Hypothesis / aims of study
The overactive bladder syndrome (OAB) is a clinical syndrome characterized by the urgent voiding with or without urge incontinence 1. The physiological and lower urinary tract changes are affected by the advancing age. Trauma in the pelvic floor, hereditary factors, menopause, obesity; and behavioral factors contribute to a significant increase in OAB2. Previous studies relate patient’s position in with OAB 3. However, there are no studies that correlate poor habits with the severity of OAB symptoms in older women. The objective of the present study is to correlate urinary habits with the severity of symptoms of overactive bladder syndrome in older women.
Study design, materials and methods
Across-sectional study with older women diagnosed clinically with overactive bladder syndrome. Inclusion criteria: female gender, age 60 years or older. Women presenting with lower urinary tract infection, previous treatment for overactive bladder syndrome, neurological diseases, bladder cancer, pelvic radiotherapy, presence of pelvic organ prolapse with> 3 degree and inability to answer the questionnaires were excluded from the study. Once included in the research, the patients underwent an anamnesis, composed of questions about BMI, number of pregnancies, vaginal deliveries. For the analysis of the voiding habits, a questionnaire was elaborated by the authors with questions about the voiding habits such as: positioning adopted during urination in public and private bathrooms; presence of voiding hesitation, voiding effort and incomplete emptying sensation. In addition, the ICIQ - OAB questionnaire was used to analyze the symptoms of overactive bladder and the ICIQ - SF aimed at urinary incontinence and quality of life
Results
In total, 55 patients were invited to participate in the evaluations, but 2 patients were excluded, one due to previous treatment for overactive bladder syndrome and another due to the presence of neurological disease (CVA). The mean age of the patients was 70 years (± 6.3 years). Patients had a mean BMI of 29.61 (± 5.8), therefore they were overweight or obesity grade I. The demographic characteristics can be seen in table 1.
Table 1: Demographic characteristics
When the hyperactive bladder symptom questionnaires were applied, we obtained a score of 15.40 (± 3.97) in the ICIQ-SF questionnaire and 9.58 (± 3.37) in the ICIQ-OAB. The correlation between the ICIQ - SF, ICIQ - OAB and the voiding habits was performed. There was no significant difference in most of the analyzed data. However, when specifically analyzed voiding hesitation, a negative correlation was observed with ICIQ-OAB (r = -0.38; p <0.05), that is, the lower the hesitation, the greater the symptoms of overactive bladder, Table 2
Table 2: Correlation between the severity of the symptoms and the voiding habits
Interpretation of results
Older women with voiding hesitation have a lower OAB symptom. This may be due to the balance between sympathetic and parasympathetic influences. The parasympathetic pathway provides an exciting input to the detrusor muscle causing contraction and leading to urinary excretion. Continence is maintained by a sympathetic mechanism that facilitates bladder filling and inhibits micturition. Urinary hesitancy or retention is caused by disruption in the sympathetic / parasympathetic balance involved in the process of urination.