You are what you eat: The impact of diet on overactive bladder and lower urinary tract symptoms

Disruption of circadian rhythm as a potential pathogenesis of nocturia

Increasing evidence suggested the multifactorial nature of nocturia, but the true pathogenesis of this condition still remains to be elucidated. Contemporary clinical medications are mostly symptom based, aimed at either reducing nocturnal urine volume or targeting autonomic receptors within the bladder to facilitate urine storage. The day-night switch of the micturition pattern is controlled by circadian clocks located both in the central nervous system and in the peripheral organs. Arousal threshold and secretion of melatonin and vasopressin increase at night-time to achieve high-quality sleep and minimize nocturnal urine production. In response to the increased vasopressin, the kidney reduces the glomerular filtration rate and facilitates the reabsorption of water. Synchronously, in the bladder, circadian oscillation of crucial molecules occurs to reduce afferent sensory input and maintain sufficient bladder capacity during the night sleep period. Thus, nocturia might occur as a result of desynchronization in one or more of these circadian regulatory mechanisms. Disrupted rhythmicity of the central nervous system, kidney and bladder (known as the brain-kidney-bladder circadian axis) contributes to the pathogenesis of nocturia. Novel insights into the chronobiological nature of nocturia will be crucial to promote a revolutionary shift towards effective therapeutics targeting the realignment of the circadian rhythm.

Relationship between alcohol use and overactive bladder disease: a cross-sectional study of the NHANES 2005-2016

Background

Overactive bladder syndrome (OAB) is a prevalent urological condition which has a substantial impact on the life quality of affected individuals, resulting in restrictions in daily activities and work productivity. Alcohol is a diuretic, which means that it increases urine production and can potentially worsen urinary urgency and frequency. Several studies have investigated the association between alcohol consumption and OAB symptoms, but the results have been conflicting. This study aimed to investigate the relationship between alcohol consumption and OAB symptoms using a large, nationally representative sample.

Method

Data from the National Health and Nutrition Examination Survey 2005-2016 were obtained for analysis. The Overactive Bladder Symptom Scale (OBSS) was used to determine the presence of OAB in each participant. Multivariate logistic regression and ordinal logistic regression were used to analyze the association of alcohol use frequency and quantity with the onset and severity of OAB, respectively.

Results

A total of 7,805 samples (representing the 1,473,525,341 US population after weighting) were included in our analysis. Approximately 12.4% of this weighted sample self-reported having OAB. A greater proportion of nondrinkers, a higher proportion of females, higher blood pressure, older age, and lower income levels were observed in OAB patients compared to non-OAB patients. Univariate logistic regression revealed that the risk of OAB was significantly greater in the nondrinker group than in the 1-5 drinks/month (OR 0.64; 95% CI, 0.50-0.83), 5-10 drinks/month (OR 0.60; 95% CI, 0.43-0.82) and 10+ drinks/month groups (OR 0.41; 95% CI, 0.30-0.56) and the risk of OAB in the lowest quartile of alcohol consumption quantity was significantly higher than the second (OR 0.58; 95% CI, 0.47-0.70), third (OR 0.49; 95% CI, 0.39-0.62), and highest quartiles groups (OR 0.58; 95% CI, 0.45-0.75). The adjusted model revealed that only patients in the 10+ drinks/month group had a significantly lower risk of OAB than did those in the nondrinker group (OR = 0.64; 95% CI = 0.45-0.92), while the other two groups had similar risks. Furthermore, no significant association was found for the highest quartiles in the adjusted model; however, the second and third quartiles of alcohol consumption quantity group still exhibited obvious associations. These findings suggest that higher alcohol consumption, when appropriate, is associated with a lower risk of OAB compared to nondrinkers and the lowest quartile of alcohol consumption quantity group, even after adjusting for age, sex, race, and comorbidities.

