% confidence interval: 1.16-1.25, I2 =58%, n=13) for population-based studies and 1.19 (95% CI: 1.08-1.30, I2 =87.1%, n=8) for pregnancy-based studies, 1.18 (95% CI: 1.14-1.22, I2 =0%, n=2) per 10 cm increase in waist circumference and 1.34 (95% CI: 1.11-1.62, I2 =90%, n=2) per 10 kg of weight gain. Although the test for nonlinearity was significant for BMI, p=0.04, the association was approximately linear. For subtypes of urinary incontinence the summary RR per 5 BMI units was 1.45 (95% CI: 1.25-1.68, I2 =85%, n=3) for frequent incontinence, 1.52 (95% CI: 1.37-1.68, I2 =34%, n=4) for severe incontinence, 1.33 (95% CI: 1.26-1.41, I2 =0%, n=8) for stress incontinence, 1.26 (95% CI: 1.14-1.40, I2 =70%, n=7) for urge incontinence, and 1.52 (95% CI: 1.36-1.69, I2 =0%, n=3) for mixed incontinence.
Conclusion:
These results suggest excess weight may increase risk of urinary incontinence. This article is protected by copyright. All rights reserved.
Overactive bladder (OAB), a common lower urinary tract dysfunction, is defined by the International Continence Society as a syndrome characterized by urinary urgency, with or without urgency incontinence, usually with frequency and nocturia [1, 2]. OAB can be classified as OAB wet (with incontinence) or OAB dry (without incontinence). A prerequisite for the diagnosis is the absence of urinary tract infection or other detectable underlying disease.
Objective:
The aim of this study was to determine if higher artificially sweetened beverage intake is associated with higher prevalence of urinary incontinence symptoms.
Methods:
We conducted a secondary analysis of data from the Women's Health Initiative Observational Study. Our analytic cohort included 80,388 women. Participants who answered questions about beverage consumption and urinary incontinence symptoms at a 3-year follow-up visit were included. Demographic characteristics were compared between three groups of beverage consumers: never to less than one serving per week, one to six servings per week, and greater than or equal to one serving per day. Multivariable logistic regression models were constructed to estimate odds and type of urinary incontinence and adjust for potential confounders.
Results:
Most participants (64%) were rare consumers of artificially sweetened beverages, with 13% (n = 10,494) consuming greater than or equal to 1 serving per day. The unadjusted odds of reporting urinary incontinence were 10% to 12% higher in women consuming one to six servings per week (odds ratio [OR], 1.10; 95% CI, 1.06-1.14) or greater than or equal to one serving per day (OR, 1.12; 95% CI, 1.07-1.18) versus never to less than one serving per week. In multivariable analyses, women consuming greater than or equal to one serving per day (ref: never to <1 serving/wk) had 10% higher odds of reporting mixed urinary incontinence (OR, 1.10; 95% CI, 1.02-1.19). There were no significant differences for stress or urgency urinary incontinence symptoms between groups.
Conclusions:
When compared to never to less than one serving per week, women consuming greater than or equal to one serving per day of artificially sweetened beverages had 10% greater odds of reporting mixed urinary incontinence after adjustments. Amount of artificially sweetened beverage consumption was not associated with stress or urgency urinary incontinence symptoms.
Objectives
To assess the postoperative status of clinically localized prostate cancer patients who underwent robot-assisted radical prostatectomy (RARP) with a focus on de novo overactive bladder (OAB).
Methods
The present study included 156 patients who did not have preoperative OAB and underwent RARP between December 2015 and April 2020 at our institution. Patients were divided into the de novo OAB group and non-OAB group based on the findings of overactive bladder symptoms score (OABSS) 6 months after RARP, and comparative assessments were performed between the two groups.
Results
Six months after RARP, de novo OAB was detected in 38 (24.4%) out of 156 patients. Body mass index (BMI) and the proportion of patients with hypertension were significantly higher in the de novo OAB group than in the non-OAB group. No significant differences were observed in the other characteristics examined. Furthermore, the preoperative findings of uroflowmetry and a urodynamic study did not significantly differ between the two groups. Despite the lack of significant differences in preoperative OABSS, total international prostate symptom score, the voiding symptom score, storage symptom score, and quality of life score between the two groups, all of these findings 6 months after RARP were significantly worse in the de novo OAB group than in the non-OAB group. Among the several factors examined, only BMI was independently associated with the development of de novo OAB 6 months after RARP.
Conclusions
Patients with a high BMI may develop de novo OAB after RARP, resulting in the significant deterioration of lower urinary tract symptoms.
Introduction and hypothesis:
Urinary incontinence (UI) and overactive bladder (OAB) are common conditions worldwide. These conditions significantly affect the quality of life (QoL) of patients with limited mobility. Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, resulting in pain relief, as well as improved function and QoL. This study was aimed at evaluating changes in patients' mobility as a result of TKA surgery and the effect of these changes on their OAB and UI symptoms.
Methods:
A total of 49 female patients with stage IV osteoarthrosis were included in the study. The International Consultation on Incontinence Question-Short Form (ICIQ-SF), Overactive Bladder-Validated 8 (OAB-V8), Visual Analog Scale (VAS), and Oxford Knee Score (OKS) forms were completed pre-operatively and at the 6th post-operative month. Both knee flexion angles were measured, and the post-void residual urine volume (PVR) was recorded.
Results:
A statistically significant (p<0.001) decrease was observed in the ICIQ-SF, VAS, OKS, and OAB-V8 scores in the post-operative period compared with the pre-operative values. No statistically significant change was detected in PVR (p=0.103). There was a statistically significant increase in the flexion angle (p<0.001).
Conclusions:
After knee arthroplasty, there was a noticeable improvement in the OAB symptoms and UI complaints of the patients. Therefore, we consider that increasing mobility after TKA will positively affect OAB/UI in female patients.
Overactive bladder (OAB) is a common yet under-reported condition affecting both men and women. Prevalence rises with age, but OAB can affect people of any age. It is associated with increased physical and mental health problems and may lead to social isolation and escalating care needs. It is a clinical diagnosis with symptoms of urgency, with or without urge incontinence and usually with urinary frequency and nocturia. Management includes conservative, medical and surgical treatments, which can significantly improve quality of life. This review aims to raise awareness of this under-reported condition and to empower health professionals to open discussions on bladder health with all those in their care.
Introduction and hypothesis:
Caffeinated, alcoholic, artificially sweetened, carbonated, and acidic beverages are pervasive and consumed in large quantities. Reputedly, these beverages are "irritating to the bladder" and result in heightened void frequency, but prior studies lack control for intake volume. We tested the null hypothesis that women recruited from the community who demonstrate overactive bladder symptoms will show no difference by groups in void frequency when one group is instructed to replace listed beverages by substituting non-irritants (emphasis on water or milk) and the other group is instructed in healthy eating.
Methods:
This was a parallel-group randomized controlled trial design with a three-period fixed sequence (baseline and 2 and 6 weeks post-baseline). We recruited 105 community women with overactive bladder symptoms.
Inclusion criteria:
>7 voids per day or 2 voids per night, daily intake of ≥16 oz. (473 ml) of beverages containing the ingredients listed above, and ≥ 32 oz. (946 ml) of total fluid intake. Stratified randomization was conducted. The primary outcome was average daily void frequency on a 3-day diary.
Results:
Participants were 86% white, mean (SD) age was 46.6 (17.6) years, and baseline void frequency was 9.2 (2.9) voids per day. At 2 and 6 weeks, estimated average (SD) difference in void frequency between group 1 and group 2 was -0.46 (0.57) and -0.31 (0.57) voids per day (p > 0.05); the null hypothesis was not rejected.
Conclusions:
Women who reduce potentially irritating beverages while maintaining total fluid volume intake is not predictive of void frequency. Further research on type and volume of beverage intake is recommended.
Background:
Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts.
Objectives:
This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy", and (b) compare urination frequencies by age, race/ethnicity, and fluid intake.
Methods:
Secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake.
Results:
Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, while women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies.
Discussion:
Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms.
Introduction and hypothesis:
In the current study we hypothesized that total knee arthroplasty might improve the overactive bladder symptoms by providing pain relief and improving physical function.
Methods:
One hundred patients who underwent total knee arthroplasty were preoperatively evaluated for overactive bladder and 47 patients that met inclusion criteria were included in this study. All the patients included in the study were assessed both preoperatively and at the 3rd month postoperatively using the Overactive Bladder-Validated 8 (OAB-V8) questionnaire for overactive bladder symptoms, the Oxford Knee Score (OKS) for pain and physical function, and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity.
