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Obesity and the Overactive Bladder

  • Overactive Bladder (A Klausner, Section Editor)
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Abstract

Obesity (BMI greater than 30 kg.m-2) and overweight (BMI greater 25-30 kg.m-2) are associated with an increased prevalence of pelvic floor disorders, including urinary incontinence and overactive bladder (OAB) syndrome. A positive association between obesity and OAB is present in women, although it is more difficult to demonstrate in men. OAB may result from several obesity-related conditions including the mechanical effect of increased body mass on the bladder, a result of type-II diabetes or the presence of metabolic syndrome. The underlying metabolic defects of the latter two conditions in generating OAB are discussed. Finally the involvement of endothelial dysfunction as a cause of OAB is considered, as this pathology is a result of several obesity-related conditions.

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References

  1. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country- years and 9.1 million participants. Lancet. 2011;377:557–67.

    Article  PubMed  Google Scholar 

  2. Tennstedt SL, Link CL, Steers WD, McKinlay JB. Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH) Survey. Am J Epidemiol. 2008;167:390–9.

    Article  PubMed  Google Scholar 

  3. Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence: epidemiology and clinical research update. J Urol. 2009;182(6 Suppl):S2–7.

    Article  PubMed  Google Scholar 

  4. Richter HE, Kenton K, Huang L, et al. The impact of obesity on urinary incontinence symptoms, severity, urodynamic characteristics and quality of life. J Urol. 2010;183:622–8.

    Article  PubMed  Google Scholar 

  5. Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008;27:749–57.

    Article  PubMed  Google Scholar 

  6. Whitcomb EL, Horgan S, Donohue MC, Lukacz ES. Impact of surgically induced weight loss on pelvic floor disorders. Int Urogynecol J. 2012;23:1111–6.

    Article  PubMed  Google Scholar 

  7. Subak LL, Marinilli Pinto A, Wing RR, et al. Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weight loss to treat urinary incontinence. Obstet Gynecol. 2012;120:277–83.

    Article  PubMed  Google Scholar 

  8. Muscatello DJ, Rissel C, Szonyi G. Urinary symptoms and incontinence in an urban community: prevalence and associated factors in older men and women. Intern Med J. 2001;31:151–60.

    Article  PubMed  CAS  Google Scholar 

  9. Kim IH, Chun H, Kwon JW. Gender differences in the effect of obesity on chronic diseases among the elderly Koreans. J Korean Med Sci. 2011;26:250–7.

    Article  PubMed  Google Scholar 

  10. Dallosso HM, McGrother CW, Matthews RJ, Donaldson MM. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int. 2003;92:69–77.

    Article  PubMed  CAS  Google Scholar 

  11. Lawrence JM, Lukacz ES, Liu IL, et al. Pelvic floor disorders, diabetes, and obesity in women. Diabetes Care. 2007;30:2536–41.

    Article  PubMed  Google Scholar 

  12. McGrother CW, Donaldson MM, Hayward T, et al. Urinary storage symptoms and comorbidities: a prospective population cohort study in middle-aged and older women. Age Ageing. 2006;35:16–24.

    Article  PubMed  Google Scholar 

  13. Townsend MK, Curhan GC, Resnick NM, Grodstein F. BMI, waist circumference, and incident urinary incontinence in older women. Obesity. 2008;16:881–6.

    Article  PubMed  Google Scholar 

  14. Sampselle CM, Harlow SD, Skurnick J, et al. Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women. Obstet Gynecol. 2002;100:1230–8.

    Article  PubMed  Google Scholar 

  15. Agur W, Rizk DE. Obesity and urinary incontinence in women: is the black box becoming grayer? Int Urogynecol J. 2011;22:257–8.

    Article  PubMed  Google Scholar 

  16. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function. Neurourol Urodyn. 2002;21:167–78.

    Article  PubMed  Google Scholar 

  17. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327–36.

