Lower urinary tract symptoms in women with irritable bowel syndrome

Association between chronic conditions and urinary incontinence in females: a cross-sectional study using national survey data

BACKGROUND

Urinary incontinence affects up to half of women, yet few speak to their health care provider about or receive treatment for the condition. To aid with identifying subpopulations at risk for urinary incontinence, we examined the associations between 10 chronic health conditions and urinary incontinence among Canadian adult females.

METHODS

We conducted a cross-sectional analysis of survey data from the Canadian Community Health Survey (2013-2014) involving female respondents aged 25 years or older living in a private dwelling. Presence of chronic conditions and urinary incontinence were measured by self-report. We used logistic regression modelling with sampling weights, controlling for age, income, ethnicity, body mass index and smoking. Multiple imputation and probabilistic bias analysis were used to address missing covariate data and unmeasured confounding from parity.

RESULTS

Our analysis included 60 186 respondents representing more than 12 million Canadian females, of whom 45.8% (95% confidence interval [CI] 45.0%-46.6%) reported at least 1 chronic condition. Chronic conditions were associated with more than twice the odds of urinary incontinence (adjusted odds ratio [OR] 2.42, 95% CI 2.02-2.89). Associations were largest for bowel disorders (adjusted OR 2.92, 95% CI 2.44-3.49); modest for chronic obstructive pulmonary disease (adjusted OR 2.00, 95% CI 1.63-2.45), asthma (adjusted OR 1.82, 95% CI 1.52-2.19), arthritis (adjusted OR 1.98, 95% CI 1.74-2.24) and heart disease (adjusted OR 1.73, 95% CI 1.48-2.02); and smallest for diabetes (adjusted OR 1.20, 95% CI 1.02-1.41) and high blood pressure (adjusted OR 1.27, 95% CI 1.12-1.44). Results slightly attenuated but did not substantively change after imputation and bias analysis.

INTERPRETATION

We found that chronic conditions are associated with significantly higher odds of comorbid urinary incontinence among Canadian adult females, which is consistent with previous research. Our findings support routine inquiry regarding urinary incontinence symptoms among women accessing health care for chronic conditions.

Association between lower urinary tract symptoms (LUTS) and obsessive-compulsive disorders (OCD) in women: A study based on urodynamic findings and micturition problem

AIM

This study focused on women with chronic lower urinary tract symptoms (LUTS) who simultaneously suffered from obsessive-compulsive disorder (OCD) to evaluate the association between micturition abnormality and OCD.

METHODS

A cohort case study was conducted on 128 women with chronic LUTS who visited the academic clinic from 2012 to 2018. The participants with a history of OCD were grouped together, whereas the other group consisted of those with no psychiatric issues. Data were analyzed using the Kolmogorov-Smirnov test and also the nonparametric Kruskal-Wallis and χ² tests.

RESULTS

The participants with OCD had a lower mean age (41.7 vs. 48.8 years) and longer symptom duration than the control group. Moreover, voiding phase problems were more prevalent among OCD patients (mean voiding score: 9.3 vs. 6.9). Urge urinary incontinence (UUI) was the most common type of urinary incontinence in OCD patients, and the most important urodynamic study finding was bladder outlet obstruction (45% and 17% in the OCD and control groups, respectively). Voiding disorders resulted in chronic renal failure in two patients (3.12%). It was shown that bladder outlet obstruction (odds ratio (OR) 4.43, 95% confidence interval [CI] 1.53-12.78, p = 0.006] was the strongest predictor of OCD and stress urinary incontinence (OR 0.20, 95% CI 0.07-0.53, p < 0.001) was the best protector against OCD.

CONCLUSION

The findings revealed that chronic LUTS was related to voiding dysfunction and urodynamic abnormality in OCD patients. These disorders may be categorized as somatoform disorder that requires appropriate treatments.