Results:
The mean age of the patients was 65.4 ± 7 (56-83) years. The OAB-V8, OKS and IPAQ-SF scores significantly improved at the 3rd month postoperatively compared with the initial assessment. All the OAB-V8 domains, namely, frequency, urgency, nocturia, and urgency urinary incontinence, significantly improved following total knee arthroplasty.
Conclusions:
Our results showed that following total knee arthroplasty, overactive bladder questionnaire scores significantly improved at the 3rd month postoperatively.
Initial management recommended for the treatment of urinary incontinence in women includes behavioral therapies and lifestyle modifications. These treatments include dietary modifications, fluid and caffeine management, reduction of alcohol and tobacco intake, timed voiding and bladder training, bowel management, exercise, weight loss, and recommendations regarding absorptive products and skin care. Given their minimal risk and potential effectiveness, these treatments are considered first-line in the management of urinary incontinence in women and should be recommended to women seeking care prior to higher risk and invasive therapies.KeywordsUrinary incontinenceStress urinary incontinenceUrgency urinary incontinenceOveractive bladderBehavioral therapyLifestyle modificationsNonsurgical therapy
Aim
Cerebral small vessel disease and lower urinary tract symptoms are common in older people. However, the association between white matter hyperintensity (WMH) and overactive bladder (OAB) is not fully understood. We aimed to identify the relationship between WMH and OAB.
Methods
We carried out neuropsychological testing and head magnetic resonance imaging (T2-weighted and fluid-attenuated inversion recovery) of 72 outpatients at a memory clinic and evaluated their Overactive Bladder Symptom Score. WMH was assessed using the Fazekas scale, and WMH volumes were determined using Software for Neuro-Image Processing in Experimental Research. OAB was diagnosed based on a urinary urgency score (the third question of the Overactive Bladder Symptom Score) of two or higher and a total Overactive Bladder Symptom Score of three or higher. Multivariate logistic analysis was carried out, with the presence/absence of overactive bladder as the outcome variable, and age, sex, body mass index and diabetes mellitus as covariates.
Results
Of the 72 participants, 17 (24%) were diagnosed with OAB. WMH assessed by the visual rating scale was not associated with OAB. However, participants with OAB showed significantly higher WMH volume than those without OAB. Regionally, participants with OAB showed high WMH volume in the frontal, occipital and parietal lobes. Multiple logistic regression analysis showed that WMH was significantly associated with OAB (OR 1.82, 95% CI 1.11–2.98), after adjustment for clinically important confounders.
Conclusions
Cerebral WMH volume is associated with OAB, independent of age, sex, body mass index and diabetes mellitus. Geriatr Gerontol Int 2021; ••: ••–••.
Overactive bladder (OAB) is a heterogeneous syndrome estimated to affect approximately 10% to 15% of men and women globally. OAB not only negatively impacts quality of life but also results in a significant financial burden to both patients and health systems. Therefore, it is crucial that OAB is properly addressed. This manuscript provides a general review of the diagnostic algorithm for OAB and treatment per the AUA/SUFU guidelines, and an overview of new developments in OAB therapy. Given the wide array of therapeutic options that currently exist and those that are currently under development, there is tremendous opportunity to treat OAB successfully and positively affect our patients’ lives.
Lower urinary tract symptoms (LUTS) are common among men and increase with age. First-line therapy for the treatment of LUTS includes behavioral changes and dietary modifications. Providers should have a thorough investigation of a patient’s daily fluid intake, and the timing of such intake prior to making any recommended changes to ensure fluids are not restricted to an unsafe level. A 24- to 72-hour voiding diary of intake and output can be helpful to quantify their fluid intake and voiding symptoms. Caffeine and carbonated beverage reduction can be helpful to decrease LUTS, while increasing citrus beverage intake may be protective. The relationship between alcohol intake and LUTS is less clear, and therapeutic recommendations should be made on an individual basis.
Overactive bladder (OAB) is often treated with medications that block the cholinergic receptors in the bladder (known as anticholinergics). The effect of this medication class on cognition and risk of dementia has been increasingly studied over the past 40 years after initial studies suggested that the anticholinergic medication class could affect memory. Short-term randomized clinical trials demonstrated that the administration of the anticholinergic oxybutynin leads to impaired memory and attention, and large, population-based studies showed associations between several different anticholinergic medications and dementia. However, trials involving anticholinergics other than oxybutynin have not shown such substantial effects on short-term cognitive function. This discordance in results between short-term cognitive safety of OAB anticholinergics and the long-term increased dementia risk could be explained by the high proportion of patients using oxybutynin in the OAB subgroups of the dementia studies, or a study duration that was too short in the prospective clinical trials on cognition with other OAB anticholinergics. Notably, all studies must be interpreted in the context of potential confounding factors, such as when prodromal urinary symptoms associated with the early stages of dementia lead to an increase in OAB medication use, rather than the use of OAB medication causing dementia. In patients with potential risk factors for cognitive impairment, the cautious use of selected OAB anticholinergic agents with favourable physicochemical and pharmacokinetic properties and clinical trial evidence of cognitive safety might be appropriate.
Modifiable lifestyle-related risk factors are the object of increasing attention, with a view to primary and tertiary prevention, to limit the onset and development of diseases.
Also in the urological field there is accumulating evidence of the relationship between urological diseases and lifestyle-related risk factors that can influence their incidence and prognosis. Risk factors such as nutrition, physical activity, sexual habits, tobacco smoking, or alcohol consumption can be modified to limit morbidity and reduce the social impact and the burdensome costs associated with diagnosis and treatment.
This review synthesizes the current clinical evidence available on this topic, trying to satisfy the need for a summary on the relationships between the most important lifestyle factors and the main benign urological diseases, focusing on benign prostatic hyperplasia (BPH), infections urinary tract (UTI), urinary incontinence (UI), stones, erectile dysfunction, and male infertility.
Urinary incontinence in the transgender patient is a common quality of life issue. It is important to understand the impact and overall trends in this population, as well as considering options for treatment. Evaluation includes a thorough history as well as physical examination and determination of cause of incontinence. Treatment options must be individualized to the patient and specific source of incontinence.
Vaginoplasty is the most common genital surgery performed for gender affirmation. Annually, there are more than 3000 performed each year. Vaginoplasty is a safe, reliable technique for performing genital transition in transgender female patients. Penile inversion vaginoplasty is the most common technique used today, although there are several other methods of vaginoplasty: penile inversion, visceral interposition, and pelvic peritoneal vaginoplasty. Overall, outcomes are excellent. It is recommended surgeons follow the World Professional Association for Transgender Health (WPATH) guidelines for determining who is a candidate for surgery. There are no absolute contraindications to vaginoplasty, only relative contraindications that include active smoking and morbid obesity. Important but rare complications include flap necrosis, rectal and urethral injuries, rectal fistula, vaginal stenosis, and urethral fistula. When performed correctly in appropriately selected patients by expert surgeons, this is a rewarding operation for both patient and surgeon.
BACKGROUND CONTEXT
Cauda equina syndrome (CES) occurs due to compression of the lumbar and sacral nerve roots and is considered a surgical emergency. Although the condition is relatively rare, the associated morbidity can be devastating to patients. While substantial research has been conducted on the timing of treatment, the literature regarding long-term rates of bladder dysfunction in CES patients is scarce.
PURPOSE
The aim of this study was to identify long-term rates of bladder dysfunction in CES patients and to compare those rates to non-CES patients who underwent similar spinal decompression.
STUDY DESIGN/SETTING
Retrospective database study.
PATIENT SAMPLE
The CES cohort was comprised of 2,362 patients who underwent decompression surgery following CES diagnosis with a 5-year follow-up. These patients were matched to 9,448 non-CES control patients who underwent spinal decompression without a diagnosis of CES.
OUTCOME MEASURES
Diagnosis of bladder dysfunction, surgical procedure to address bladder dysfunction
METHODS
Using the national insurance claims database, PearlDiver, CES patients who underwent decompression surgery were identified and 1:4 matched to non-CES patients who underwent similar spinal decompression surgery. The 1-year, 3-year, and 5-year rates of progression to a bladder dysfunction diagnosis and surgical intervention to manage bladder dysfunction were recorded. The CES and non-CES groups were compared with univariate testing, and an analysis of risk factors for bladder dysfunction was performed with multivariate logistic regression analysis.
RESULTS
A total of 2,362 CES patients who underwent decompression surgery were identified and matched to 9,448 non-CES control patients. After 5 years, CES patients had a 10%–12% increased absolute risk of continued bladder dysfunction and a 0.7%–0.9% increased absolute risk of undergoing a surgical procedure for bladder dysfunction, as compared to matched non-CES patients. Multivariate analysis controlling for age, sex, obesity, tobacco use, and diabetes, identified CES as independently associated with increased 5-year risk for bladder dysfunction diagnosis (odds ratio [OR]: 1.72; 95% confidence interaval [CI] 1.56–1.89; p<.001) and procedure (OR: 1.40; 95% CI 1.07–1.81; p=.012).