    PubMed  CAS  Google Scholar 

  18. Foon R, Drake MJ. The overactive bladder. Therap Adv Urol. 2010;2:147–55.

    Article  CAS  Google Scholar 

  19. Teleman PM, Lidfeldt J, Nerbrand C, et al. Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle-aged women. BJOG. 2004;111:600–4.

    Article  PubMed  Google Scholar 

  20. Cheung WW, Khan NH, Choi KK, et al. Prevalence, evaluation and management of overactive bladder in primary care. BMC Fam Pract. 2009;10:8.

    Article  PubMed  Google Scholar 

  21. Link CL, Steers WD, Kusek JW, McKinlay JB. The association of adiposity and overactive bladder appears to differ by gender: results from the Boston Area Community Health survey. J Urol. 2011;185:955–63.

    Article  PubMed  Google Scholar 

  22. de Boer TA, Slieker-Ten Hove MC, Burger CW, et al. The prevalence and factors associated with previous surgery for pelvic organ prolapse and/or urinary incontinence in a cross-sectional study in The Netherlands. Eur J Obstet Gynecol Reprod Biol. 2011;158:343–9.

    Article  PubMed  Google Scholar 

  23. Cheung WW, Blank W, Borawski D, et al. Prevalence of overactive bladder, its under-diagnosis, and risk factors in a male urologic veterans population. Int J Med Sci. 2010;7:391–4.

    Article  PubMed  Google Scholar 

  24. Dallosso HM, Matthews RJ, McGrother CW, et al. The association of diet and other lifestyle factors with the onset of overactive bladder: a longitudinal study in men. Public Health Nutr. 2004;7:885–91.

    Article  PubMed  Google Scholar 

  25. Laven BA, Orsini N, Andersson SO, et al. Birth weight, abdominal obesity and the risk of lower urinary tract symptoms in a population based study of Swedish men. J Urol. 2008;179:1891–5.

    Article  PubMed  Google Scholar 

  26. Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481–90.

    Article  PubMed  CAS  Google Scholar 

  27. Tikkinen KA, Auvinen A, Johnson TM, et al. A systematic evaluation of factors associated with nocturia–the population-based FINNO study. Am J Epidemiol. 2009;170:361–8.

    Article  PubMed  Google Scholar 

  28. Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis. 2009;5:524–8.

    Article  PubMed  Google Scholar 

  29. Richter HE, Creasman JM, Myers DL, et al. Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1653–8.

    Article  PubMed  Google Scholar 

  30. Sørensen S, Gregersen H, Sørensen SM. Long term reproducibility of urodynamic investigations in healthy fertile females. Scand J Urol Nephrol Suppl. 1988;114:35–41.

    PubMed  Google Scholar 

  31. Kershen RT, Azadzoi KM, Siroky MB. Blood flow, pressure and compliance in the male human bladder. J Urol. 2002;168:121–5.

    Article  PubMed  Google Scholar 

  32. Greenland JE, Brading AF. Urinary bladder blood flow changes during the micturition cycle in a conscious pig model. J Urol. 1996;156:1858–61.

    Article  PubMed  CAS  Google Scholar 

  33. Azadzoi KM, Pontari M, Vlachiotis J, Siroky MB. Canine bladder blood flow and oxygenation: changes induced by filling, contraction and outlet obstruction. J Urol. 1996;155:1459–65.

    Article  PubMed  CAS  Google Scholar 

  34. Liston TG, Palfrey EL, Raimbach SJ, Fry CH. The effects of pH changes on human and ferret detrusor muscle function. J Physiol. 1991;432:1–21.

    PubMed  CAS  Google Scholar 

  35. Ferguson DR, Kennedy I, Burton TJ. ATP is released from rabbit urinary bladder epithelial cells by hydrostatic pressure changes - a possible sensory mechanism? J Physiol. 1997;505:503–11.

    Article  PubMed  CAS  Google Scholar 

  36. Vlaskovska M, Kasakov L, Rong W, et al. P2X3 knock-out mice reveal a major sensory role for urothelially released ATP. J Neurosci. 2001;21:5670–7.