Enhancing behavioral treatment for women with pelvic floor disorders: Study protocol for a pilot randomized controlled trial

Approximately one in four American women report bothersome urinary symptoms (e.g., urgency, frequency), which greatly impact quality of life, including mental health. Bidirectional relationships have been found between urinary symptoms and anxiety, such that urinary symptoms worsen emotional distress (i.e., anxiety and depression), and in turn anxiety can exacerbate these symptoms. Current methods to treat urinary symptoms, such as physical therapy and medications, do not address their emotional impact. As such, our multidisciplinary team is conducting a randomized control trial (RCT) of cognitive-behavior therapy (CBT) using the Unified Protocol (UP) versus supportive therapy in the context of integrated behavioral treatment in the urogynecology context. Women with bothersome urinary symptoms and anxiety are recruited from the Northwestern Medicine Integrated Pelvic Health Program (IPHP) -a transdisciplinary clinic including urogynecologists, urologists, colorectal surgeons, nurses, and physical therapists- and Northwestern Medicine Urology. Participants are randomized to one of two interventions: UP or supportive therapy. All participants attend therapy once per week for 12 weeks. Assessments of urinary symptoms, anxiety, and other indicators of psychological and physical functioning are completed at baseline, mid-treatment, post-treatment, and at 3- and 6-month follow-ups using patient-reported outcomes. The study has been preregistered on clinicaltrails.gov (ID: NCT03623880) and is currently ongoing.

Regions of the brain activated in bladder filling vs rectal distention in healthy adults: A meta-analysis of neuroimaging studies

AIMS

Adults with pelvic floor disorders commonly present with overlapping bladder and bowel symptoms; however, the relationship between urinary and defecatory dysfunction is not well understood. Our aim was to compare and determine if overlapping brain regions are activated during bladder filling and rectal distention in healthy adults.

METHODS

We conducted separate Pubmed searches for neuroimaging studies investigating the effects of rectal distention and bladder filling on brain activation in healthy subjects. Coordinates of activated regions were extracted with cluster-level threshold P < .05 and compared using the activation likelihood estimate approach. Results from the various studies were pooled and a contrast analysis was performed to identify any common areas of activation between bladder filling and rectal distension.

RESULTS

We identified 96 foci of activation from 14 neuroimaging studies on bladder filling and 182 foci from 17 studies on rectal distension in healthy adults. Regions activated during bladder filling included right insula, right and left thalamus, and right periaqueductal grey. Regions activated during rectal distention included right and left insula, right and left thalamus, left postcentral gyrus, and right inferior parietal lobule. Contrast analysis revealed common activation of the right insula with both rectal distention and bladder filling.

CONCLUSION

Bladder filling and rectal distention activate several separate areas of the brain involved in sensory processing in healthy adults. The common activation of the insula, the region responsible for interoception, in these two conditions may offer an explanation for the coexistence of bladder and defecatory symptoms in pelvic floor disorders.

Partners in Crime: NGF and BDNF in Visceral Dysfunction

Neurotrophins (NTs), particularly Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF), have attracted increasing attention in the context of visceral function for some years. Here, we examined the current literature and presented a thorough review of the subject. After initial studies linking of NGF to cystitis, it is now well-established that this neurotrophin (NT) is a key modulator of bladder pathologies, including Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS. NGF is upregulated in bladder tissue and its blockade results in major improvements on urodynamic parameters and pain. Further studies expanded showed that NGF is also an intervenient in other visceral dysfunctions such as endometriosis and Irritable Bowel Syndrome (IBS). More recently, BDNF was also shown to play an important role in the same visceral dysfunctions, suggesting that both NTs are determinant factors in visceral pathophysiological mechanisms. Manipulation of NGF and BDNF improves visceral function and reduce pain, suggesting that clinical modulation of these NTs may be important; however, much is still to be investigated before this step is taken. Another active area of research is centered on urinary NGF and BDNF. Several studies show that both NTs can be found in the urine of patients with visceral dysfunction in much higher concentration than in healthy individuals, suggesting that they could be used as potential biomarkers. However, there are still technical difficulties to be overcome, including the lack of a large multicentre placebo-controlled studies to prove the relevance of urinary NTs as clinical biomarkers.

High risk of lower urinary tract symptoms in patients with irritable bowel syndrome

BACKGROUND

The aim of the present study was to investigate the prevalence of urinary tract infection (UTI) and the risk of lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhea, and mixed) compared to women in the general population.

