Skip to main content

Advertisement

SpringerLink
Log in

The Aging Overactive Bladder: a Review of Aging-Related Changes from the Brain to the Bladder

  • Overactive Bladder (U Lee, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To understand the current literature on age-related neural and detrusor changes associated with overactive bladder symptoms.

Recent Findings

Recent functional magnetic resonance imaging (fMRI) studies have unveiled an age-related decrease in the neural control of continence, represented in the insula, anterior cingulate cortex (ACC), and prefrontal cortex (PFC). Older individuals with overactive bladder symptoms also demonstrate heightened activation of the ACC with low volumes, representing increased bladder sensitivity or sense of urgency. At the level of the bladder, age-related changes in the urothelium, neurotransmitters/receptors (both muscarinic and purinergic), and inflammation (including nerve growth factor (NGF), monocyte chemoattractant protein-1 (MCP-1), and oxidative stress) are also associated with overactive bladder.

Summary

Overactive bladder among older adults is a complex condition incorporating physiologic age-related changes from the brain to the bladder and beyond.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Milsom I, Stewart W, Thuroff J. The prevalence of overactive bladder. Am J Manag Care. 2000;6(11 Suppl):S565–73.

    CAS  PubMed  Google Scholar 

  2. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    Article  PubMed  Google Scholar 

  3. Wolff GF, Kuchel GA, Smith PP. Overactive bladder in the vulnerable elderly. Res Rep Urol. 2014;6:131–8.

    PubMed  PubMed Central  Google Scholar 

  4. Hald T, Horn T. The human urinary bladder in ageing. Br J Urol. 1998;82 Suppl 1:59–64.

    Article  PubMed  Google Scholar 

  5. Homma Y, Imajo C, Takahashi S, Kawabe K, Aso Y. Urinary symptoms and urodynamics in a normal elderly population. Scand J Urol Nephrol Suppl. 1994;157:27–30.

    CAS  PubMed  Google Scholar 

  6. Tadic SD, Griffiths D, Schaefer W, Murrin A, Clarkson B, Resnick NM. Brain activity underlying impaired continence control in older women with overactive bladder. Neurourol Urodyn. 2012;31(5):652–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. •• de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5(1):327–96. Excellent up-to-date review of insights into neural activity controlling the lower urinary tract.

    PubMed  PubMed Central  Google Scholar 

  8. •• Smith PP, Kuchel GA, Griffiths D. Functional brain imaging and the neural basis for voiding dysfunction in older adults. Clin Geriatr Med. 2015;31(4):549–65. In-depth review of recent advances in brain imaging, particularly studies using fMRI, and contributions to our understanding o neural control of the lower urinary tract.

    Article  PubMed  Google Scholar 

  9. Griffiths D, Derbyshire S, Stenger A, Resnick N. Brain control of normal and overactive bladder. J Urol. 2005;174(5):1862–7.

    Article  PubMed  Google Scholar 

  10. Kuhtz-Buschbeck JP, Gilster R, van der Horst C, Hamann M, Wolff S, Jansen O. Control of bladder sensations: an fMRI study of brain activity and effective connectivity. NeuroImage. 2009;47(1):18–27.

    Article  CAS  PubMed  Google Scholar 

  11. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Griffiths DJ, Tadic SD, Schaefer W, Resnick NM. Cerebral control of the lower urinary tract: how age-related changes might predispose to urge incontinence. NeuroImage. 2009;47(3):981–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Griffiths D, Tadic SD, Schaefer W, Resnick NM. Cerebral control of the bladder in normal and urge-incontinent women. NeuroImage. 2007;37(1):1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sakakibara R, Panicker J, Fowler CJ, et al. Is overactive bladder a brain disease? The pathophysiological role of cerebral white matter in the elderly. Int J Urol: Off J Jpn Urol Assoc. 2014;21(1):33–8.

