Urogenital symptoms in women aged 50-59 years. Women's Health in Lund Area (WHILSA) Study Group

Prevalence of overactive bladder in Chinese women: A systematic review and meta-analysis

BACKGROUND

Overactive bladder (OAB) is a significant public health issue that adversely affects the quality of life of patients and imposes a significant socioeconomic burden, with varying prevalence rates across study populations in Chinese women. A systematic review and meta-analysis were conducted to estimate the prevalence of OAB in Chinese women.

METHODS

Relevant published articles on the prevalence of OAB in Chinese women were searched through July 21, 2022, using PubMed, EMbase, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data, and VIP databases. After the independent screening of articles, data extraction, and quality assessment of included studies by two investigators, a meta-analysis was performed using Stata 16.0 software, and the prevalence was determined using a random-effects model. To identify potential sources of heterogeneity, subgroup analyses were conducted with subgroup categories including age, Body Mass Index (BMI), region, and survey year. Publication bias was assessed by visually examining the funnel plot and Egger's test.

RESULTS

Twenty studies were included in this meta-analysis. The results of the random-effects model indicated that the prevalence of OAB in Chinese women was 14% (95% Confidence Interval: 9%-18%). The prevalence increased significantly in the past decade (from 8% in pre-2006 to 18% in 2016-2021). A prevalence (18%) was observed among women aged 31-40 compared with other age groups. The BMI range of 24-27.9 (18%) was higher than the other groups. Additionally, the prevalence of this BMI range was comparatively higher in North China and Southwest China (21%) than in Central China and East China. In addition, publication bias was observed.

CONCLUSIONS

OAB incidence has increased in Chinese women over the last two decades, affecting more than 20% of women aged 31-40 years and above. With the increasing prevalence of OAB, greater emphasis has been placed on implementing preventative and control measures.

Effect of Long-term Exercise on Voiding Functions in Obese Elderly Women

Purpose

An overactive bladder (OAB) may be defined as urgency that is a sudden, compelling, difficult to defer desire to pass urine that is usually accompanied by frequency and nocturia and possibly by incontinence. Obesity and old age are two factors in various causes of OAB. Several epidemiologic studies have identified positive associations among obesity, old age, urinary incontinence, and OAB. However, although exercise has been known to improve obesity and reduce incontinent urine loss, little research has been done in elderly women. Therefore, we investigated the effects of exercise on obesity-related metabolic factors, blood lipid factors, and OAB symptoms in elderly Korean women.

Methods

Twenty-one women aged between 69 and 72 years were recruited from the Seoul senior towers in Korea. All subjects worked out on a motorized treadmill and stationary cycle for 40 minutes, respectively, and performed resistance exercise for 30 minutes once a day for 52 weeks. Body composition, blood pressure, blood lipids, OAB symptom score, and King's health questionnaire were investigated and analyzed.

Results

Before performing physical exercise, all subjects showed increased OAB symptoms in association with enhanced body mass index (BMI), percentage fat, and blood lipid profiles. However, physical exercise for 52 weeks suppressed BMI, percentage fat, and blood lipid profiles and thus improved OAB symptoms.

Conclusions

We suggest that long-term physical exercise can be a valuable tool for remarkable improvement of OAB.

Relationship between Body Mass Index and Overactive Bladder in Women and Correlations with Urodynamic Evaluation

PURPOSE

Overactive bladder (OAB) is a common condition. In women, studies have shown that the prevalence of OAB is positively related to increasing body mass index (BMI). Our objective was to define a relationship between BMI and OAB through correlation with urodynamic study (UDS).

METHODS

A prospective study was conducted. Ambulatory women aged 18 years or older who had symptoms of OAB for at least 3 months were enrolled. Patients answered a questionnaire, had their weight and height recorded, and underwent UDS. Patients were categorized into 3 groups as follows: group 1, BMI<25; group 2, BMI 25 to 29.9; and group 3, BMI≥30.