METHODS

Between January 2014 and December 2015, consecutive adult female patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy women with regular bowel habits were enrolled in the study. At baseline, we checked for UTI with a dipstick test and questioned patients about the presence of LUTS in the previous 24 h.

RESULTS

We enrolled 141 IBS patients and 91 healthy controls in the study. There was no difference in the prevalence of UTI between IBS patients and healthy controls (4.9 vs 3.3%, p = 0.5). When we excluded patients with UTI, we found a 2.79 higher risk of increased urinary frequency [odds ratio (OR) 2.79, 95% confidence interval (CI) 1.37-5.68], a 2.68 higher risk of urinary urgency (OR 2.68, 95% CI 1.04-6.91), and more than three times the risk of having dysuria (OR 3.25, 95% CI 1.06-9.97) in IBS women compared to healthy controls. The risk of having at least one urinary symptom was independent of IBS subtype and IBS severity.

CONCLUSIONS

Our study shows that IBS women have a similar risk of UTI compared to healthy women even if they complain more of LUTS, independently of IBS subtype and severity.

Does central sensitization help explain idiopathic overactive bladder?

The pathophysiological mechanisms underlying overactive bladder syndrome (OAB) can include dysfunction of sensory pathways of the peripheral and central nervous systems, resulting in bladder hypersensitivity. Central sensitization describes an induced state of spinal hypersensitivity that is associated with a variety of chronic pain disorders that share many attributes with OAB, albeit without the presence of pain. As such, the concept of central sensitization might be relevant to understanding the mechanisms and clinical manifestations of OAB syndrome. An understanding of the pathophysiology and clinical manifestations of central sensitization, and the evidence that supports a role of central sensitization in OAB, including the potential implications of mechanisms of central sensitization for the treatment of patients with OAB could provide a novel approach to the treatment of patients with this disease. Such an approach would be especially relevant to those patients with central sensitization-related comorbidities, and has the potential to improve the outcomes of these patients in particular.

Somatic syndromes and chronic pain in women with overactive bladder

AIMS

Mechanisms underlying pain perception and afferent hypersensitivity, such as central sensitization, may impact overactive bladder (OAB) symptoms. However, little is known about associations between OAB symptom severity, pain experience, and presence of comorbid chronic pain syndromes. This study examined relationships between OAB symptoms, somatic symptoms, and specific chronic pain conditions in which central sensitization is believed to play a primary role, in a community-based sample of adult women with OAB.

METHODS

We recruited adult women with OAB to complete questionnaires assessing urinary symptoms, pain and somatic symptoms, and preexisting diagnoses of central sensitivity syndromes. We analyzed the effects of overall bodily pain intensity, general somatic symptoms, and diagnoses of central sensitivity syndromes on OAB symptom bother and health-related quality of life.

RESULTS

Of the 116 women in this study, over half (54%) stated their urge to urinate was associated with pain, pressure, or discomfort. Participants reported a wide range of OAB symptoms and health-related quality of life. There was a significant, positive correlation between OAB symptoms and somatic symptoms as well as overall pain intensity. Only 7% of women met diagnostic criteria for fibromyalgia; yet these women demonstrated significantly increased OAB symptom burden and decreased OAB quality of life compared to those without fibromyalgia.

CONCLUSION

Women with more severe OAB symptoms reported increased general somatic symptom burden and increased overall body pain intensity, especially women with fibromyalgia. These findings suggest that attributes of pain and co-morbidity with chronic pain conditions may impact the experience of OAB symptoms for many women. Neurourol. Urodynam. 36:1113-1118, 2017. © 2016 Wiley Periodicals, Inc.

Changes in mast cell infiltration: a possible mechanism in detrusor overactivity induced by visceral hypersensitivity

OBJECTIVE

To establish the detrusor overactivity (DO) model induced by visceral hypersensitivity (VH) and investigate the relationship between mast cell (MC) infiltration and DO.

MATERIALS AND METHODS

Sixty rats are divided into 4 groups randomly: Group 1:Baseline group; Group 2: DO group; Group 3: CON group; Group 4: VH group. The colorectal distension (CRD) and abdominal withdral reflex (AWR) scores are performed to evaluate VH. The cystometric investigation and histological test of MC infiltration are assessed.

