Lower urinary tract symptoms (LUTS) are highly prevalent conditions globally, and due to aging populations, the number of affected individuals is expected to increase. LUTS are common in both men and women, and frequently co-exist with other types of pelvic floor symptoms (PFS), such as defecation problems and pelvic pain (1). To understand the etiology and pathogenesis of LUTS, the natural course of symptoms and the concomitant conditions need to be characterized. Although some general trends in PFS have been examined in women (e.g., prevalence of urinary and fecal incontinence over 5 years time (2)), most longitudinal studies are performed in specific samples. To date, the course of symptoms in women have been studied in relation to pregnancy and delivery or related to the effect of pelvic floor muscle training. Longitudinal studies on LUTS in men are limited to the natural history of LUTS, without including the possible association with other PFS on the course of LUTS. Concluding, there is a lack of information about the impact of different types of PFS on the course of LUTS in the general population.
Therefore, the aim of this study was to provide quantitative estimates in terms of incidence and progression of LUTS, and to assess the association of defecation problems and pelvic pain with the course of LUTS in both community-dwelling men and women.

We conducted a prospective observational population-based study, including citizens aged ≥16 years living in a municipality in the northern part of the Netherlands. After signing informed consent, men and women filled in questionnaires at baseline, after one year follow-up (T1) and 2 years follow-up (T2). 
LUTS was assessed using the International Consultation on Incontinence Modular Questionnaire-(fe)male LUTS (ICIQ-MLUTS and FLUTS). Defecation problems were assessed using the combined Wexner incontinence and constipation scores. Pelvic pain was defined as the presence of pain in the pelvic region.
Men and women with available change scores on LUTS (period 1: T1 versus baseline, or period 2: T2 versus T1) and with a baseline score for defecation problems and pelvic pain, were selected for the current analysis. Medians (interquartile range (IQR)) were used to display the LUTS scores over time, separate for men and women and for different age groups. Wilcoxon signed rank tests were used to compare median LUTS scores for the different age groups and for men and women separately. 
For assessing the incidence, men and women without LUTS at baseline were selected (i.e., those falling within the lowest quartile for LUTS score on baseline; women: scores ≤4 on the ICIQ-FLUTS, men: scores ≤4 on the ICIQ-MLUTS). Linear mixed model analyses were used to test the association between defecation problems at baseline and LUTS change score, and the association between pelvic pain at baseline and LUTS change score, separately for men and women.

Of the 11.724 invited people, 694 men and 997 women gave informed consent. For the current analyses, data from 427 men and 585 women were available. Median LUTS scores did not significantly change over time for men and women, with an exception for men aged 55-75 years for the first period (from median [IQR] 8.0 [4.0 to 12.5] to 9.0 [5.0 to 13.0], p<.001, Table 1). The mean change scores for the ICIQ-MLUTS (men) during period 1 and period 2 were 0.68 [5th-95th percentile range -4.9 – 7.0], and 0.14 [-5.0 – 5.6] respectively, and the mean change scores for the ICIQ-FLUTS (women) during period 1 and 2 were 0.00 [-6.0 – 6.0], and 0.02 [-6.0 – 5.0] respectively.
In total, 135 men and 165 women had no LUTS at baseline. Two percent of those men developed LUTS during the first year, of which all still had LUTS after 2 years of follow-up. One man developed LUTS in the second year of follow-up. Of the women without LUTS at baseline, 2% developed LUTS during the first year, and two women developed LUTS in the second year of follow-up (Figure 1).
The results of the mixed model analyses showed that relations between defecation problems and pelvic pain, and the change scores for LUTS were in general weak. For men, higher scores for defecation problems at baseline were associated with lower change scores on LUTS (=more improvement; estimate -.04 [95% confidence interval -.13 to .06] for period 1, and -.08 [-.18 to .02] for period 2). Having pelvic pain was associated with lower change scores on LUTS for both men and women. For women, having higher scores for defecation problems at baseline were associated with lower change scores for LUTS during period 1 (-.05 [-.11 to .001], p=.06), but with higher change scores during period 2 (.07 [.01 to .13], p=.03).

The results of the mixed model analyses suggest that the course of LUTS is not clinically different between community-dwelling men and women with or without defecation problems or pelvic pain.

Although in clinical practice, patients may benefit from an integrated care approach including all PFS, the results of this study showed no strong associations of defecation problems and pelvic pain with the course of LUTS in both community-dwelling men and women. Further analyses are warranted to get more insight into the possible impact of other PFS on the course of LUTS in both men and women.

Knol-de Vries GE, Malmberg GGA, Notenboom-Nas FJM, Voortman DBH, de Groot A, Dekker JH, van Koeveringe GA, Leusink P, Bosch M, Slieker-Ten Hove MCP, Keuken DG, Blanker MH. Exploring concomitant pelvic floor symptoms in community-dwelling females and males. Neurourol Urodyn. 2022 Nov;41(8):1770-1780. doi: 10.1002/nau.25020. Epub 2022 Aug 21. PMID: 35989534; PMCID: PMC9804521.
Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, Markland AD. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014 Jan;123(1):141-148. doi: 10.1097/AOG.0000000000000057.