Conclusion

In conclusion, our findings revealed a significant association between alcohol consumption and the incidence of OAB in the study population. In terms of long-term effects, alcohol may not be a risk factor for OAB. These factors may represent intervention targets for lowering the risk and severity of OAB symptoms, but this needs to be confirmed in large clinical trials.

Association of healthy eating index-2015 and overactive bladder: a cross-sectional study

Objective

The aim of this cross-sectional study was to investigate the association of HEI-2015 and overactive bladder (OAB) in a large population.

Methods

Data were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2005-2020 datasets. Univariate and multivariate logistic regression were performed to evaluate the association between HEI-2015 and OAB. The restricted cubic spline (RCS) model was conducted to investigate the dose-response relationship.

Results

Totally, this study included 29,206 participants with 6,184 OAB patients among them. The higher continuous HEI-2015 value was independently associated with lower OAB incidence (OR: 0.87; 95%CI: 0.78, 0.98). Similarly, the highest quartile categorical HEI-2015 was significantly associated with a lower OAB odds (OR: 0.72; 95%CI: 0.52, 0.99) when compared with the lowest quartile. The RCS curve also showed a favorable non-linear dose-response relationship between HEI-2015 and OAB.

Conclusion

A higher HEI-2015 had a favorable association with OAB and there was a non-linear dose-response relationship between them. We suggest adherence to the United States diet recommendation as a potential behavioral prevention of OAB. Large-scale long term prospective cohort studies across various regions are needed to verify the findings of this paper.

The association between wet overactive bladder and consumption of tea, coffee, and caffeine: Results from 2005-2018 National Health and Nutrition Examination Survey

BACKGROUND & AIMS

Previous studies have reported an inconsistent relationship between overactive bladder (OAB) and the consumption of tea, coffee, and caffeine. Our study aims to determine these associations in a large and nationally representative adult sample.

METHODS

This cross-sectional study included 15,379 participants from the 2005-2018 US National Health and Nutrition Examination Survey (NHANES) database. The outcome was the risk of wet OAB that was diagnosed when the OAB symptom score was ≥3 with urgent urinary incontinence and excluded other diseases affecting diagnosis. The exposures were the consumption of tea, coffee, and caffeine. Weighted logistic regression models were established to explore these associations by calculating odds ratios (OR) and 95% confidence intervals (CI), as did restricted cubic splines (RCS) used to analyze the nonlinear associations.

RESULT

Of all the participants (n = 15,379), 2207 had wet OAB. Mean [SE] consumption of tea, total coffee, caffeinated coffee, decaffeinated coffee, and caffeine was 233.6 [15.7] g/day, 364.3 [15.5] g/day, 301.6 [14.9] g/day, 62.7 [7.9] g/day, 175.5 [6.6] mg/day in participants with wet OAB, respectively. In the fully adjusted model, compared to those without tea consumption, the high consumption of tea (>481 g/day) was associated with an increased risk of wet OAB (OR: 1.29; 95%CI: 1.01-1.64). Low decaffeinated coffee (0.001-177.6 g/day) had a negative association with the risk (OR: 0.66; 95%CI: 0.49-0.90). In the RCS analysis, tea consumption showed a positive linear association with the risk of wet OAB, and decaffeinated coffee showed a nonlinear relationship with the risk and had a turning point of 78 g/day in the U-shaped curve between 0 and 285 g/day. Besides, total coffee, caffeinated coffee, and caffeine consumption had no significant association with the risk. Interestingly, in the high tea consumption, participants with high total coffee consumption [>527.35 g/day, OR and 95%CI: 2.14(1.16-3.94)] and low caffeine consumption [0.1-74.0 mg/day, OR and 95%CI: 1.50(1.03-2.17)] were positively associated with the risk of wet OAB.

CONCLUSION

High tea consumption was associated with the increased risk of wet OAB, especially intake together with high total coffee and low caffeine consumption, but no significant association with the single consumption of total coffee and caffeine. Low decaffeinated coffee was associated with a decreased risk of wet OAB. It is necessary to control tea intake when managing the liquid intake of wet OAB patients.