RESULTS

The threshold pressure of CRD in the VH group is significantly lower than that in the CON group (P<0.001). At the distension pressure ≥20 mmHg, the AWR scores of the VH group are significantly higher than those of the CON group (10 mmHg: P=0.33; 20 mmHg: P=0.028; 40 mmHg: P<0.001; 60 mmHg: P<0.001; 80 mmHg: P<0.001). DO model is successfully established in the VH group (DO rate=100%). Compared with the CON group, the numbers of MC infiltration are significantly increased in the VH group, including submucosa of bladder (P<0.001), mucosa lamina propria/mesentery of small intestine (P<0.001), and mucosa lamina propria/mesentery of large intestine (P<0.001). Furthermore, more MC activation as well as degranulation are observed in the VH group.

CONCLUSIONS

It is indicated that DO model can be established in the VH rats. The MC infiltration may play an important role in DO induced by VH, and may be helpful to understand the mechanisms of DO in VH patients.

Psychosocial impact of irritable bowel syndrome: A brief review

Irritable bowel syndrome (IBS) is a common disorder of the gastrointestinal tract with unclear etiology and no reliable biomarker. Like other chronic and functional disorders, medical treatments for IBS are suboptimal and the overall illness burden is high. Patients with IBS report high rates of psychopathology, low quality of life, and increased suicidal ideation. These patients also miss more days of work, are less productive at work, and use many healthcare resources. However, little is known about the burden of IBS on daily functioning. The primary aim of this paper is to review the current literature on the burden of IBS and to highlight the need for further research to evaluate the impact of IBS on daily activities. This research would contribute to our existing understanding of the impact of IBS on overall quality of life and well-being.

Effect of anticholinergics on the overactive bladder and bowel domain of the electronic personal assessment questionnaire (ePAQ)

INTRODUCTION AND HYPOTHESIS

Evidence suggests that OAB (overactive bladder) can occur alongside disorders of the colon, such as irritable bowel syndrome (IBS). Moreover, patients with constipation are more likely to develop OAB symptoms than those without. Anticholinergic medications (AcH) are commonly used for treating OAB, and can result in the unwanted side effects of constipation. We aimed to study the relationship of AcH, and their effects on quality of life using the electronic Personal Assessment Questionnaire (ePAQ) by assessing changes in the bowel and bladder domains, pre- and post-AcH treatment.

METHODS

Ninety patients completed the ePAQ pre- and post-AcH treatment from January 2011 to April 2014. Data were collected retrospectively and prospectively, and analysed using a paired t test. Effect size (ES) was calculated for OAB and bowel domains to quantify the effect on QoL.

RESULTS

There was a significant improvement in the OAB (p = 0.0005) and bowel domains (p = 0.0005). In the bowel domains, the largest effect size was seen for IBS (0.5) followed by continence (0.4), evacuation (0.375) and a small ES was seen for constipation (0.2). There was a reduction in the "degree of bother" in OAB and bowel domains.

CONCLUSIONS

Patients may benefit from the possible effects of AcH on their bowels, and assessment of all aspects of pelvic floor function is important before commencing AcH. This may help to counsel patients, with possibly improved compliance with therapy.

Glucocorticoid mediates water avoidance stress-sensitized colon-bladder cross-talk via RSK2/PSD-95/NR2B in rats