    Article  Google Scholar 

  15. Sakakibara R, Hattori T, Uchiyama T, Yamanishi T. Urinary function in elderly people with and without leukoaraiosis: relation to cognitive and gait function. J Neurol Neurosurg Psychiatry. 1999;67(5):658–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Baloh RW, Vinters HV. White matter lesions and disequilibrium in older people. II. Clinicopathologic correlation. Arch Neurol. 1995;52(10):975–81.

    Article  CAS  PubMed  Google Scholar 

  17. Yamanouchi H, Nagura H. Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke; J Cereb Circ. 1997;28(5):965–9.

    Article  CAS  Google Scholar 

  18. Mok VC, Wong A, Wong K, et al. Executive dysfunction and left frontal white matter hyperintensities are correlated with neuropsychiatric symptoms in stroke patients with confluent white matter hyperintensities. Dement Geriatr Cogn Disord. 2010;30(3):254–60.

    PubMed  Google Scholar 

  19. Tadic SD, Griffiths D, Murrin A, Schaefer W, Aizenstein HJ, Resnick NM. Brain activity during bladder filling is related to white matter structural changes in older women with urinary incontinence. NeuroImage. 2010;51(4):1294–302.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Araki I, Kitahara M, Oida T, Kuno S. Voiding dysfunction and Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol. 2000;164(5):1640–3.

    Article  CAS  PubMed  Google Scholar 

  21. Kitta T, Kakizaki H, Furuno T, et al. Brain activation during detrusor overactivity in patients with Parkinson’s disease: a positron emission tomography study. J Urol. 2006;175(3 Pt 1):994–8.

    Article  PubMed  Google Scholar 

  22. Sakakibara R, Fowler CJ, Hattori T. Voiding and MRI analysis of the brain. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(3):192–9.

    Article  CAS  PubMed  Google Scholar 

  23. Griffiths D. Clinical studies of cerebral and urinary tract function in elderly people with urinary incontinence. Behav Brain Res. 1998;92(2):151–5.

    Article  CAS  PubMed  Google Scholar 

  24. Ishiura Y. Experimental study of voiding dysfunction induced by cerebral infarction in rats. Nihon Hinyokika Gakkai zasshi Jpn J Urol. 1996;87(11):1221–30.

    CAS  Google Scholar 

  25. Suzuki M, Ohtake A, Yoshino T, et al. Effects of solifenacin succinate (YM905) on detrusor overactivity in conscious cerebral infarcted rats. Eur J Pharmacol. 2005;512(1):61–6.

    Article  CAS  PubMed  Google Scholar 

  26. Maruyama S, Kurosawa S, Takagi Y, et al. Urodynamics and bladder muscarinic receptors in rats with cerebral infarction and bladder outlet obstruction. Neurosci Lett. 2007;414(1):80–4.

    Article  CAS  PubMed  Google Scholar 

  27. Siroky MB. The aging bladder. Rev Urol. 2004;6 Suppl 1:S3–7.

    PubMed  PubMed Central  Google Scholar 

  28. Lepor H, Sunaryadi I, Hartanto V, Shapiro E. Quantitative morphometry of the adult human bladder. J Urol. 1992;148(2 Pt 1):414–7.

    CAS  PubMed  Google Scholar 

  29. Ameda K, Sullivan MP, Bae RJ, Yalla SV. Urodynamic characterization of nonobstructive voiding dysfunction in symptomatic elderly men. J Urol. 1999;162(1):142–6.

    Article  CAS  PubMed  Google Scholar 

  30. Azadzoi KM, Tarcan T, Kozlowski R, Krane RJ, Siroky MB. Overactivity and structural changes in the chronically ischemic bladder. J Urol. 1999;162(5):1768–78.

    Article  CAS  PubMed  Google Scholar 

  31. • Birder L, Andersson KE. Urothelial signaling. Physiol Rev. 2013;93(2):653–80. Thorough review of the complexities of urothelial signalling incorporating current research studies/advances.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Mulvey MA, Schilling JD, Martinez JJ, Hultgren SJ. Bad bugs and beleaguered bladders: interplay between uropathogenic Escherichia coli and innate host defenses. Proc Natl Acad Sci U S A. 2000;97(16):8829–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gibson W, Wagg A. New horizons: urinary incontinence in older people. Age Ageing. 2014;43(2):157–63.