CONCLUSIONS
Understanding the long-term risk for bladder dysfunction in CES patients is important for the future care and counseling of patients. Compared to non-CES patients who underwent similar spinal decompression, CES patients were observed to have a significantly higher long-term likelihood for both bladder dysfunction diagnosis and urologic surgical procedure.
Résumé
Introduction
L’évaluation initiale des patients souffrant du syndrome clinique d’hyperactivité vésicale (SCHV) a fait l’objet de recommandations internationales.
Objectif
Faire une synthèse des connaissances actuelles sur l’évaluation du syndrome clinique d’hyperactivité vésicale (SCHV).
Méthode
Une revue systématique de la littérature à partir de PubMed, Embase et Google Scholar a été menée en juin 2020.
Résultats
Le recueil précis de l’anamnèse et l’évaluation des symptômes du bas appareil urinaire est la première étape de l’évaluation des patients ayant un SCHV. En outre, la recherche de facteurs, favorisants l’élimination de causes urologiques pouvant être responsables d’urgenturies et la recherche de contre-indications thérapeutiques, sont essentielles. L’examen clinique et le calendrier mictionnel d’une durée de 3 à 7 jours font partie de l’évaluation initiale. Les auto-questionnaires validés en français mesurent la gêne ressentie par le patient et l’impact sur la qualité de vie. La bandelette urinaire et l’examen cytobactériologique des urines permettent d’éliminer une infection urinaire. La cytologie urinaire et la cystoscopie cherchent une tumeur de vessie en cas de contexte évocateur. La mesure du résidu post-mictionnel évalue un trouble de vidange vésicale associé. Le bilan urodynamique et les examens d’imagerie ne sont pas des examens complémentaires de première intention.
Conclusion
Il est essentiel de bien connaître l’évaluation initiale du SCHV afin d’instaurer un traitement adapté à la gêne ressentie par les patients.
Résumé
Introduction
L’objectif de ce travail était de faire une synthèse des connaissances actuelles sur le traitement de première ligne du syndrome clinique d’hyperactivité vésicale (SCHV).
Méthode
Une revue systématique de la littérature à partir de Pub Med, Embase et Google Scholar a été menée en juin 2020.
Résultats
Les traitements comportementaux reposent sur l’entraînement vésical et la reprogrammation mictionnelle en se basant sur le catalogue mictionnel. Des mesures hygiénodiététiques doivent être proposées. Elles incluent la diminution des apports hydriques, de la consommation de caféine, de sodas, la perte de poids, l’éviction de jus de fruits acides et d’une alimentation salée épicée et acide, l’alcalinisation des urines par régime et éventuellement, une supplémentation en vitamine D. La rééducation périnéo-sphinctérienne repose principalement sur les techniques manuelles, l’électrostimulation et/ou le biofeedback. Elle a montré son efficacité dans le traitement du SCHV. Chez la femme ménopausée, l’hormonothérapie locale permet d’améliorer l’ensemble des symptômes du SCHV. Les traitements médicamenteux oraux incluent les anticholinergiques et les bêta-3-agonistes. Ils ont une efficacité comparable et supérieure au placebo. En cas d’échec de la monothérapie, ils peuvent être associés.
Conclusion
En dehors de certaines règles hygiénodiététiques, l’efficacité des traitements de première ligne du syndrome clinique d’hyperactivité vésicale a été montrée par des études prospectives contrôlées. Ils peuvent être proposés isolément ou en association.
Sacral neuromodulation (SNM) is a therapy system used to improve bladder function, including in people with overactive bladder (OAB). It is safe and can improve quality of life. SNM helps improve symptoms through direct modulation of nerve activity; it involves electrically stimulating the sacral nerves that carry signals between the pelvic floor, spinal cord and the brain and is thought to normalise neural communication between the bladder and brain. If patients with OAB do not respond to non-surgical and conservative options, minimally invasive procedures can be offered, including SNM. SNM is performed in two stages: the trial phase, to assess whether it would be effective in the long term; and permanent implantation. This year, the National Institute for Health and Care Excellence (NICE) released guidance on the Axonics SNM System® for treating refractory OAB. The Axonics System is rechargeable and lasts at least 15 years, minimising the need for repeat surgery. NICE suggests the Axonics System may have cost advantages for the NHS. Having more than one SNM therapy option available increases options for patients, offering them a choice of handsets and rechargeable versus non-rechargeable implants. Three case studies illustrate how the system works in practice.
Objectives
To evaluate the level of evidence behind recommendations on social media for disease prevention in five lower urinary tract symptoms.
Materials and Methods
We conducted a digital analysis of anonymous online posts on social media sites collected by a social media data mining service. One thousand posts about pelvic organ prolapse (POP), stress urinary incontinence (SUI), overactive bladder (OAB), urinary tract infection (UTI), and interstitial cystitis / bladder pain syndrome (IC/BPS) were randomly selected. We analyzed these posts for recommendations regarding the prevention and treatment of these diseases, which were then compared to recommendations in available clinical guidelines and assessed for level of evidence.
Results
A total of 158/1000 posts contained 239 prevention strategies. For POP there were 41 strategies identified, 25 (61%) of which had no evidence. For UTI 14/58 (29%) had no evidence, including recommendations for dietary modifications and urinary alkalization. For OAB 8/28 (29%) had level 4 or no evidence. For SUI, 12/34 (36%) of prevention strategies had no evidence, such as laser rejuvenation and bladder training. IC had the highest number of prevention strategies, and most were low or non-evidence based (70/79, 89%).
Conclusions
Prevention and treatment strategies are common in online discussions of pelvic floor disorders, but at least one third of these recommendations have no evidential support. There is a role for further online education and social media engagement by health care specialists to promote evidence-based practices.
Üriner inkontinans; medikal, psikososyal ve hijyenik sorunlara neden olan, bireylerin yaşam kalitesini olumsuz etkileyebilen, önemli ve yaygın bir sağlık sorunudur. Dünyada ortalama 200 milyon insan üriner inkontinans şikâyeti yaşamaktadır. Yaşam kalitesi üzerinde önemli bir etkiye sahip olan üriner inkontinans semptomlarının tedavisinde sağlık profesyonelleri sürekli olarak daha iyi müdahaleler aramaktadırlar. Tamamlayıcı ve Alternatif Tedavi yöntemlerinden olan davranış değişikliği, yaşam tarzı değişiklikleri, mesane eğitimi, Pelvik Taban Kas Egzersizleri, vajinal konlar, biofeedback, yoga, akupressure, akupunktur gibi uygulamalar mesane fonksiyon bozukluğunu önleyebilir veya azaltabilir. Derlememiz, üriner inkontinansta kullanılan kanıt temelli tamamlayıcı ve alternatif tedavi uygulamalarını incelemek amacıyla hazırlanmıştır. Derlemenin hazırlanma sürecinde, Cochrane ve PubMed’de yayınlanmış konuyla ilgili makaleler taranmış ve elde edilen makalelerin kanıt düzeyi Joanna Briggs Enstitüsünün kabul ettiği kanıt düzeyi sınıflandırmasına göre incelenmiştir. Elde edilen veriler sonucunda, tamamlayıcı ve alternatif tedavi yöntemlerinin yararlı olup olmadığı konusunda güvenilir, yeterli kanıt bulunamamıştır ve araştırma önceliği olması gerekmektedir.
The complexity of LUTS is greater when viewed in some of the contexts with which they are particularly associated. Mixed urinary incontinence reflects co-existence of both storage and voiding LUTS, each substantially affecting the patient’s quality of life. Pelvic organ prolapse (POP) is common and can cause voiding difficulty; furthermore, POP treatment can allow emergence of stress incontinence that was largely unrecognized before the operation. For men, erectile dysfunction (or concern about developing it) can affect treatment choice. LUTS are commonplace in metabolic syndrome, indicating how the complex physiology of the system is vulnerable to medical conditions. Urinary tract and sexually transmitted infections are exceptionally important factors complicating LUTS mechanisms and assessment. Prostatitis is an inflammation of the prostate which may be caused by infection or non-infectious causes, and is another cause of storage and voiding LUTS. The psychological impact of symptoms, assessment, and treatment are exceptionally influential in prognosis at every stage. Both adolescence and advanced age bring additional challenges.
