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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 1  |  Page : 139-144

Risk factors for overactive bladder in postmenopausal women attending Kafr El-Baramoon Family Health Unit, Egypt


Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission23-May-2017
Date of Acceptance09-Jul-2017
Date of Web Publication17-Apr-2019

Correspondence Address:
Safaa A. Y. El Shopaky
Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia 35723
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_355_17

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  Abstract 


Objective
The aim of this study was to assess the prevalence of overactive bladder (OAB) among postmenopausal women attending Kafr El-Bramoon Family Health Unit and to identify risk factors for OAB among studied group.
Background
OAB is a common urological abnormality with adverse effects on quality of life. In women, postmenopausal status has been associated with an increase in OAB symptoms.
Participants and methods
This was a case–control study nested in a cross-sectional design conducted on 200 postmenopausal women aged 45–65 years attending the selected family health unit. Each participant was assessed using a predesigned questionnaire. It consisted of three sections (sociodemographic, medical history, and OAB symptoms score). The OAB symptoms score contains questions about OAB symptoms (frequency, urgency, and urge incontinence). The studied women were divided into two groups: patients in group I had OAB and those in group II did not have OAB.
Results
This study revealed that among 200 studied patients, the frequency of OAB was 38.5%. OAB was more significant among postmenopausal women who were more than 60 years old (63.6%) (P < 0.001) and those who had literate certificate level of education (41.1%) (P < 0.05). Obesity (P < 0.01), menopausal duration more than 5 years (P < 0.001), parity (P < 0.001), and history of previous gynecological surgery (P < 0.001) were potential risk factors for OAB.
Conclusion
This study concluded that about one-third of postmenopausal women had OAB. The most important risk factors were advanced age, high parity, gynecological surgery, and obesity. Therefore, the study recommends frequent screening of OAB in postmenopausal women.

Keywords: overactive urinary bladder, postmenopause, prevalence, risk factors


How to cite this article:
Farahat TM, El Esergy FA, El Shopaky SA. Risk factors for overactive bladder in postmenopausal women attending Kafr El-Baramoon Family Health Unit, Egypt. Menoufia Med J 2019;32:139-44

How to cite this URL:
Farahat TM, El Esergy FA, El Shopaky SA. Risk factors for overactive bladder in postmenopausal women attending Kafr El-Baramoon Family Health Unit, Egypt. Menoufia Med J [serial online] 2019 [cited 2019 Aug 25];32:139-44. Available from: http://www.mmj.eg.net/text.asp?2019/32/1/139/256105




  Introduction Top


Overactive bladder (OAB) is a symptom complex, and consistent with the International Continence Society definition, OAB includes urinary urgency, commonly followed by frequency and nocturia, without or with urgency urinary incontinence, within the absence of urinary tract infection or different apparent pathology [1]. The prevalence of OAB in adult female has been mentioned to vary from 7.7 to 31.3% [2]. In Egypt, the prevalence of OAB in women is 39.0% [3].

In women, postmenopausal status has been identified with an expansion in OAB signs and symptoms. This association can be related to decrease in estrogen levels after menopause. Estrogen receptors were discovered inside the vagina, urethra, bladder, and pelvic floor musculature, and there is a capacity position for vaginal estrogen in the treatment of OAB symptoms [4],[5].

There are many risk factors for OAB, including obesity [6], higher parity [7], constipation [8], and lifestyle and behavioral factors, for example, both inadequate and excessive fluid intake, caffeine, carbonated beverages, spicy food, and artificial sweeteners [9],[10].

OAB is an embarrassing situation that interferes with not only social functioning but also with a wide variety of activities of daily living. Postmenopausal women with OAB are much more likely to show restriction in social communication, physical movement, and cooperation in social events [11].

The aim of this study was to assess the prevalence of OAB among postmenopausal women attending the Kafr El-Bramoon Family Health Unit and to identify the risk factors for OAB among the studied group.