Impact of a Mediterranean diet on prevention and management of urologic diseases

Compared to a Western diet, the Mediterranean diet moves away from red meat and processed foods. Universally regarded as a healthier dietary alternative, the Mediterranean diet has garnered scientific endorsement for its ability to confer an array of compelling benefits. These health benefits encompass not only a lowered incidence of Type 2 diabetes with a reduction in obesity, but also a robust protective effect on cardiovascular health. Extensive literature exists to corroborate these health benefits; however, the impact of a Mediterranean diet on urologic diseases, specifically sexual dysfunction, lower urinary tract symptoms, stone disease, and urologic cancers are not well studied. Understanding how dietary habits may impact these urologic conditions can contribute to improved prevention and treatment strategies.A total of 955 papers from PubMed and Embase were systematically reviewed and screened. After exclusion of disqualified and duplicated studies, 58 studies consisting of randomized controlled trials, cohort studies, cross sectional studies, reviews and other meta-analyses were included in this review. 11 primary studies were related to the impact of a Mediterranean diet on sexual dysfunction, 9 primary studies regarding urinary symptoms, 8 primary studies regarding stone disease, and 9 primary studies regarding urologic cancers. All primary studies included were considered of good quality based on a New-Castle Ottawa scale. The results demonstrate a Mediterranean diet as an effective means to prevent as well as improve erectile dysfunction, nephrolithiasis, lower urinary tract symptoms, and urinary incontinence. The review highlights the need for additional research to study the impact of diet on urologic cancers and other urologic conditions such as premature ejaculation, loss of libido, female sexual dysfunction, and overactive bladder.

Age‐related white matter hyperintensities and overactive bladder: A systematic review

INTRODUCTION

Age-related white matter hyperintensities (ARWMHs) on brain magnetic resonance imaging have been associated with lower urinary tract symptoms/dysfunction (LUTS/LUTD), namely overactive bladder (OAB) and detrusor overactivity. We aimed to systematically review existing data on the association between ARWMH and LUTS and which clinical tools have been used for this assessment.

MATERIALS AND METHODS

We searched PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov (from 1980 to November 2021) and considered original studies reporting data on ARWMH and LUTS/LUTD in patients of both sexes aged 50 or above. The primary outcome was OAB. We calculated the unadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the outcomes of interest using random-effects models.

RESULTS

Fourteen studies were included. LUTS assessment was heterogeneous and mainly based on the use of nonvalidated questionnaires. Urodynamics assessment was reported in five studies. ARWMHs were graded using visual scales in eight studies. Patients with moderate-to-severe ARWMHs were more likely to present with OAB and urgency urinary incontinence (UUI; OR = 1.61; 95% CI: 1.05-2.49, p = 0.03), I²  = 21.3%) when compared to patients with similar age and absent or mild ARWMH.

DISCUSSION AND CONCLUSIONS

High-quality data on the association between ARWMH and OAB is scarce. Patients with moderate to severe ARWMH showed higher levels of OAB symptoms, including UUI, when compared to patients with absent or mild ARWMH. The use of standardized tools to assess both ARWMH and OAB in these patients should be encouraged in future research.

Artificially sweetened beverages and urinary incontinence-a secondary analysis of the Women's Health Initiative Observational Study

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.

Mediterranean Diet and Overactive Bladder

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.Conclusions: 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.

Overactive bladder syndrome in nulliparous female university students: prevalence and risk factors including waterpipe smoking

INTRODUCTION AND HYPOTHESIS

The 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.

RESULTS

A 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.

The impact of movement, physical activity and position on urine production: A pilot study

BACKGROUND

Many different internal factors have been proven to influence urine production such as age, weight, and quality of sleep. External factors such as consumption of caffeine and fluid consumption have been shown to have an impact on urine production.