Introduction: The study was carried out to determine the relation between lower urinary tract symptoms and possible associated factors in women aged 40-60 years. Methods: In a normal population study, 502 women with lower urinary tract symptoms and 742 women without symptoms (controls) were asked about possible associated factors. Results: Four hundred and eighty-seven (97.0%) women with symptoms and 564 (76.0%) controls completed the study. Stress incontinence was associated with parity (primipara: OR=2.2 [95% CI: 1.0; 4.9]; para II: OR=3.9 [95% CI: 1.9; 8.0]; para III: OR=4.5 [95% CI: 2.1; 9.5]), the use of diuretics (OR=2.2 [95% CI: 1.2; 3.9]), hysterectomy (OR=2.4 [95% CI: 1.6; 3.7]), and increased BMI. Urge incontinence was associated with the use of diuretics (OR=4.0 [95% CI: 2.2; 7.1]) and increased BMI. Urgency was associated with parity (primipara: OR=1.9 [95% CI: 0.9; 4.2]; para II: OR=3.0 [95% CI: 1.5; 5.9]; para III: OR=3.1 [95% CI: 1.5; 6.5]), the use of diuretics (OR=2.7 [95% CI: 1.5; 4.7]) and increased BMI. Associations between non-incontinence symptoms (except urgency) and the factors studied were weak and inconsistent. Straining at stool and constipation were inversely associated with lower urinary tract symptoms. Overall, lesion of the anal sphincter, episiotomy, fetal weight, physical activity, and hormonal status had a minor, if any, association with lower urinary tract symptoms. Conclusions: Lower urinary tract symptoms were associated positively with parity, BMI, prior hysterectomy, use of diuretics, straining at stool, and constipation.
The relationship between diet and estrogens was studied in two groups of women with different dietary habits and breast cancer risks. Plasma estrogens and androgens and 24-h urinary and fecal excretion of estrogens were measured in premenopausal and postmenopausal Caucasians and recent Oriental immigrants from Southeast Asia to Hawaii. Premenopausal Caucasians had 30-75% higher plasma estrone and estradiol levels than their age-matched cohorts in Hawaii, and the postmenopausal Caucasians had 3-fold higher plasma levels of estradiol. The Oriental women excreted more than twice the amount of estrogen in their feces but they excreted significantly less in their urine. Thus, the ratio of urinary-to-fecal excretion was approximately 3-5 times higher in young Caucasian women. Analysis of dietary components and plasma estrogens in premenopausal women showed a positive correlation between daily intake of total fat and saturated fat and plasma estrone and estradiol concentrations.
Results from analysis of 24 h urine collections, verified for completeness with para-amino benzoic acid, and blood samples collected over 1 year were compared with 16 d weighed records of all food consumed collected over the year, and with results from 24 h recalls, food-frequency questionnaires and estimated food records in 160 women. Using the weighed records, individuals were sorted into quintiles of the distribution of the urine N excretion:dietary N intake ratio (UN:DN). UN exceeded DN in the top quintile of this ratio; mean ratio UN:DN = 1.13. Individuals in this top quintile were heavier, had significantly greater body mass indices, were reportedly more restrained eaters, had significantly lower energy intake:basal metabolic rate ratios (EI:BMR), and had correlated ratios of UN:DN and EI:BMR (r -0.62). Those in the top quintile reported lower intakes of energy and energy-yielding nutrients, Ca, fats, cakes, breakfast cereals, milk and sugars than individuals in the other quintiles but not lower intakes of non-starch polysaccharides, vitamin C, vegetables, potatoes or meat. Correlations between dietary intake from weighed records and 24 h urine K were 0.74 and 0.82, and between dietary vitamin C and beta-carotene and plasma vitamin C and beta-carotene 0.86 and 0.48. Correlations between dietary N intake from weighed records and 24 h urine excretion were high (0.78-0.87). Those between N from estimated food records and urine N were r 0.60-0.70. Correlations between urine N and 24 h recalls and food-frequency questionnaires were in the order of 0.01 to 0.5. Despite problems of underreporting in overweight individuals in 20% of this sample, weighed records remained the most accurate method of dietary assessment, and only an estimated 7 d diary was able to approach this accuracy.
The dietary customs of people of South Asian origin living in Britain are important determinants of health but have been relatively little studied. As part of the Coventry study of diabetes carried out in the Foleshill ward of the city, subjects undergoing oral glucose tolerance tests provided information on this aspect of lifestyle. A questionnaire was completed by all of the last 612 subjects undergoing testing. These included 304 of European origin, 118 Punjabi Sikhs, seventy-six Pakistani/Punjabi Moslems, twenty-eight Gujerati Moslems, twenty-five Punjabi Hindus and forty-seven Gujerati Hindus. There were no discernible differences in the dietary customs of those with normal glucose tolerance, impaired glucose tolerance and newly diagnosed diabetes. Subjects of South Asian origin ate significantly fewer meals per day than European subjects. Evening meal times were 2-3 h later among South Asians. Europeans ate less fruit but more vegetables and more brown rice than South Asians. Gujeratis ate more rice, fried snacks and white flour. Moslems were least likely to be vegetarians, to drink alcohol and to use home-made ghee and yoghurt, and Punjabi Sikhs and Hindus ate dhal more frequently than Pakistani Moslems, Gujerati Moslems or Hindus. Most South Asians ate Indian sweets and 'Western' snacks.
To determine the incidence and rates of remission of lower urinary tract symptoms at one year in women aged 40-60, and to assess factors associated with remission.
Ongoing longitudinal cohort study.
One rural and one urban county in Denmark.
4000 women recruited on a random basis, 2860 of whom were followed up at one year.
Incidence and rates of remission of lower urinary tract symptoms.
Prevalence, incidence, and rates of remission of lower urinary tract symptoms in 2284 women were respectively 28.5% (95% confidence interval 26.7% to 30.4%), 10.0% (8.5% to 11.4%), and 27.8% (25.6% to 30.0%). Overall, symptoms were not significantly associated with events performed or initiated in the study period: medical consultation (1.6, 0.8 to 2.8), pelvic floor physiotherapy (0.9, 0.5 to 1.8), treatment with antibiotics on suspicion of a lower urinary tract infection (1.3, 0.8 to 2.2), or other treatment (1.7, 0.7 to 4. 1). Many of the individual symptoms were, however, associated with seeking professional help.
Lower urinary tract symptoms constitute dynamic conditions, with women experiencing more or fewer symptoms, and eventually a cessation of symptoms. The distinction between permanent and fluctuating cases may have important clinical and scientific implications.
The aim of the study was to establish the prevalence of urinary symptoms and felt need in adults. This paper discusses problems with setting thresholds to distinguish cases from non-cases in this field of research. Few studies have provided detailed age- and sex-specific prevalence estimates for felt need in relation to urinary symptoms.
A cross-sectional postal survey was carried out of 15,904 community-dwelling adults aged 40 years or more registered with general practitioners in Leicestershire. Subjects were selected randomly by household from the Leicestershire Health Authority Register. The postal questionnaire consisted of questions on general health, urinary and bowel symptoms, quality of life, service use and demographic characteristics.
Thirty-four per cent of the sample reported clinically significant symptoms. The prevalence and severity of symptoms increased with age. However, only 2 per cent of the sample reported symptoms that were clinically significant, bothersome and socially disabling.
Urinary symptoms are very common in adults over 40 years of age living in the community. However, symptom-based estimates probably overestimate the level of need for health care in the community. It may be more effective and efficient to target services, in the first instance, on those people who report clinically significant symptoms that are bothersome or socially disabling. A consensus on thresholds and definitions of urinary symptoms is required to standardize clinical and research work and to target services more appropriately.
As the number of older people is growing rapidly worldwide and the fact that elderly people are also apparently living longer, dementia, the most common cause of cognitive impairment is getting to be a greater public health problem. Nutrition plays a role in the ageing process, but there is still a lack of knowledge about nutrition-related risk factors in cognitive impairment. Research in this area has been intensive during the last decade, and results indicate that subclinical deficiency in essential nutrients (antioxidants such as vitamins C, E and beta-carotene, vitamin B(12), vitamin B(6), folate) and nutrition-related disorders, as hypercholesterolaemia, hypertriacylglycerolaemia, hypertension, and diabetes could be some of the nutrition-related risk factors, which can be present for a long time before cognitive impairment becomes evident. Large-scale clinical trials in high-risk populations are needed to determine whether lowering blood homocysteine levels reduces the risk of cognitive impairment and may delay the clinical onset of dementia and perhaps of Alzheimer's disease. A curative treatment of cognitive impairment, especially Alzheimer's disease, is currently impossible. Actual drug therapy, if started early enough, may slow down the progression of the disease. Longitudinal studies are required in order to establish the possible link of nutrient intake--nutritional status with cognitive impairment, and if it is possible, in fact, to inhibit or delay the onset of dementia.