Unexpected environmental and social stimuli could trigger stress. Although coping with stress is essential for survival, long-term stress impacts visceral functions, and therefore, it plays a role in the development and exacerbation of symptoms of gastrointestinal/urogenital disorders. The aim of this study is to characterize the role of corticosterone in stress-sensitized colon-bladder cross-talk, a phenomenon presumed to underlie the comorbidity of functional bowel and bladder disorders. Cystometry and protein/mRNA expression in the lumbosacral dorsal horn (L6-S1) in response to intracolonic mustard oil (MO) instillation were analyzed in female Wistar-Kyoto rats subjected to water avoidance stress (WAS; 1 h/day for 10 days) or sham stress (WAsham). Whereas it had no effect on baseline-voiding function, chronic stress upregulated plasma corticosterone concentration and dorsal horn spinal p90 ribosomal S6 kinase 2 (RSK2) protein/mRNA levels, and RSK2 immunoreactivity colocalized with NeuN-positive neurons. Intracolonic MO dose-dependently decreased intrercontraction intervals and threshold pressure, provoked spinal RSK2 and NR2B phosphorylation, and enhanced PSD-95-RSK2 and PSD-95-NR2B coupling. Intrathecal kaempferol (a RSK2 activation antagonist; 30 min before MO instillation), bilateral adrenalectomy (7 days prior the stress paradigm), and subcutaneous RU-38486 (a glucocorticoid receptor antagonist; 30 min daily before stress sessions), but not RU-28318 (a mineralocorticoid receptor antagonist), attenuated MO-induced bladder hyperactivity, protein phosphorylation, and protein-protein interactions in the WAS group. Our results suggest that stress-associated glucocorticoid release mediates WAS-dependent sensitization of colon-bladder cross-talk via the spinal RSK2/PSD-95/NR2B cascade and offer a possibility for developing pharmacological strategies for the treatment of stress-related pelvic pain.

Relationship between overactive bladder and irritable bowel syndrome: a large-scale internet survey in Japan using the overactive bladder symptom score and Rome III criteria

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There is known to be an association between overactive bladder (OAB) and irritable bowel syndrome (IBS). The study investigates the association between OAB and IBS using an internet-based survey in Japan. It is the first to investigate the prevalence and severity of OAB in the general population using the OAB symptom score questionnaire.

OBJECTIVE

To investigate the association between overactive bladder (OAB) and irritable bowel syndrome (IBS) by using an internet-based survey in Japan.

SUBJECTS AND METHODS

Questionnaires were sent via the internet to Japanese adults. The overactive bladder symptom score was used for screening OAB, and the Japanese version of the Rome III criteria for the diagnosis of IBS was used for screening this syndrome.

RESULTS

The overall prevalence of OAB and IBS was 9.3% and 21.2%, respectively. Among the subjects with OAB, 33.3% had concurrent IBS. The prevalence of OAB among men was 9.7% and among women it was 8.9%, while 18.6% of men and 23.9% of women had IBS. Concurrent IBS was noted in 32.0% of men and 34.8% of women with OAB.

CONCLUSION

Taking into account a high rate of concurrent IBS in patients with OAB, it seems to be important for physicians to assess the defaecation habits of patients when diagnosing and treating OAB.

Determining lower urinary tract symptoms and associated risk factors in young women

OBJECTIVE

To determine lower urinary tract symptoms (LUTS) and associated risk factors in women aged 20 years and older.

METHODS

The present population-based, randomized, cross-sectional study recruited 766 women aged 20 years and older from the province of Malatya, Turkey. Data on LUTS were collected via face-to-face interviews between December 1, 2006, and July 30, 2007. The data were reported descriptively and analyzed by logistic regression for associated risk factors.

RESULTS

Regarding female LUTS, the incidence of urgency, urinary incontinence, nocturia, and frequency symptoms was 36.1%, 32.4%, 27.1%, and 22.8%, respectively. Logistic regression indicated that LUTS development was 6.1 times higher among women who had vaginal delivery than among those who had cesarean delivery; 3.7 times higher among women with gas incontinence than among those without; 2.9 times higher among women with frequent urinary tract infections that among those without; and 4.8 times higher among women whose mothers had a history of urine incontinence than among those whose mothers did not.

CONCLUSION

Vaginal delivery was found to be the highest risk factor for LUTS among women.

The clinical significances of irritable bowel syndrome in Taiwan

BACKGROUND AND AIM

According to the Rome III definition, irritable bowel syndrome (IBS) has been a biopsychosocial dysfunction. We tried to know whether the IBS clinical manifestations were comparable to other countries.

METHOD

We have reviewed the IBS publications in Taiwan, thus its clinical significances are summarized and compared to others.