    Article  PubMed  Google Scholar 

  34. Yoshida M, Homma Y, Inadome A, et al. Age-related changes in cholinergic and purinergic neurotransmission in human isolated bladder smooth muscles. Exp Gerontol. 2001;36(1):99–109.

    Article  CAS  PubMed  Google Scholar 

  35. Mansfield KJ, Liu L, Mitchelson FJ, Moore KH, Millard RJ, Burcher E. Muscarinic receptor subtypes in human bladder detrusor and mucosa, studied by radioligand binding and quantitative competitive RT-PCR: changes in ageing. Br J Pharmacol. 2005;144(8):1089–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. O’Reilly BA, Kosaka AH, Knight GF, et al. P2X receptors and their role in female idiopathic detrusor instability. J Urol. 2002;167(1):157–64.

    Article  PubMed  Google Scholar 

  37. Santos ML, Gomes WF, Pereira DS, et al. Muscle strength, muscle balance, physical function and plasma interleukin-6 (IL-6) levels in elderly women with knee osteoarthritis (OA). Arch Gerontol Geriatr. 2011;52(3):322–6.

    Article  CAS  PubMed  Google Scholar 

  38. Blain H, Jaussent A, Beziat S, et al. Low serum IL-6 is associated with high 6-minute walking performance in asymptomatic women aged 20 to 70 years. Exp Gerontol. 2012;47(2):143–8.

    Article  CAS  PubMed  Google Scholar 

  39. •• Tyagi P, Tyagi V, Qu X, et al. Association of inflammaging (inflammation + aging) with higher prevalence of OAB in elderly population. Int Urol Nephrol. 2014;46(5):871–7. Recent study describing age-related biochemical changes associated with inflammation and overactive bladder, particularly NGF and MCP-1.

    Article  CAS  PubMed  Google Scholar 

  40. Kashyap M, Kawamorita N, Tyagi V, et al. Down-regulation o f nerve growth factor expression in the bladder by antisense oligonucleotides as new treatment for overactive bladder. J Urol. 2013;190(2):757–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Taylor 3rd JA, Kuchel GA. Detrusor underactivity: clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc. 2006;54(12):1920–32.

    Article  PubMed  Google Scholar 

  42. Liu HT, Chancellor MB, Kuo HC. Decrease of urinary nerve growth factor levels after antimuscarinic therapy in patients with overactive bladder. BJU Int. 2009;103(12):1668–72.

    Article  CAS  PubMed  Google Scholar 

  43. Semirale AA, Zhang XW, Wiren KM. Body composition changes and inhibition of fat development in vivo implicates androgen in regulation of stem cell lineage allocation. J Cell Biochem. 2011;112(7):1773–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Tajar A, O’Connell MD, Mitnitski AB, et al. Frailty in relation to variations in hormone levels of the hypothalamic-pituitary-testicular axis in older men: results from the European male aging study. J Am Geriatr Soc. 2011;59(5):814–21.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of California, San Francisco, 400 Parnassus Ave, Box 0738, San Francisco, CA, 94143, USA

    Anne M. Suskind

Authors
  1. Anne M. Suskind
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne M. Suskind.

Ethics declarations

Conflict of Interest

Dr. Suskind has no conflicts of interests to declare.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Funding

This paper was supported and funded by NIDDK K12 DK83021-09.

Additional information

This article is part of the Topical Collection on Overactive Bladder

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suskind, A.M. The Aging Overactive Bladder: a Review of Aging-Related Changes from the Brain to the Bladder. Curr Bladder Dysfunct Rep 12, 42–47 (2017). https://doi.org/10.1007/s11884-017-0406-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-017-0406-7

Keywords

Search

Navigation