Objective: The purpose of the study was to establish whether dietary elements are related to lower urinary tract symptoms (LUTS) and thus to diseases causing LUTS. Materials and methods: This population-based study was carried out in 1994; a questionnaire was mailed to all men born in 1924, 1934 or 1944 living in Tampere or 11 rural or semi-rural municipalities in the same county, altogether 3143 men. Of this population, 68% were ultimately included in the study. A modified version of the DAN-PSS-1 questionnaire (10 of the questions) was used to assess urinary symptoms and problems arising from them. A symptom index was formed by multiplying the symptom and problem scores for hesitancy, incomplete emptying, urge, urge incontinence, nocturia and daytime frequency, and totalling the products. The men were also asked to report on their medical history, how often they ate vegetables and meat, whether they used butter, margarine or vegetable oil in food, how much alcohol and coffee they consumed, their smoking...
Objective: To determine the prevalence of stress, urge, and mixed urinary incontinence and associated risk factors in postmenopausal women. Methods: Before enrollment in a 4-year, randomized trial of combination hormone therapy to prevent coronary heart disease, 2763 participants completed questionnaires on prevalence and type of incontinence. We measured factors potentially associated with incontinence including demographics, reproductive and medical histories, height, weight, and waist-to-hip circumference ratio. We used multivariate logistic models to determine independent associations between those factors and weekly incontinence by type. Results: The mean (+/- standard deviation [SD]) age of the participants was 67 +/- 7 years; 89% were white and 8% were black. Fifty-six percent reported weekly incontinence. In multivariate analyses, the prevalence of weekly stress incontinence was higher in white than black women (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1), in women with higher body-mass index (BMI) (OR 1.1 per 5 units, 95% CI 1.0, 1.3), and higher waist-to-hip ratio (OR 1.2 per 0.1 unit, 95% CI 1.0, 1.4). The prevalence of weekly urge incontinence was higher in older women (OR 1.2 per 5 years, 95% CI 1.1, 1.3), diabetic women (OR 1.5, 95% CI 1.1, 2.0) and women who had reported two or more urinary tract infections in the prior year (OR 2.0, 95% CI 1.1, 3.6). Conclusion: Stress and urge incontinence are common in postmenopausal women and have different risk factors, suggesting that approaches to risk-factor modification and prevention also might differ and should be specific to types of incontinence. (C) 1999 by The American College of Obstetricians and Gynecologists.
A case control study was conducted on 100 patients with benign prostatic hypertrophy (BPH) and 100 controls matched by age and residence. Interviews were performed by well- trained urologists using an original questionnaire. Matched-pair analysis revealed the following characteristics and relative risks (RR) as being significantly (P < 0.05) different among the BPH patients versus the controls: higher educational background (RR = 2.77); not engaged in farming, forestry, or fishing (RR = 4.82); no environmental pollution at work (RR = 2.90); a present annual income of more than 2,400,000 yen (RR = 3.84); a previous annual income of more than 2,400,000 yen (RR = 3.82); practice the highest standard of living (RR = 4.24); more than two children (RR = 2.67); experienced first nocturnal emission before reaching the age of 20 (RR = 3.11); expending more than 10 min to complete one act of sexual intercourse (RR = 2.43); having no episode of sexual impotence that lasted more than 1 month (RR = 2.29); no family history of gastric ulcer (RR = 7.98); no family history of breast cancer (RR = 8.25); regular consumption of milk (RR = 2.25); irregular consumption of green and yellow vegetables (RR = 3.91); and pickles not consumed at every meal (RR = 1.99). Characteristics that did not achieve a high level of statistical significance (0.05 < P < 0.10) between cases and controls were as follows: past history of gonorrhea, urethritis, or prostatitis and syphilis (RR = 1.84, 2.76, and 4.26, respectively), and daily meat consumption (RR = 3.18). On the basis of interviews of the patients and cases reported in this study, we conclude that dietaly and sexual habits may be important factors which place individuals at a higher risk for developing BPH.
Objective: To determine the relationship between lower urinary tract symptoms and possible associated risk factors in women 40–60 years old.Methods: In a normal population study, 502 women with lower urinary tract symptoms and 742 women with no symptoms (controls) were asked about possible associated factors.Results: Four hundred eighty-seven women (97.0%) with symptoms and 564 controls (76.0%) completed the study. Stress incontinence was associated with parity (primipara odds ratio [OR] 2.2, 95% confidence interval [CI] 1.0, 4.9; para 2 OR 3.9, 95% CI 1.9, 8.0; para 3 OR 4.5, 95% CI 2.1, 9.5), use of diuretics (OR 2.2, 95% CI 1.2, 3.9), hysterectomy (OR 2.4, 95% CI 1.6, 3.7), and increased body mass index (BMI). Urge incontinence was associated with use of diuretics (OR 4.0, 95% CI 2.2, 7.1) and BMI. Urgency was associated with parity (primipara OR 1.9, 95% CI 0.9, 4.2; para 2 OR 3.0, 95% CI 1.5, 5.9; para 3 OR 3.1, 95% CI 1.5, 6.5), use of diuretics (OR 2.7, 95% CI 1.5, 4.7) and BMI. Associations between non–incontinence symptoms (except urgency) and observed factors were weak and inconsistent. Straining at stool and constipation were inversely associated with lower urinary tract symptoms. Overall, lesion of sphincter ani, episiotomy, fetal weight, physical activity, and hormonal status had minor association with lower urinary tract symptoms.Conclusion: Lower urinary tract symptoms were associated positively with parity, BMI, prior hysterectomy, use of diuretics, straining at stool, and constipation.
An association between smoking and impaired wound healing has been reported in retrospective studies. The smoking status of a surgical patient may be confounded by social and medical parameters. We have evaluated the effect of smoking in a test wound in volunteers, with special reference to a reliable scientific match between smokers and nonsmokers.
In a prospective open study with blinded assessment, 19 smoking (20 cigarettes/day) and 18 nonsmoking healthy volunteers were matched with respect to baseline characteristics. The deposition of total protein and mature collagen (expressed as hydroxyproline) was assessed in an expanded polytetrafluoroethylene wound healing model implanted subcutaneously for 10 days.
The nonsmokers had a 1.8 times higher median amount of hydroxyproline than the smokers (p < 0.01). The deposition of hydroxyproline was negatively correlated with the consumption of tobacco both before (r = -0.44; p < 0.01) and during the study (r = -0.48; p < 0.005). The impairment was specific for the production of collagenous proteins and not other proteins.
The synthesis of subcutaneous collagen in smokers is specifically impeded, indicating an impaired wound-healing process. Because mature collagen is the main determinator of strength of an operative wound, the results support the view that patients should be advised to stop smoking before an operation.
The goal of this case control study was to evaluate the relationship between smoking and female urinary incontinence.
The study included 606 women whose smoking histories were known; 322 were incontinent and 284 were continent. The condition(s) causing each subject's incontinence was determined by urodynamic testing; 40% of the continent subjects had the same testing.
There were highly significant overall differences (p = 0.000009) in the distribution of current, former, and never smokers between incontinent (35%, 16%, 49%) and continent (24%, 8%, 68%) groups. The odds ratio for genuine stress incontinence was 2.20 for former (95% confidence interval 1.18 to 4.11) and 2.48 for current smokers (95% confidence interval 1.60 to 3.84); for motor incontinence it was 2.92 for former (95% confidence interval 1.58 to 5.39) and 1.89 (95% confidence interval 1.19 to 3.02) for current smokers. Increasing daily and lifetime cigarette consumption was associated with an increasing odds ratio for genuine stress incontinence but not for motor incontinence. The increased risk for incontinence was not due to differences in age, parity, weight, or hypoestrogenic status.
The data establish a strong statistical relationship between current and former cigarette smoking and both stress and motor urinary incontinence in women.
The subjective and objective effects of massive weight loss on lower urinary tract function in morbidly obese women were examined.
Thirteen subjects underwent a comprehensive evaluation of lower urinary tract function before and 1 year after surgically induced weight loss.
We demonstrated significant improvements in lower urinary tract function after weight loss. Of 12 subjects who complained of incontinence before surgery only three complained of incontinence (p = 0.004) and only one requested treatment after weight loss. Objective and subjective resolution of both stress and urge incontinence was documented. Statistically significant changes were seen in measures of vesical pressure, the magnitude of bladder pressure increases with coughing, bladder-to-urethra pressure transmission with cough, urethral axial mobility, number of incontinence episodes, and the need to use absorptive pads.
Weight reduction is desirable for obese women complaining of urinary incontinence and may obviate the need for further incontinence therapy.
