Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies

Abstract

Objectives: To conduct a systematic review to determine whether there is an association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) or overactive bladder (OAB) in women. Methods: We systematically reviewed English language observational studies on the effect of MetS (or component factors) on the presence of OAB or LUTS in women. We searched PubMed, Web of Science and The Cochrane Library with no date restrictions, checked reference lists and undertook citation searches in PubMed and Google Scholar. Studies were assessed for risk of bias. Because of heterogeneity, results were not pooled, but are reported narratively. Results: Of 27 included studies, only three looked at the link between MetS and OAB. The rest looked at links between OAB and components of MetS such as obesity or insulin resistance (n = 10), between MetS and urinary symptoms (n = 3) and between urinary symptoms and components of MetS, such as obesity (n = 14). Evidence is currently limited, but it does suggest that there may be important links between MetS and OAB and components of MetS such as obesity. Conclusions: The literature on MetS and OAB or LUTS in women is limited, and poor quality. However, the evidence available on obesity appears to support MetS as a contributor and predictor of LUTS in women. Many of the women with LUTS will be overweight and will have features of the MetS, if looked for. This provides not only an opportunity to encourage weight loss as an adjunct to therapy for the OAB symptoms but also a window of opportunity to address cardiovascular risk factors and prevent future cardiovascular morbidity and mortality. Review criteriaObservational studies examining the link between metabolic syndrome (MetS) (or components of MetS) and the presence of OAB or LUTS were identified through database and lateral searches. Message for the clinicBoth obesity and MetS have been shown to have complex links with LUTS. It is not known whether reducing insulin resistance and central obesity-related chronic inflammation and oxidative stress might prevent the onset of OAB or improve the outcome of current treatment. However, identifying women with MetS who harbour a portfolio of cardiovascular risk factors does provide an opportunity to address future cardiovascular risk, and prevent premature morbidity and mortality; although whether this will have an effect on the storage component of LUTS is unclear. The key variables to address are diet and lifestyle, especially exercise. The investigations should include a blood pressure recording, BMI and waist circumference measurement together with a lipid profile and HbA1c. These results should be transmitted to the GP for action.

Are blood vessels a target to treat lower urinary tract dysfunction?

“…In line with these clinical findings, bladder dysfunction has also been reported in rat models of metabolic syndrome (Chung et al 2013;Lee et al 2008). In line with others (Bunn et al 2015;Kirby et al 2010), we conclude that metabolic syndrome apparently exhibits a more robust association with LUTS than its individual components of dyslipidemia and diabetes.…”

“…A recent systematic review of associations between female LUTS and metabolic syndrome or components thereof identified four studies exploring such associations for hyperlipidemia, of which three found no significant association and one increased odds for OAB in women with hyperlipidemia (Bunn et al 2015). Among similar studies in men, one comparing 120 men with and 285 without LUTS, total, HDL, and LDL cholesterol as well as triglyceride levels measured after an overnight fast did not differ significantly between groups (Rohrmann et al 2005).…”

Sleep Disturbance and Fatigue Are Associated With More Severe Urinary Incontinence and Overactive Bladder Symptoms

“…Sleep disturbance has also been shown to be a significant risk factor for cardiovascular and metabolic disorders (e.g., obesity, diabetes), 3 and the literature available to date appears to support a link between metabolic disorders and OAB. 21 …”

Systemic Nonurological Symptoms in Patients with Overactive Bladder

“…A link between OAB and metabolic syndrome, or components of metabolic syndrome such as diabetes, may explain some of the cardiovascular and neurological symptoms. 25 In a large population-based study, Coyne et al (2011) showed that men and women with LUTS/OAB had higher prevalence of hypertension, diabetes, heart disease, arthritis, and neurologic conditions compared to individuals with no or minimal LUTS/OAB symptoms. 7, 8 We noticed high rates of hypertension (37%), diabetes (8%) and stroke/transient ischemic attack (8%) among our OAB cohort, however the rates were not statistically different from controls (33%, 3% and 7% respectively), due to small sample size.…”