Abstract
Objective: To examine the prospective association between constipation and risk of developing lower urinary tract symptoms (LUTS) in parous middle-aged women.Materials and Methods: The study uses data from 3,729 women from the Avon Longitudinal Study of Parents and Children who provided self-reports of medication intake for constipation at two time points (Baseline): 2001–2003 and 2003–2005. Women with LUTS at baseline were excluded. After 10 years of follow-up, women provided self-reports of LUTS using an adapted version of the International Consultation on Incontinence Questionnaire on Female LUTS. LUTS were categorized according to International Continence Society definitions as stress urinary incontinence (UI), urgency UI, mixed UI, nocturia, increased daytime frequency, urgency, hesitancy, and intermittency. LUTS were considered present if symptoms were reported to occur at least “sometimes” for all subtypes, except for increased daytime frequency (≥9 times) and nocturia (≥2 times nightly).Results: At follow-up, the prevalence of any LUTS was 40%. Women (mean age 43.3 years, standard deviation 0.5), who took medication for constipation at either time point had increased risks of urgency (adjusted relative risks [RRs] = 1.35; 95% confidence interval [CI] 1.04–1.95) and hesitancy (adjusted RR = 1.72; 95% CI 1.04–3.01) compared with women who reported not using medication for constipation at either time point. The risk of urgency (adjusted RR = 1.94; 95% CI 1.15–3.29) and hesitancy (adjusted RR = 1.78; 95% CI 1.03–4.19) was greater for women who reported taking medication for constipation at both time points. There was no evidence that constipation was associated with stress UI, urgency UI, mixed UI, nocturia, increased daytime frequency, and intermittency.Conclusion: Constipation is prospectively associated with an increased risk of urgency and hesitancy among parous middle-aged women. If further research finds evidence that this association is causal, this implies that women should seek treatment to alleviate constipation to reduce their consequent risk of developing these LUTS.
Highlights
The International Continence Society (ICS) groups lower urinary tract symptoms (LUTS) into storage, voiding, and postmicturition symptoms.[1]
Box Lists the LUTS-Related Questions Included in the Bristol Female LUTS (BFLUTS) and ICIQ-Questionnaires, Which Were Used to Identify Women with LUTS at Baseline and at Follow-Up After Ten Years
There have been limited prospective studies concerning the association between constipation and LUTS
Summary
The International Continence Society (ICS) groups lower urinary tract symptoms (LUTS) into storage, voiding, and postmicturition symptoms.[1]. Established risk factors for LUTS include parity, delivery ALHABABI ET AL. Mode, older age, obesity, and hysterectomy.[2,6,7] It has been suggested that constipation could increase the risk of LUTS in women.[8,9] This is because the urinary and bowel tracts are interrelated structures and their common embryology, overlapping innervation, and anatomical proximity could mean that dysfunction in the bowel may affect the bladder.[8,9] Constipation is common and is estimated to affect 12%–32% of middle-aged women.[9] The National Institute for Health and Care Excellence guidelines state that constipation and LUTS often co-occur and recommend screening for constipation in women while assessing and treating LUTS.[10] The temporal relationship between constipation and LUTS is, unclear because previous studies are mostly cross-sectional. Other limitations of conducted studies include modest sample sizes, limited adjustment for potentially important confounders, such as physical activity and hysterectomy,[11,12,13,14,15] and recall bias when participants report constipation retrospectively
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