In this study, patterns of urinary incontinence, its severity and types were studied by three sequential data collections at annual intervals. The data are from a panel survey of a probability sample of 1,956 noninstitutionalized persons aged 60 and over residing in Washtenaw County, Michigan, who were interviewed in their homes about urine loss. Based on these self-reports, the prevalence of urinary incontinence was 18.9% in men and 37.7% in women. One-year incidence rates of about 20% among women and about 10% among men were found. One-year remission rates were about 12% for women and about 30% for men. When becoming incontinent, respondents were most likely to develop mild incontinence. Those who changed their severity level were most likely to progress from mild to moderate.
1. Nicotine produced a transient contraction of isolated strips of guinea-pig urinary bladder. The response to nicotine was antagonized by the nicotinic receptor antagonist, hexamethonium but was insensitive to tetrodotoxin. 2. The nicotine-induced contraction was potentiated by the cholinesterase inhibitor, physostigmine, and was reduced to 50% and 70% by the muscarinic cholinoceptor antagonist, atropine and the sympathetic neurone blocking drug, guanethidine, respectively. Chemical denervation with 6-hydroxydopamine abolished the inhibitory effect of guanethidine. Simultaneous treatment with atropine and guanethidine did not abolish the response to nicotine, but the degree of inhibition was comparable to that obtained with atropine alone. 3. The nicotine-induced contraction was insensitive to bunazosin and yohimbine (alpha 1- and alpha 2-adrenoceptor antagonists, respectively), and exogenously applied noradrenaline did not cause a contraction even in the presence of blockade of noradrenaline uptake mechanisms with desipramine and normetanephrine and of beta-adrenoceptors with propranolol, suggesting a non-adrenergic nature of the sympathomimetic effect of nicotine in this tissue. 4. The nicotine-induced contraction in the presence of atropine was abolished after desensitization of P2-purinoceptors with alpha, beta-methylene adenosine 5'-triphosphate, a slowly degradable ATP analogue selective for P2-purinoceptors. By this desensitization, the response to ATP, but not to histamine, was also abolished. 5. A cyclo-oxygenase inhibitor flurbiprofen partially inhibited the nicotine-induced contraction. The degree of the inhibition was more pronounced in the presence of atropine than in its absence. Flurbiprofen antagonized the response to exogenously applied ATP in an unsurmountable manner, but not that to carbachol. 6. The present results suggest that nicotine might induce a contraction through an interaction with nicotinic receptors located on the terminals of, possibly, (i) parasympathetic cholinergic, (ii) sympathetic non-adrenergic and (iii) non-sympathetic purinergic nerves in guinea-pig detrusor preparations, and that a portion of the contraction due to the purine nucleotide released is possibly potentiated by intramural prostaglandin(s). Parasympathetic cholinergic output might be modulated by an unknown excitatory substance released by nicotine from sympathetic nerve. 7. Nicotine reveals a latent excitatory effect of the sympathetic hypogastric nerve which innervates guinea-pig detrusor.
1. Nicotine produced a transient contraction of rabbit isolated iris sphincter muscle, a parasympathetic ganglion-free tissue. The response to nicotine was antagonized by hexamethonium, but was insensitive to tetrodotoxin (TTX). While single treatments with atropine, capsaicin or [D-Arg1, D-Pro2, D-Trp7,9, Leu11]-substance P (rpwwL-SP) partially blocked the response, combined treatment abolished it. 2. Chronic treatment of animals with nicotine added to the drinking water (about 12 mg kg-1 per day) had no effect on the responsiveness to nicotine or the pharmacological properties of nicotine-induced contraction. 3. These results suggest that acetylcholine and tachykinin(s) released via sodium channel-independent mechanisms from nerve terminals of parasympathetic and primary sensory nerves, respectively, are involved in the nicotine-induced contractile response.
Serum vitamin C levels were compared in smokers and nonsmokers in relation to dietary and supplemental intake of vitamin C, using data from the Second National Health and Nutrition Examination Survey. Smokers reported a lower mean daily intake (53 mg) of vitamin C than nonsmokers (65 mg) and a higher percentage (41% compared to 31%) consuming less than 70% RDA. Smoking status of respondents was judged by carboxyhemoglobin levels or by questionnaire. With both methods, percent of nonsupplemented smokers with serum vitamin C 0.3 mg/dl or less was two or more times as high as nonsupplemented nonsmokers at similar dietary intake levels. When smokers and nonsmokers with similar dietary vitamin C intake were ranked by serum C level, median and mean serum C for smokers was consistently lower than nonsmokers by approximately 0.2 mg/dl. By using the parallel bioassay methods, it was estimated that smokers would need an additional 59 mg/day dietary vitamin C (95% confidence interval of 52-68 mg/day) based on median values or 65 mg/day (53-79 mg/day) based on mean values to attain serum C levels comparable to nonsmokers.
Constipation and defecation straining have been implicated in the pathogenesis of anorectal incontinence. We have studied 24 women with chronic constipation and 20 age- and parity-matched control subjects. Electrophysiologic techniques were used to study the innervations of the puborectalis and external anal sphincter muscles. The results show that damage can occur to the nerve supply of both these muscles in chronic constipation, and that this probably is due to perineal descent during defecation straining.
PIP
This review considers the possibility that female smokers have a modified risk of estrogen-related disease. The association of smoking with 2 estrogen deficiency states--early menopause and postmenopausal osteoporosis--is examined, and data on possible negative relationships between smoking and cancers of the breast and endometrium are reviewed. Data were obtained through literature searches and consultations with investigators having unpublished results. Epidemiologic evidence strongly supports an association of smoking with early menopause. Toxic effects on the ovary, enhancement of estrogen metabolism, and effects on central nervous system hormone release have been proposed as the mechanism of this relationship, but none has been fully investigated. Smoking also appears to be associated with osteoporotic fractures in postmenopausal women, particularly among thin women not on estrogen. Although data are sparse and confounding questions exist, female smokers appear to be at lower risk of endometrial cancer than nonsmokers. Ex-smokers may be at higher risk of breast cancer than current smokers, perhaps reflecting hormonal changes associated with stopping smoking. The precise role of estrogens in breast cancer etiology remains undefined, however. Data are insufficient to determine whether a smoking association with osteoporosis and breast and endometrial cancer arises through smoking's association with early menopause. Overall, the data suggest a smoking impact on estrogen-related phenomena. The mechanism of this association is probably extraovarian. It is noted that whatever protective effect smoking may have for estrogen excess disease, smokers have a substantially higher overall mortality than nonsmokers.
The association of alcohol, diet, and other lifestyle factors with obstructive uropathy was investigated in a cohort of 6581 Japanese-American men, examined and interviewed from 1971 to 1975 in Hawaii. By studying this migrant population with its heterogeneous exposures, it increases the probabilities of identifying potential risk factors of this prostate disorder. After 17 years of follow-up, 846 incident cases of surgically treated obstructive uropathy were diagnosed with benign prostatic hyperplasia. Total alcohol intake was inversely associated with obstructive uropathy (P < 0.0001). The relative risk was 0.64 (95% confidence interval: 0.52-0.78) for men drinking at least 25 ounces of alcohol per month compared with nondrinkers. Among the 4 sources of alcohol, a significant inverse association was present for beer, wine, and sake, but not for spirits. Buddhist (vs. other) religion, rural (vs. urban) birthplace, and the presence of prostate symptoms were each associated with increased risk of obstructive uropathy, but no association was found with education, number of marriages, or cigarette smoking. Increased beef intake was weakly related to an increased risk (P = 0.047), while no association was found with the consumption of 32 other food items in the study.
To determine whether there is a difference in collagen metabolism between comparable urinary stress-incontinent and -continent women.
Fibroblast cultures from skin biopsies were established from seven stress-incontinent and four continent women. Collagen production was investigated in these cultures between passages 3 and 7 by incubation with 3H-proline, followed by quantitation of 3H-proline and 3H-hydroxyproline after hydrolysis of proteins and separation by high-pressure liquid chromatography. The chemical amount of collagen was also quantitated using Sircol Red.
Fibroblast cultures established from urinary stress-incontinent women accumulated 30% less collagen than comparable cultures from continent women. The differences were statistically significant (cell layer P = .038, medium P = .004; Student t test). These results were observed both when collagen concentration was measured with chemical methods and when the production of protein-bound 3H-hydroxyproline was quantitated. General protein synthesis was similar in the two groups.
Our results suggest that women with urinary stress incontinence have an altered connective tissue metabolism causing decreased collagen production, which may result in insufficient support of the urogenital tract.
The aim of this case-control study was to examine differences in risk factors and determinants of genuine stress incontinence between smokers and nonsmokers.
Seventy one smokers and 118 nonsmokers with pure genuine stress incontinence underwent a complete urogynecologic evaluation. Differences in risk factors and determinants of genuine stress incontinence were analyzed by means of chi 2 and nonparametric techniques.