RESULTS

A total of 113 patients were examined (group 1, n=32; group 2, n=40; group 3, n=41). The patients' mean ages were 50, 55, and 59 years for groups 1, 2, and 3, respectively (P<0.05). Group 3 showed a significant increase in the incidence of subjective mixed leakage and the number of pads used compared with groups 1 and 2. No significant differences were seen among the groups in duration of symptoms, OAB V-8 score, or the incidence of subjective urgency or stress leakage. The UDS parameters of groups 1, 2, and 3 showed no statistically significant differences for most variables. Group 3 showed a significant increase in the incidence of urge leakage by UDS compared with group 2 only.

CONCLUSIONS

Increasing BMI was age related. A BMI≥30 showed a higher incidence of subjective urinary mixed leakage and pad use. UDS showed no significant correlation between OAB and any BMI category for most UDS parameters.

The women's health in the Lund area (WHILA) study--an overview

The Women's Health in the Lund Area (WHILA) study invited all women (n=10,766) living in the Lund area of Southern Sweden by 1995, who were born between 1935 and 1945. The health screening program included a postal validated questionnaire concerning medical history, drug treatment, family history of diabetes and hypertension, menopausal status, smoking and alcohol habits, education, household, and working status, physical activity, quality of life as well as subjective physical and mental symptoms. The screening consisted of a routine physical examination with standardized blood pressure measurements, bone densitometry and an extended laboratory examination. A link with the mammography registry was established. Based on menopausal status, the population was divided in three subgroups; premenopausal (PM), postmenopausal with hormone replacement therapy (PMT), and postmenopausal without hormone replacement therapy (PM0). Menopause was defined as a bleed-free interval of at least 12 months. Of 10,766 women, 6917 (64.2%) had complete data sets. A number of observational analyses were carried out based on the screening data at baseline, to be followed by long-term follow-up analyses based on national register linkages that are currently being started.

Lower urinary tract symptoms in middle-aged women - prevalence and attitude towards mild urinary incontinence. A community-based population study

OBJECTIVE

To investigate the prevalence and perceived bother of lower urinary tract symptoms (LUTS) in middle-aged women with and without self-reported urinary incontinence.

PATIENTS AND METHODS

In the Women's Health In the Lund Area study (WHILA 1995--2000), 32% of the participating 6,917 women, 50--59 years, reported urinary incontinence defined as involuntary urinary leakage causing a social and/or hygienic problem. Out of these, 1,500 women with (INCONT) and 1,500 without incontinence (CONT) received the Bristol Female lower urinary tract symptoms (LUTS) questionnaire in January 2001.

RESULTS

A total of 2,682 (89%) women were included. Most common LUTS in the INCONT and CONT groups, respectively, were any urinary leakage (93.8% vs. 53.3%, P<0.001), urgency (86.2% vs. 62.5%, P<0.001), stress incontinence (85.1% vs. 41%, P<0.001), and frequency (86.9% vs. 35.6%, P<0.001). The two groups differed significantly in the degree of reported bother by infrequently occurring stress and urge incontinence. Urinary leakage more than once a week was reported as bothersome by 97.5%. The prevalence of self-reported urinary incontinence increased from 32% to estimated 66% if the demand for social and/or hygienic bother was omitted from the definition. Conclusion. The prevalence of self-reported urinary incontinence increased from 32% to estimated 66%, if the demand for social and/or hygienic bother was omitted from the definition. LUTS other than incontinence are common in middle-aged women, with a significantly higher prevalence in women with self-reported incontinence than in continent women. The attitude towards stress- and urge incontinence varied widely when the symptoms occurred infrequently. Urinary leakage more than once a week was considered bothersome by 97.5%.

Prevalence of urinary incontinence in relation to self-reported depression, intake of serotonergic antidepressants, and hormone therapy in middle-aged women: a report from the Women's Health in the Lund Area study

OBJECTIVE

To study a perceived relationship of urinary incontinence with self-reported depression among middle-aged women, and to outline whether hormone therapy, selective serotonin reuptake inhibitors, or serotonin norepinephrine reuptake inhibitors influence the prevalence of urinary incontinence.

DESIGN

A population-based cross-sectional study of 6,642 women from the Lund area, Sweden, aged 50 to 64 years, who answered questions on urinary incontinence. We obtained information on urinary incontinence, self-reported depression, and medication by questionnaire and personal interviews between December 1995 and February 2000.