RESULTS

Among a selected population of paid physical checkup, the Rome I & II criteria defined prevalences were 17.5% and 22.1%, respectively without an observed female predominance. However, female was a factor leading to constipation predominant IBS (C-IBS). Taiwan IBS patients did excessively consume society resource in terms of physician visits and absenteeism. They also had more chance of cholecystectomy, whereas normal appendix was often found in case of appendectomy. Overlapping extra-colonic manifestations, e.g. dyspepsia and lower urinary tract symptoms were common. Helicobacter pylori infection and female gender were closely related to the coexisted dyspepsia. Various psychiatric disturbances were also confirmed here. Intestinal transit correlated well with bowel symptoms, e.g. slow in constipation but fast in diarrhea. Diminished cholinergic activity was observed among the C-IBS patients. Various agents including mebeverine, pinaverium, peppermint oil, smectitie and tegarserod did somewhat improve IBS symptoms. Unfortunately, the IBS knowledge was not well understood among the medical professionals.

CONCLUSIONS

IBS is common in Taiwan, its impacts on the society are similarly observed while female gender often results in severe impacts. Disordered motility and cholinergic nervous system are likely some of its pathogeneses. Current recommended treatments are effectively demonstrated.

Lower urinary tract symptoms and urinary flow rates in female patients with hyperthyroidism

OBJECTIVES

To investigate lower urinary tract symptoms (LUTS) and voiding function in a cohort of hyperthyroid women. The autonomic nervous system (ANS) imbalance has been thought to cause LUTS in hyperthyroidism.

METHODS

Between January 2008 and December 2008, 65 newly diagnosed, untreated female hyperthyroid patients were enrolled in this study. Another 62 age-matched healthy women were enrolled as a control group. Demographics, LUTS, urinary flow rates, hyperthyroid symptoms, and serum levels of thyroid hormones were recorded before and after the medical treatment for hyperthyroidism.

RESULTS

Compared with the control group, the hyperthyroid patients had a higher mean symptom score of frequency (1.15 ± 1.75 vs 0.31 ± 1.05, P = .01), incomplete emptying (0.91 ± 1.47 vs 0.29 ± 1.12, P = .02), straining (1.05 ± 0.85 vs 0.27 ± 0.51, P <.01), voiding symptoms (3.05 ± 3.28 vs 1.06 ± 2.63, P <.01), and total symptoms (5.88 ± 6.17 vs 2.76 ± 4.65, P <.01). Fifty-three (81.5%) of them had an IPSS of <8, while only 12 (18.5%) had an International Prostate Symptom Score (IPSS) of ≥8. Hyperthyroid women demonstrated a lower mean peak flow rate (25.0 ± 5.3 vs 28.6 ± 6.1 mL/s, P = .02). After treatment, both LUTS and flow rates improved significantly. The severity of LUTS was associated with neither serum levels of thyroid hormone nor other hyperthyroid symptoms.

CONCLUSIONS

Hyperthyroid women have worse LUTS and lower peak flow rates than healthy controls. However, the severity of LUTS is only mild (IPSS <8) in the majority, and only 18.5% have moderate-to-severe LUTS. Both LUTS and flow rates improve after the treatment for hyperthyroidism. The exact mechanisms of LUTS and/or lower urinary tract dysfunction in hyperthyroidism require further investigation.

The bladder-brain connection: putative role of corticotropin-releasing factor

The coordination of pelvic visceral activity with appropriate elimination behaviors is a complex task that requires reciprocal communication between the brain and pelvic organs. Barrington's nucleus, located in the pons, is central to a circuit involved in this function. Barrington's nucleus neurons project to both pelvic visceral motorneurons and cerebral norepinephrine neurons that modulate behavior. This circuit coordinates the descending limb of the micturition reflex with a central limb that initiates arousal and shifts the focus of attention to facilitate elimination behavior. The same circuitry that links the bladder and brain enables pathological processes in one target of the circuit to be expressed in the other. Urological disorders can, therefore, have cognitive and behavioral consequences by affecting components of this circuit; and in the opposing direction, psychosocial stressors can produce voiding dysfunctions and bladder pathology. The stress-related neuropeptide, corticotropin-releasing factor, which is prominent in Barrington's nucleus neurons, is a potential mediator of these effects.