Smokers had stronger urethral sphincters and generated greater increases in bladder pressure with coughing but had equivalent urethral mobility and pressure transmission ratios compared with nonsmokers. Smokers were significantly younger than nonsmokers, tended to be less often hypoestrogenic, but were of equivalent vaginal parity and weight.
Genuine stress incontinence develops in smokers in spite of their stronger urethral sphincter and lower risk profile than nonsmokers. More violent coughing by smokers likely promotes the earlier development of the anatomic and pressure transmission defects that allow genuine stress incontinence and overcomes any protective advantage of a stronger urethral sphincter.
The aim of the study was to investigate the relation between cigarette smoking and urinary incontinence. A group of 80 women with incontinence (Group A) were tested urodynamically and compared with a group of 80 continent women (Group B). Patients were divided into smokers (S) and non-smokers (NS) with the incontinent ones classified as suffering from stress (SI) or motor in-continent (UI). The assessment of the smoking behavior of each individual focused upon the tar and nicotine content of each cigarette. The overall exposure to smoke was assessed as follows: tar/nicotine content in mg per cigarette x consumed cigarettes per day x duration of smoking intervals in years. According to the obtained data smokers were divided into current smokers (cs) and stop/start smokers (sss), whereas the current smokers were subdivided into heavy current smokers (hcs) and light current smokers (lcs). Significantly, more S were observed in Group A compared with Group B (48/80 vs. 11/32, P < 0.0005), whereas significantly more SI was found in NS compared with S (21/32 vs. 19/48, P < 0.0025). Particularly hcs developed more frequently UI than SI, although this difference had no statistical significance. According to our data smoking women are more likely to develop incontinence, especially motor incontinence, than non-smokers. Heavy smokers seem to tend more to UI.
To determine the prevalence, incidence, and remission rates of urinary incontinence in a large group of older women over a 6-year time span and to assess factors associated with incontinence incidence and remission.
Longitudinal cohort study.
Two rural counties in Iowa.
2025 women aged 65 years or older residing in rural Iowa, enrolled in the Iowa 65+ Rural Health Study of EPESE (Establishment of Populations for Epidemiologic Studies of the Elderly) were interviewed in person annually for 6 years; specific responses to queries about urinary incontinence were given at baseline, 3-, and 6-year intervals.
Conditional multivariate logistic regression analysis was done to assess the relationship between incontinence symptoms and various factors previously found to be related to incontinence.
The baseline prevalence of urge incontinence was 36.3%, and of stress incontinence it was 40.3%. For urge incontinence, the 3-year incidence and remission rates between the third and sixth years were 28.5% and 22.1%, respectively. For stress incontinence, the 3-year incidence and remission rates between years 3 and 6 were 28.6% and 25.1%, respectively. Seventy-six percent and 84% of women who reported no urge or stress incontinence, respectively, at the baseline interview were continent at both follow-up interviews. The only significant factors related to changes in incontinence status were age, which was associated with an increased incidence of urge incontinence (OR 1.11, P = .017, 95% CI 1.019-1.203), and improvement in activities of daily living, which was associated with a increased remission of urge incontinence (OR 0.50, P = .015, 95% CI 0.28-0.9)
In some older women, urinary incontinence is a dynamic state, with women moving back and forth along a continuum between continence and incontinence. These results are tempered by limitations of the study, which include its questionnaire design and lack of ability to detect potential treatment effect.
Phytoestrogens represent a family of plant compounds that have been shown to have both estrogenic and antiestrogenic properties. A variety of these plant compounds and their mammalian metabolic products have been identified in various human body fluids and fall under two main categories: isoflavones and lignans. A wide range of commonly consumed foods contain appreciable amounts of these different phytoestrogens. For example, soy and flax products are particularly good sources of isoflavones and lignans, respectively. Accumulating evidence from molecular and cellular biology experiments, animal studies, and, to a limited extent, human clinical trials suggests that phytoestrogens may potentially confer health benefits related to cardiovascular diseases, cancer, osteoporosis, and menopausal symptoms. These potential health benefits are consistent with the epidemiological evidence that rates of heart disease, various cancers, osteoporotic fractures, and menopausal symptoms are more favorable among populations that consume plant-based diets, particularly among cultures with diets that are traditionally high in soy products. The evidence reviewed here will facilitate the identification of what is known in this area, the gaps that exist, and the future research that holds the most potential and promise.
To determine the prevalence of stress, urge, and mixed urinary incontinence and associated risk factors in postmenopausal women.
Before enrollment in a 4-year, randomized trial of combination hormone therapy to prevent coronary heart disease, 2763 participants completed questionnaires on prevalence and type of incontinence. We measured factors potentially associated with incontinence including demographics, reproductive and medical histories, height, weight, and waist-to-hip circumference ratio. We used multivariate logistic models to determine independent associations between those factors and weekly incontinence by type.
The mean (+/- standard deviation [SD]) age of the participants was 67+/-7 years; 89% were white and 8% were black. Fifty-six percent reported weekly incontinence. In multivariate analyses, the prevalence of weekly stress incontinence was higher in white than black women (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1), in women with higher body-mass index (BMI) (OR 1.1 per 5 units, 95% CI 1.0, 1.3), and higher waist-to-hip ratio (OR 1.2 per 0.1 unit, 95% CI 1.0, 1.4). The prevalence of weekly urge incontinence was higher in older women (OR 1.2 per 5 years, 95% CI 1.1, 1.3), diabetic women (OR 1.5, 95% CI 1.1, 2.0) and women who had reported two or more urinary tract infections in the prior year (OR 2.0, 95% CI 1.1, 3.6).
Stress and urge incontinence are common in postmenopausal women and have different risk factors, suggesting that approaches to risk-factor modification and prevention also might differ and should be specific to types of incontinence.
To evaluate the nutritional etiology of benign prostatic hyperplasia (BPH) by conducting a case-control study in Athens, Greece. Despite the high morbidity and substantial human suffering produced by BPH, little research has been undertaken concerning the nutritional etiology of this disease.
The study sample consisted of 184 patients with histologically confirmed BPH and 246 control patients without clinical evidence of prostate disease. All patients and controls were permanent residents of the greater Athens area. The data were modeled through unconditional logistic regression.
Among the food groups, fruits were inversely related to BPH risk, with a logistic regression-derived odds ratio of 0.79 per quintile increase and 95% confidence interval 0.67 to 0.93. Increased consumption of both butter and margarine was positively associated with BPH risk, and a marginally significant positive association was also evident for seed oils. No overall association was found with respect to consumption of olive oil. In analyses evaluating the role of nutrients rather than foods, zinc, an element selectively concentrated in the prostate gland, was significantly positively associated with BPH risk.
Our study provides evidence that, among added lipids, butter and margarine may increase the risk of BPH, and fruit intake may reduce this risk. Dietary zinc may play an important role in the etiology of BPH.
Urinary incontinence and genital prolapse are prevalent conditions in the female population. The aim of this study was to study possible determinants of female urinary incontinence in a population-based sample of young and middle-aged women.
Of 641 eligible women aged 20-59 years in a primary health care district, 487 (76%) responded to a questionnaire and accepted an invitation to a gynecological examination. The examination included digital assessment of the pelvic floor muscle strength (PFMS). Genital prolapse presence (cystocele, rectocele, uterine prolapse or absence of the urethrovesical crease) was graded in relation to the vaginal introitus.
The prevalence of urinary incontinence was 28%, 3.5% having daily leakage. Stress urinary incontinence was the dominant type. The odds ratio (OR) of having incontinence increased from 1 to 3.5 with increasing age and from 1 to 2.7 with increasing parity. The OR also increased with decreasing PFMS; from 1 in the group with the best PFMS to 3.4 in the group unable to contract their pelvic musculature. In addition, women with cystocele and/or absence of the urethrovesical crease had a 2.5-fold increased OR of incontinence (95% CI 1.5-4.2), smoking increased the OR 1.9 times (95% CI 1.1-3.2) and estrogen replacement therapy (ERT) increased the OR 2.9 times (95% CI 1.4-5.9). There were no significant correlations with the presence of chronic disease, episiotomy or the birth weights of children but small non-significant correlations with performed hysterectomy and the woman's weight.
Urinary incontinence is a frequent symptom in the female general population and related to age, pelvic floor muscle strength, genital prolapse, smoking, parity and estrogen replacement therapy.
Obesity is a common condition among women in developed countries and has a major impact on stress urinary incontinence. Women suffering from obesity manifest increased intra-abdominal pressures, which adversely stress the pelvic floor and may contribute to the development of urinary incontinence. In addition, obesity may affect the neuromuscular function of the genitourinary tract, thereby also contributing to incontinence. Accordingly, thorough evaluation of obese women must be performed prior to the institution of treatment. Weight loss may relieve urinary incontinence, but definitive therapy via operative procedures is effective even in obese patients and should be recommended with confidence.