RESULTS

Thirty-one percent of the women reported urinary incontinence of various severities and 52% reported episodes of depression. Urinary incontinence and self-reported depression were significantly associated [odds ratio (OR) 1.37; 95% CI, 1.23-1.52; P < 0.001]. Among women with self-reported depression, the use of serotonergic antidepressants was statistically associated with urinary incontinence (OR 1.78; 95% CI, 1.33-2.38; P < 0.001). Among women not reporting depression, hormone therapy was significantly associated with urinary incontinence (OR 1.45; 95% CI, 1.22-1.70; P < 0.001). After adjustment for other potential risk factors, serotonergic antidepressants and hormone therapy use were no longer associated with urinary incontinence in women with self-reported depression. However, among women not reporting depression, hormone therapy was still significantly more common in women with urinary incontinence.

CONCLUSIONS

Urinary incontinence and self-reported depression seemed to be associated in middle-aged women. Use of serotonergic antidepressants or hormone therapy does not seem to be associated with a lower prevalence of urinary incontinence.

Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle-aged women

OBJECTIVE

To investigate the prevalence of and factors associated with overactive bladder in middle-aged women.

DESIGN

Cross sectional population-based study.

SETTING

Southern Sweden and the Women's Health in the Lund Area study (WHILA 1995-2000) where 6917 (64% of the invited) women, 50-59 years old in 1995, participated.

POPULATION

From the WHILA study, 1500 women reporting troublesome urinary incontinence (INCONT-1) and 1500 without incontinence (CONT-1) were selected by computerised randomisation and received the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire in January 2001.

METHODS

Overactive bladder was defined in two versions using the ICS definition of 2002 as either urgency alone (OAB-1) or urgency combined with frequency more than eight times per day and/or nocturia twice or more per night (OAB-2). Risk factors were analysed by multiple logistic regression analyses.

MAIN OUTCOME MEASURES

Prevalence figures and odds ratios with corresponding 95% confidence intervals.

RESULTS

The prevalence of OAB-1 was 46.9% in the INCONT-1 and 16.7% in the CONT-1 group, and that of OAB-2 was 21.6% and 8.1%, respectively. Most urgency occurred in combination with stress incontinence (i.e. as mixed incontinence). The overlap between stress and urge symptoms increased with the frequency of stress incontinence episodes (P < 0.001). Metabolic risk factors were body mass index (BMI) >/= 30 for OAB-1, OAB-2 and stress incontinence, positive metabolic screening for OAB-1, family history of diabetes for OAB-2 and elevation of BMI >/= 25% since the age of 25 for stress incontinence. Stress incontinence was associated with the current use of hormonal replacement therapy.

CONCLUSIONS

Overactive bladder and stress incontinence are intimately associated with each other. Both OAB and stress incontinence are associated with abnormal metabolic factors, mainly increased BMI.

Physical activity after cancer: physiologic outcomes

Physical activity has many and varied effects on the human body. The physiologic effects of physical activity and exercise in persons with cancer have been largely unstudied. Cancer patients as a group are at risk for diseases and conditions related to lack of physical activity. In persons with cancer, exercise has been shown to improve fitness and physical functioning, reduce fatigue, and modestly decrease weight and body fat. The effects of physical activity on prognosis, however, are unknown. In persons without cancer, exercise has beneficial effects on the cardiovascular and endocrine systems, reducing risk of cardiovascular disease, cerebrovascular disease, and diabetes. Increased physical activity reduces risk for several common cancers, which is relevant to cancer survivors who are at increased risk for new primary cancers. Additional benefits of physical activity include improvements in fitness, muscular-skeletal problems including arthritis symptoms, immune system function, cognition and sleep. Risks of increased physical activity in cancer patients and survivors have not been defined, but could be expected to include musculo-skeletal injuries, and a small increased risk in sudden death with vigorous exercise and serious accidents with some sports. The effect of physical activity on survival from cancer is unknown, but physical activity might improve prognosis through beneficial effect on cancer biomarkers and energy balance, as well as decreasing risk for cardiovascular disease, an important cause of death for many cancer survivors. The long-term benefits and risks of physical activity in cancer patients and survivors are unknown. Nevertheless, increasing physical activity is probably beneficial and safe in the majority of cancer survivors.