Overactive bladder syndrome is associated with detrusor overactivity and abnormal voiding pattern in nulliparous women.

Jessica Jay Fang,Ming-Ping Wu,Yu-Chun Yen,Jeng-Cheng Wu,Hung-Yen Chin

doi:10.1097/jcma.0000000000000611

Abstract

Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial. This study investigated abnormal voiding patterns and detrusor overactivity (DO) among NP women with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) was recorded. Data were analyzed using analysis of variance, χ2 tests, and independent t tests. Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO, and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP, respectively, especially in the NP group. We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.

Highlights

Pregnancy and childbirth are frequently associated with lower urinary tract symptoms (LUTS), for example, increased urinary frequency and urgency, stress urinary incontinence, urgency urinary incontinence (UUI), and voiding difficulty[1,2]
The NP group had fewer patients with symptomatic stress urinary incontinence (SUI) and urinary urgency incontinence (UUI), which was statistically significant in the symptom of SUI (6.79%, 17.54%, and 28.72% in the NP, cesarean section (CS), and normal spontaneous delivery (NSD) groups, respectively, P < 0.001)
Our findings showed a high prevalence of detrusor overactivity (DO) (69.68%) and abnormal voiding patterns (65.16%) among NP women with overactive bladder syndrome (OAB) as compared with parous women

Summary

Introduction

Pregnancy and childbirth are frequently associated with lower urinary tract symptoms (LUTS), for example, increased urinary frequency and urgency, stress urinary incontinence, urgency urinary incontinence (UUI), and voiding difficulty[1,2]. Numerous nulliparous (NP) women may present with overactive bladder syndrome (OAB). OAB is a common and chronic syndrome that is defined as urinary urgency or UUI and is usually accompanied by increased frequency and nocturia in the absence of urinary tract infection or some other obvious pathology[3]. It is generally considered that detrusor overactivity (DO) plays a role in OAB, but not all OAB patients are diagnosed with DO after urodynamic study (UDS)[5,6]. In addition to DO, bladder outlet obstruction (BOO) may play a role in the development of OAB, because OAB and voiding dysfunction (VD) can coexist[7,8]. VD, which is defined as abnormally slow and/or incomplete micturition, can be classified as BOO (mechanical and functional) and detrusor underactivity (DU)[9,10]. Micturition disorders are frequently classified as storage phase (due to bladder overactivity or sphincteric weakness) and voiding phase (because of failure of the bladder to empty adequately)[12], the symptoms of these two phases may co-exist[13], and the symptoms may not reflect the underlying etiology

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Conclusion