    PubMed  CAS  Google Scholar 

  37. Fry CH, Young JS, Jabr RI, et al. Modulation of spontaneous activity in the overactive bladder: the role of P2Y agonists. Am J Physiol Renal Physiol. 2012;302:F1447–54.

    Article  PubMed  CAS  Google Scholar 

  38. Kumar V, Chapple CR, Rosario D, et al. In vitro release of adenosine triphosphate from the urothelium of human bladders with detrusor overactivity, both neurogenic and idiopathic. Eur Urol. 2010;57:1087–92.

    Article  PubMed  Google Scholar 

  39. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–9.

    Article  PubMed  Google Scholar 

  40. Bonadonna RC, Groop L, Kraemer N, et al. Obesity and insulin resistance in humans: a dose-response study. Metabolism. 1990;39:452–9.

    Article  PubMed  CAS  Google Scholar 

  41. Liu RT, Chung MS, Lee WC, et al. Prevalence of overactive bladder and associated risk factors in 1359 patients with type 2 diabetes. Urology. 2011;78:1040–5.

    Article  PubMed  Google Scholar 

  42. Daneshgari F, Liu G, Birder L, et al. Diabetic bladder dysfunction: current translational knowledge. J Urol. 2009;182(6 Suppl):S18–26.

    Article  PubMed  CAS  Google Scholar 

  43. Golbidi S, Laher I. Bladder dysfunction in diabetes mellitus. Front Pharmacol. 2010;1:136.

    Article  PubMed  Google Scholar 

  44. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

    Article  PubMed  CAS  Google Scholar 

  45. Subak LL, Johnson C, Whitcomb E, et al. Does weight loss improve incontinence in moderately obese women? Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:40–3.

    Article  PubMed  CAS  Google Scholar 

  46. Foschi D, Corsi F, Lazzaroni M, et al. Treatment of morbid obesity by intra-parietogastric administration of botulinum toxin: a randomized, double-blind, controlled study. Int J Obes. 2007;31:707–12.

    CAS  Google Scholar 

  47. Daniels DH, Powell CR, Braasch MR, Kreder KJ. Sacral neuromodulation in diabetic patients: success and complications in the treatment of voiding dysfunction. Neurourol Urodyn. 2010;29:578–81.

    PubMed  Google Scholar 

  48. Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011;9:48.

    Article  PubMed  Google Scholar 

  49. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome – a new worldwide definition. Lancet. 2005;366:1059–62.

    Article  PubMed  Google Scholar 

  50. Kupelian V, McVary KT, Kaplan SA, et al. Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston Area Community Health Survey. J Urol. 2009;182:616–24.

    Article  PubMed  Google Scholar 

  51. Uzun H, Zorba OU. Metabolic syndrome in female patients with overactive bladder. Urology. 2012;79:72–5.

    Article  PubMed  Google Scholar 

  52. Parsons JK, Carter HB, Partin AW, et al. Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab. 2006;91:2562–8.

    Article  PubMed  CAS  Google Scholar 

  53. Arrabal-Polo MÁ, Arias-Santiago S, López-Carmona Pintado F, et al. Metabolic syndrome, hormone levels, and inflammation in patients with erectile dysfunction. Sci World J. 2012;2012:272769.

    Article  Google Scholar 

  54. Rohrmann S, Smit E, Giovannucci E, Platz EA. Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III). Int J Obes. 2005;29:310–6.

    Article  CAS  Google Scholar 

  55. Ohgaki K, Horiuchi K, Kondo Y. Association between metabolic syndrome and male overactive bladder in a Japanese population based on three different sets of criteria for metabolic syndrome and the Overactive Bladder Symptom Score. Urology. 2012;79:1372–8.