AIM

To investigate the impact of movement, physical activity and position on urine production.

METHODS

This prospective observational study was executed at Ghent University Hospital, Belgium. Study participation was open for anyone visiting the hospital. Participants collected one basic and two extended 24-hour urine collections and filled in questionnaires concerning their general health and physical activity. Urinary levels of osmolality, sodium and creatinine were determined. Data on movement, physical activity and position was described.

RESULTS

An increase in body movement leads to a significant increase in diuresis during daytime, night-time, and 24 hours (P = .002, P < .001, and P < .001, respectively). An increase in body movement leads to a significant decrease in osmolality during night-time and 24 hours (P = .009, and P = .004, respectively). However, no significant influence of movement on osmolality was found during daytime (P = .12). An increase in body movement leads to a significant decrease in creatinine during daytime, night-time and 24 hours (P = .001, <0.001, and P < .001, respectively). An increase in body movement leads to a significant increase in sodium during daytime (P = .046) but this was statistically significant during night-time and 24 hours (P = .32, and P = .84 respectively).

CONCLUSION

Our study demonstrates a statistically significant association of movement, physical activity, and position with urine production. It would therefore be interesting to explore this association further with the use of new technology to have more accurate data. Here, lays a potential role for conservative measurements and lifestyle adaptations in the management of patients with bothersome LUTS and more precisely nocturia.

Behavioral therapy versus drug therapy in individuals with idiopathic overactive bladder: A systematic review and meta-analysis

The aim of this study was to systematically review randomized clinical trials comparing the treatment of individuals with overactive bladder syndrome through the use of behavioral therapy versus drug therapy. A systematic electronic search of MEDLINE via PubMed, Embase, and Cochrane Library was performed, including studies indexed until August 2019. Five randomized clinical trials were included. The studies presented a high risk of bias. There was no significant difference between the evaluated treatments. Thus, behavioral therapy and drug therapy also promote the improvement of the symptoms of overactive bladder syndrome, and the behavioral therapy does not have significant adverse effects reported. Due to the high risk of bias in included studies, data should be interpreted with caution. Future studies with more comprehensive protocols may change the effect estimates of behavioral therapy on overactive bladder syndrome.

Quantitative Proteomic Analysis Reveals Caffeine-Perturbed Proteomic Profiles in Normal Bladder Epithelial Cells

Lower urinary tract symptoms (LUTSs) are highly prevalent among the elderly and negatively impact quality of life. Since caffeinated beverages are enjoyed worldwide and the relationship between LUTS and caffeine is still not fully understood, it would be of particular interest to examine the underlying mechanisms that drive caffeine's influence on LUTS development and progression. The aim of this study is to characterize the effects of caffeine on hTert-immortalized normal bladder epithelial cells by investigating whether exposure to caffeine can cause potential changes in the bladder proteome and/or biological pathways. In labeled LC-MS/MS proteomic analysis, 57 proteins are found as being differentially expressed in caffeine-treated bladder epithelial cells, compared to controls; this included 32 upregulated and 25 downregulated proteins. Further functional gene enrichment analysis reveals that caffeine affects major biological pathways, including those for "muscle contraction" and "chromatin assembly." These findings provide new scientific insights that may be useful in future studies investigating the role of caffeine in bladder dysfunctions.

Urinary Urgency in Working Women: What Factors Are Associated with Urinary Urgency Progression?

BACKGROUND

Urinary urgency is the primary symptom of overactive bladder (OAB). This study aimed to identify targets for effective intervention to delay progression of urinary urgency.

MATERIAL AND METHODS

Secondary analyses of data from a study conducted with female employees of a large academic medical center were conducted. Women were ≥18 years and nonpregnant at the time of the survey. An online questionnaire obtained demographic information, presence of lower urinary tract symptoms, and toileting behaviors. Bivariate analyses and multivariate logistic regression were applied to explore factors related to different stages of urinary urgency.

