FUNCTIONAL CONSTIPATION AND OVERACTIVE BLADDER IN WOMEN: A POPULATION-BASED STUDY

Abstract

An association between urinary disorders and functional constipation has been registered in children and adults, with functional constipation being a common complaint in individuals with overactive bladder. To evaluate the prevalence of functional constipation, overactive bladder and its dry/wet subtypes in women and to determine which bowel symptoms predict overactive bladder. A cross-sectional study of women randomly approached in public spaces. Exclusion criteria: neurological/anatomical abnormalities of the bowel or urinary tract. Constipation was defined as ≥2 positive symptoms of those listed in the Rome criteria. Urinary abnormalities (frequent urination, urgency, incontinence, nocturia) were defined by a score ≥2 in the respective item of the International Consultation on Incontinence Questionnaire - Overactive Bladder. Dry overactive bladder was defined as urgency without incontinence, while wet overactive bladder included incontinence. A total of 516 women with a mean age of 35.8±6 years were interviewed. Rates of functional constipation, overactive bladder, dry overactive bladder and wet overactive bladder were 34.1%, 15.3%, 8.9% and 6.4%, respectively. Functional constipation was associated with overactive bladder and dry overactive bladder, with functional constipation predicting dry overactive bladder (OR=2.47). Quality of life was poorer in constipated women compared to non-constipated and even worse in constipated women with wet overactive bladder (median 22.5; 95%CI: 17.25-35.25). Manual maneuvers were significantly associated with both overactive bladder subtypes. Independent predictive factors for overactive bladder were manual maneuvers (OR=2.21) and <3 defecations/week (OR=2.18), with the latter being the only predictive factor for dry overactive bladder (OR=3.0). Functional constipation is associated with overactive bladder and its dry subtype, particularly in the younger population. In addition, this association is responsible for lower quality of life scores, especially when urinary incontinence is present. The presence of manual maneuvers and less than three defecations per week should direct us to look for overactive bladder.