    Article  PubMed  Google Scholar 

  56. Brading AF. A myogenic basis for the overactive bladder. Urology. 1997;50(6A Suppl):57–67.

    Article  PubMed  CAS  Google Scholar 

  57. Andersson KE. LUTS treatment: future treatment options. Neurourol Urodyn. 2007;26(6 Suppl):934–47.

    Article  PubMed  CAS  Google Scholar 

  58. Tai HC, Chung SD, Ho CH, et al. Metabolic syndrome components worsen lower urinary tract symptoms in women with type 2 diabetes. J Clin Endocrinol Metab. 2010;95:1143–50.

    Article  PubMed  CAS  Google Scholar 

  59. Hong GS, Shim BS, Chung WS, Yoon H. Correlation between Metabolic Syndrome and Lower Urinary Tract Symptoms of Males and Females in the Aspect of Gender-Specific Medicine: A Single Institutional Study. Korean J Urol. 2010;51:631–5.

    Article  PubMed  Google Scholar 

  60. Abdulla MH, Sattar MA, Johns EJ. The relation between fructose-induced metabolic syndrome and altered renal haemodynamic and excretory function in the rat. Int J Nephrol. 2011;2011:934659.

    PubMed  Google Scholar 

  61. Tong YC, Cheng JT. Alterations of M2,3-muscarinic receptor protein and mRNA expression in the bladder of the fructose fed obese rat. J Urol. 2007;178:1537–42.

    Article  PubMed  CAS  Google Scholar 

  62. Lee WC, Chuang YC, Chiang PH, et al. Pathophysiological studies of overactive bladder and bladder motor dysfunction in a rat model of metabolic syndrome. J Urol. 2011;186:318–25.

    Article  PubMed  CAS  Google Scholar 

  63. Lee WC, Chien CT, Yu HJ, Lee SW. Bladder dysfunction in rats with metabolic syndrome induced by long-term fructose feeding. J Urol. 2008;179:2470–6.

    Article  PubMed  Google Scholar 

  64. van den Oever IA, Raterman HG, Nurmohamed MT, Simsek S. Endothelial dysfunction, inflammation, and apoptosis in diabetes mellitus. Mediators Inflamm. 2010;2010:792393.

    PubMed  Google Scholar 

  65. Masuda H, Kihara K, Saito K, et al. Reactive oxygen species mediate detrusor overactivity via sensitization of afferent pathway in the bladder of anaesthetized rats. BJU Int. 2008;101:775–80.

    Article  PubMed  CAS  Google Scholar 

  66. Yeh CH, Chiang HS, Chien CT. Hyaluronic acid ameliorates bladder hyperactivity via the inhibition of H2O2-enhanced purinergic and muscarinic signaling in the rat. Neurourol Urodyn. 2010;29:765–70.

    Article  PubMed  CAS  Google Scholar 

  67. Khattab MM, Al-Hrasen MN. Contractile activity of ATP and diadenosine tetraphosphate on urinary bladder in the rats: role of superoxide anion and urothelium. Auton Autacoid Pharmacol. 2006;26:149–56.

    Article  PubMed  CAS  Google Scholar 

  68. Vovk T, Bogataj M, Mrhar A. Antioxidant levels in the pig urinary bladder: distribution within the bladder wall and in the urothelium derived from different bladder regions. Biol Pharm Bull. 2009;32:801–6.

    Article  PubMed  CAS  Google Scholar 

  69. Christiaansen CE, Sun Y, Hsu YC, Chai TC. Alterations in expression of HIF-1α, HIF-2α, and VEGF by idiopathic overactive bladder urothelial cells during stretch suggest role for hypoxia. Urology. 2011;77(1266):e7–11.

    PubMed  Google Scholar 

  70. Burgu B, Aydogdu O. Vascular endothelial growth factor and bladder from a different perspective: not only an angiogenic factor. J Pediatr Surg. 2010;45:447–52.

    Article  PubMed  Google Scholar 

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Acknowledgement

This article was written while the author was a member of an EU FP7 consortium, INComb.

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Fry, C.H. Obesity and the Overactive Bladder. Curr Bladder Dysfunct Rep 8, 62–68 (2013). https://doi.org/10.1007/s11884-012-0172-5

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