RESULTS

Four stages of urinary urgency were constructed: (1) Stage 1: no urinary symptoms (n = 20), (2) Stage 2: continent but urinary urgency reported (n = 19), (3) Stage 3: nonsevere urgency urinary incontinence (UUI) (incontinent but leakage ≤1/day, n = 74); and (4) Stage 4: severe UUI (leakage ≥1/day, n = 26). In multivariate analyses, older women were more likely to be in Stage 3 than in Stage 2 (aOR 1.053, 95% CI 1.012-1.096). Women who lost urine with defecation were more likely to be in Stage 4 than Stage 3 (aOR 3.828, 95% CI 1.921-7.629). Women who habitually strained to empty the bladder faster were more likely to be in Stage 4 than in Stage 3 (aOR 6.588, 95% CI 1.317-32.971).

CONCLUSIONS

Losing urine with defecation and making the bladder empty faster by pushing down should be explored as intervention targets to prevent women from progressing from Stage 3 to Stage 4.

Caffeine as a Probable Factor for Increased Risk of OAB Development in Elderly People

OBJECTIVE

This study was conducted to compare overactive bladder (OAB) prevalence among people greater than 60 years of age who intake various doses of caffeine, as well as those who abstain from caffeine.

PATIENTS AND METHODS

A randomized observational study was carried out in Vladivostok Gerontological Hospital. A total of 1,098 retired people greater than 60 years of age (659 women and 439 men, average age 67.1 years) took part in the study. They were admitted to the in-patient department with the purpose of annual physical examination performed in accordance with the order of the Ministry of Public Health of the Russian Federation. People over age 60, who at the moment of examination were in satisfactory health condition, were included into the study. People in which OAB had been detected or who used to take antimuscarinic were excluded from the study. Assessment tools for examining the patients' lower urinary tract condition were as follows: OAB-q SF, urination diaries, and uroflowmetry.

RESULTS

In the course of the experiment conducted, we found that 1/3 of people, both men and women greater than 60 years of age, who did not previously seek medical advice due to urination troubles, had symptoms of detrusor overactivity. These symptoms were moderate and did not bother patients too much in most cases (63.4%). It was also found that most patients consumed no more than 300mg caffeine with beverages per day, with 30% and 10% of patients suffering from OAB or severe detrusor overactivity, respectively. At the same time, almost 50% of patients taking more than 300 mg of caffeine per day suffer from OAB.

CONCLUSION

48.1% of people over 60 years of age suffering from overactive detrusor symptoms consume greater than 300 mg caffeine daily, which is significantly higher than that of their peers who do not intake excessive amounts of caffeine.

Overactive bladder

Overactive bladder syndrome is highly prevalent, and increasingly so with aging. It is characterized by the presence of urinary urgency, and can be associated with incontinence, increased voiding frequency, and nocturia. Assessment needs to exclude serious medical disorders that might present with similar symptoms, and a bladder diary is an invaluable part of understanding the presentation. Initial management is conservative, comprising education, bladder training, and advice on fluid intake. Drug therapy options include antimuscarinic medications and beta-3 adrenergic receptor agonists. Persistent overactive bladder syndrome, despite initial therapy, requires a review of the patient’s understanding of conservative management and compliance, and adjustment of medications. For refractory cases, specialist review and urodynamic testing should be considered; this may identify detrusor overactivity or increased filling sensation, and needs to exclude additional factors, such as stress incontinence and voiding dysfunction. Botulinum neurotoxin-A bladder injections can be used in severe overactivity, provided the patient is able and willing to do intermittent self-catheterisation, which is necessary in about 5% of treated patients. Sacral nerve stimulation and tibial nerve stimulation are other approaches. Major reconstructive surgery, such as augmentation cystoplasty, is rarely undertaken in modern practice but remains a possibility in extreme cases.