The purpose of the study was to establish whether dietary elements are related to lower urinary tract symptoms (LUTS) and thus to diseases causing LUTS.
This population-based study was carried out in 1994; a questionnaire was mailed to all men born in 1924, 1934 or 1944 living in Tampere or 11 rural or semi-rural municipalities in the same county, altogether 3143 men. Of this population, 68% were ultimately included in the study. A modified version of the DAN-PSS-1 questionnaire (10 of the questions) was used to assess urinary symptoms and problems arising from them. A symptom index was formed by multiplying the symptom and problem scores for hesitancy, incomplete emptying, urge, urge incontinence, nocturia and daytime frequency, and totalling the products. The men were also asked to report on their medical history, how often they ate vegetables and meat, whether they used butter, margarine or vegetable oil in food, how much alcohol and coffee they consumed, their smoking history and their weight and height. The risk of LUTS was estimated according to the frequency of meat and vegetable intake and the kind of fat used.
The confounder-adjusted risk of LUTS was 0.68 (95% CI 0.54-0.86) among men consuming vegetables daily compared with men consuming vegetables less frequently. Compared with men who eat meat less frequently, the confounder-adjusted risk of LUTS was 2.08 (95% CI 1.00-4.10) among men consuming meat weekly, and 2.56 (95% CI 1.30-5.02) among men consuming meat daily. The confounder-adjusted risk of LUTS was 0.73 (95% CI 0.58-0.93) among men who consumed butter compared to those who did not.
Dietary elements may also have an important role in the development of diseases causing LUTS. Direct effects of food components may likewise influence the occurrence of LUTS.
The effect on individual rankings and total intakes of nutrients of correcting total fruit and vegetable frequencies from a long food frequency questionnaire (FFQ) using the responses to two summary questions was examined in a group of women.
The performance of a self-administered FFQ in ranking individual levels of intake and estimating absolute levels of nutrient and energy intake was compared with the performance of the questionnaire when it was corrected for fruit and vegetable intake reported using the Block summary questions.
The study population included 123 women, aged between 18 and 54 years, who were recruited from the Family Planning Association Colposcopy Clinic in Sydney.
Substantial and significant differences (P < 0.001) were found in fruit and vegetable intakes between the FFQ and the summary questions. Intake frequency by the FFQ was more than double that by the summary questions. When the FFQ was corrected for fruit and vegetable intakes using the summary questions, the intakes of beta-carotene, vitamins A and C, and dietary fibre were more than 20% lower (p < 0.001) than the uncorrected results. However, this had little effect on ranking individuals. This study also examined seasonal differences in vegetable intakes and differences in nutrient intakes when either summer or winter vegetable consumption was substituted for seasonal vegetable intake in the FFQ. Although there were seasonal differences for some foods, the substitution had little effect on intake of nutrients.
These results indicate that important differences in intakes are observed when two methods, which appear to yield the same results, are used. Further work is needed to determine which, if either, of the two methods yields intakes that can be compared quantitatively with national references for assessing the adequacy of population intakes.
To evaluate the association of smoking with urgency in older people.
A population-based survey involving 1,059 people aged 60-89 years. A stratified sampling method was used and data were collected by interviews. The response rate was 82%. The indicators were urgency, former and current smoking, alcohol and coffee drinking. Prevalences of urgency were calculated for 15-year age groups of the two genders. Logistic regression models were used to analyse the age-adjusted association of urgency with smoking, use of alcohol and coffee drinking in the whole study population and separately in the two gender groups.
The prevalence of urgency was lowest among younger men (6.6%) and highest among older women (19.5%). In the whole study population including both genders the current smokers were at greater risk of suffering from urgency [OR (odds ratio) 2.76; 95% CI (confidence interval) 1.43-5.32] than the never-smokers while the OR of urgency for former smokers was 1.63 (95% CI 0.97-2.74). In the separate models for the two genders the current male smokers (OR 2.55; 95% CI 1.13-5.73) and the former female smokers (OR 2.62; 95% CI 1.14-6.0) were at greater risk. The OR for current female smokers was 2.54 (95% CI 0.79-8.22), but the group was very small. Alcohol use and coffee drinking were not associated with urgency.
Smoking is associated with urgency in older people. Especially current smokers are at greater risk than never-smokers. The prevalence of urgency is higher among women and is increased in both genders with advancing age. The study material being cross-sectional the causal relationship cannot be confirmed.
The study was carried out to determine the relation between lower urinary tract symptoms and possible associated factors in women aged 40-60 years.
In a normal population study, 502 women with lower urinary tract symptoms and 742 women without symptoms (controls) were asked about possible associated factors.
Four hundred and eighty-seven (97.0%) women with symptoms and 564 (76.0%) controls completed the study. Stress incontinence was associated with parity (primipara: OR = 2.2 [95% CI: 1.0; 4.9]; para II: OR = 3.9 [95% CI: 1.9; 8.0]; para III: OR = 4.5 [95% CI: 2.1; 9.5]), the use of diuretics (OR = 2.2 [95% CI: 1.2; 3.9]), hysterectomy (OR = 2.4 [95% CI: 1.6; 3.7]), and increased BMI. Urge incontinence was associated with the use of diuretics (OR = 4.0 [95% CI: 2.2; 7.1]) and increased BMI. Urgency was associated with parity (primipara: OR = 1.9 [95% CI: 0.9; 4.2]; para II: OR = 3.0 [95% CI: 1.5; 5.9]; para III: OR = 3.1 [95% CI: 1.5; 6.5]), the use of diuretics (OR = 2.7 [95% CI: 1.5; 4.7]) and increased BMI. Associations between non-incontinence symptoms (except urgency) and the factors studied were weak and inconsistent. Straining at stool and constipation were inversely associated with lower urinary tract symptoms. Overall, lesion of the anal sphincter, episiotomy, fetal weight, physical activity, and hormonal status had a minor, if any, association with lower urinary tract symptoms.
Lower urinary tract symptoms were associated positively with parity, BMI, prior hysterectomy, use of diuretics, straining at stool, and constipation.
Benign prostatic hyperplasia (BPH) is a common disease of older men. Although the etiology remains unclear, nutritional factors may have an effect on the disease.
Because the literature on the relations between macronutrient intakes and BPH risk is limited, we examined these relations among men in the Health Professionals Follow-up Study.
We followed men aged 40-75 y from baseline in 1986 to 1994. Total BPH cases (n = 3523) comprised men who reported BPH surgery (n = 1589) or who did not undergo surgery but scored 15-35 points on the lower urinary tract symptom questionnaire of the American Urological Association (n = 1934); non-cases were men who scored < or = 7 points (n = 24388). Odds ratios (ORs) and 95% CIs were calculated by using multivariate logistic regression.
The ORs rose with increasing total energy intake in a comparison of the highest and lowest quintiles for total BPH (OR: 1.29; 95% CI: 1.14, 1.45) and symptoms of BPH (1.43; 1.23, 1.66). Energy-adjusted total protein intake was positively associated with total BPH (1.18; 1.05, 1.33) and BPH surgery (1.26; 1.06, 1.49). Energy-adjusted total fat intake was not associated with risk of total BPH, but intakes of eicosapentaenoic, docosahexaenoic, and arachidonic acids were associated with a moderate increase in risk of total BPH.
We observed modest direct associations between BPH and intakes of total energy, protein, and specific long-chain polyunsaturated fatty acids. Because eicosapentaenoic, docosahexaenoic, and arachidonic acids are highly unsaturated fatty acids, our findings support a possible role of oxidative stress in the etiology of BPH.
The aim of this study was to evaluate the effect of weight reduction on urinary incontinence in moderately obese women. This prospective cohort study enrolled moderately obese women experiencing four or more incontinence episodes per week. BMI and a 7-day urinary diary were collected at baseline and on the completion of weight reduction. The study included 10 women with a mean (+/-SD) baseline BMI of 38.3 (+/-10.1) kg/m2 and 13 (+/-10) incontinent episodes per week. Participants had a mean BMI reduction of 5.3 (+/-6.2) kg/ m2 (P < 0.03). Among women achieving a weight loss of > or = 5%, 6/6 had > or = 50% reduction in incontinence frequency compared to 1 in 4 women with < 5% weight loss (P < 0.03). Incontinence episodes decreased to 8 (+/-10) per week following weight reduction (P < 0.07). The study demonstrated an association between weight reduction and improved urinary incontinence. Weight reduction should be considered for moderately obese women as part of non-surgical therapy for incontinence.