This original study aims to verify and compare the presence of functional constipation (FC), systemic arterial hypertension (SAH) and sexual function of patients with and without overactive bladder (OAB).

This is a cross-sectional observational study, that included women aged between 18 and 65 years with OAB (studied group - SG). The exclusion criterias were difficulty in comprehending the research steps, cognitive impairment, or psychiatric illness that might lead to lack of understanding the study, neurogenic overactive bladder, and pregnancy. On the other hand, the control group (CG), consisted of women without urinary urgency – confirmed by the ICIQ-OAB questionnaire (score equal to zero). After the sample groups have been selected and the women signed the Free and Informed Consent Form, they went through an anamnesis and a socio-demographic data questionnaire. Additionally, blood pressure (BP) assessment and a 3-day voiding diary (VD) was requested for the SG. In the following week, the VD was analyzed and the patients of both groups responded the ICIQ-OAB, FSFI, Rome III Criteria questionnaires and graded their feces according to the Bristol Scale. All participants provided written informed consent. Sample calculation was performed by a WINPEPI calculator under the command of proportion estimation, with a 95% confidence interval and an acceptable difference of 2%, totaling a sample number of 23 participants.

Twenty three women evaluated – 14 participants in the SG and 9 in the CG, with a median age of 46.5 (22.0-56.0) and 22.0 (21.0-52.0) years old, respectively, with no significant difference between groups (p = 0.253). In both groups, single women were more prevalent. The most prevalent signs and symptoms on SG were urge urinary incontinence and nocturia – 57.1% (p = 0.007) and 78.6% (p = 0.000), respectively. According to the Rome III Criteria, the presence of FC was higher on SG (42.9%) when compared with CG (22.2%), (p = 0.400). Regarding the Bristol Scale, both CG and SG, reported feces similarities with types 3 and 4. As for associated comorbidities, only one of the participants in each group reported SAH and diabetes. The assessment of the participant's blood pressure (11 on SG) revealed normal boundaries – values of 124.5mmHg and standard deviation (SD) of 19.5 for systolic pressure of the right arm (RA), 125.1 (SD: 20.5) the left arm systolic pressure (LA); 78 mmHg (SD: 12.3) the diastolic pressure of the RA and 79.3 with a standard deviation of 11.6 to the diastolic pressure of the LA. The patient diagnosed with SAH had regular BP, with 132x79 mmHg in the RUL and 120x70 mmHg in the LA. During blood pressure exam, two patients (without previous diagnosis of SAH) showed high levels (165x86 mmHg, 140x100 mmHg and 174x88 mmHg). Regarding sexual function, only 9 patients in each group were able to answer the FSFI questionnaire. Concerning lubrication, the medians of the SG and the CG were, respectively, 4.2 (3.2 - 6.0) and 5.4 (0.0 - 5.9) (p = 0.796). Regarding satisfaction, the medians were 4.8 (4.0 - 6.0) as for SG and 5.2 (3.6 - 6.0) as for CG, (p = 0.931). Pain was more common among patients with OAB, and the medians were 5.2 (4.4 - 6.0) and 6.0 (0.0 - 6.0) respectively for SG and CG (p = 0.863). Finally, when contrasting the total scores on both groups – SG had a median of 26.6 (22.7 - 34.5), and CG had 29.0 (4.8 - 31.9), (p = 0.666).

The incidence of constipation on SG women was 42.9%, contrasting to 22.2% on CG women. Although there was no significant difference between the groups, the results of the present study suggest that there is a higher prevalence of constipation among women with overactive bladder when compared to those who do not have such bladder dysfunction. Therefore, these results are consistent with previous reports, in which the presence of FC was found in about 23% of women with OAB compared to approximately 11% of women without it, however, they differed in statistical significance (1). Systemic arterial hypertension had a prevalence of 7.1% in the population studied. This findings were not consistent to other studies published, in which the prevalence was above 50% on OAB patients. Such disparity might have occurred due to the difference between the average ages and in the sample number of the current study compared to other literature. Additionally, by measuring blood pressure the researchers might infer that two patients were  undiagnosed to systemic arterial hypertension. This fact corroborates to a higher prevalence of SAH in patients with overactive bladder (2). As for sexual dysfunction, this study showed that this condition is more common in women with OAB. Although there was no statistical significance in the analyzes performed, such results show consistency with previous studies published. Thus, this condition, combined or not with urinary incontinence (mainly urge-incontinence), could impact women's sexual life (3).

Considering the small sample on each group, the results could not be applicable to society. Therefore, it is necessary to carry out studies with larger population samples to affirm the real impacts and relationships of functional constipation, systemic arterial hypertension and sexual function in patients with and without OAB.

ABREU GE, DOURADO ER, ALVES D DE N, DE ARAUJO MQ, MENDONÇA NSP, BARROSO JUNIOR U. Functional Constipation and Overactive Bladder in Women: A Population-Based Study. Arq Gastroenterol. 2018;55:35–40.
BONTEMPO, A.P.S; ALVES, A.T; MARTINS, G.S; JÁCOMO, R.H; MALSCHIK, D.C; MENEZES, R.L. Fatores associados à síndrome da bexiga hiperativa em idosas: um estudo transversal. Revista Brasileira de Geriatria e Gerontologia, vol. 20, nº4, Rio de Janeiro, 2017
BALZARRO, M. et al. Impact of Overactive Bladder-Wet Syndrome on Female Sexual Function: A Systematic Review and Meta-Analysis. International Society for Sexual Medicine. Italy: Elsevier Inc., 2019.