  Participants and Methods Top


This was a case–control study nested in a cross-sectional design. It was conducted on a time frame of 18 months (starting on 1 November 2015, till the end of April 2017) on postmenopausal women who attended the Kafr El-Bramoon Family Health Unit, Mansoura District, Dakahlia Governorate, which is the only family health unit in Kafr El-Bramoon village.

The sample size was calculated using Epi Info developed by Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (US) based on prevalence of OAB in postmenopausal women from previous literature (21.4%) [12]. The sample size was estimated to be 180 and was increased to 200 to round the figure.

Patients with urological abnormalities, urinary tract infection (including urocystitis), neurological or severe psychiatric disorders, diabetic bladder, and pelvic organ prolapse; patients who underwent urogenital surgery; and patients using diuretics were excluded.

All postmenopausal women aged 45–65 years who met the inclusion and exclusion criteria and attended the Kafr El-Bramoon Family Health Unit clinic from 10: 00 a.m. till 2: 00 p.m. daily for 3 days (selected randomly) were invited to participate in the study.

The postmenopausal women who participated in the study were evaluated with a predesigned questionnaire, which was distributed to them. This questionnaire consisted of three sections.

The first section included the sociodemographic and personal characteristics of postmenopausal women such as age, home telephone, residence, and socioeconomic status, which included eight parameters (occupation, education, computer use, per capita income, family size, crowding index, sewage disposal, and refuse disposal) [13].

The second section included questions on the following:

  1. Present history: presence of symptoms of OAB (frequency, urgency, and urge incontinence); water, coffee, soda, and tea intake (numbers of cups per day); and current medication (type of medication)
  2. Past medical history, including hospitalization, previous gynecological surgery, trauma, injuries, allergies, number of living children, and chronic diseases (diabetes mellitus, osteoporosis, hypertension, and myoma of uterus)
  3. Menopausal history, including reason for menopause (natural menopause, radiation, medical drugs, and surgery – surgical removal of the bilateral ovaries), awareness of menopausal symptoms, and duration of menopause.


The third section for diagnosis of OAB was by overactive bladder symptom score (OABSS) [14]. The participants were asked to rate their symptom severity using a Likert scale, with maximum (most severe) scores of 2, 3, 5, and 5 for daytime frequency, night-time frequency, urgency, and urge incontinence, respectively. The total score ranged from 0 to 15, with a higher score indicating more severe OAB. According to clinical guidelines, a minimum OABSS of 3 and a minimum urgency score of 2 are required to diagnose OAB, and the severity of OAB is classified as mild (OABSS, 3–5), moderate (OABSS, 6–11), or severe (OABSS, 12–15) [15].

According to history, postmenopausal women (200 women) were divided into two groups: group I, which included 77 women who had OAB, and group II, which included 123 women did not have OAB.

Ethical consideration

The study was approved by the Ethical Committee of the Faculty of Medicine, Menoufia University. An official permission was obtained from the authorities of Kafr El-Bramoon Family Health Unit. Informed consent was signed by all participants after simple and clear explanation of the research objectives and procedures.

Statistical design

The data were collected, tabulated, and analyzed statistically using IBM personal computer with statistical package for the social sciences (SPSS, version 20; SPSS Inc., Chicago, Illinois, USA). Qualitative data were expressed as number and percentage and analyzed applying χ2-test.


  Results Top


Among 200 postmenopausal women, 77 (38.5%) had OAB [Figure 1].
Figure 1: Frequency of overactive bladder among the studied postmenopausal women.

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There was a statistical significant difference between the studied groups regarding age, BMI, and education, where 63.6% of the studied women who were more than 60 years, 45% who were obese, and 42.1% who had literate certificate level of education had OAB [Table 1].
Table 1: Comparison between overactive bladder and non-overactive bladder in postmenopausal women regarding the socioeconomic and personal characteristics

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There was a highly statistically significant difference between the studied groups regarding previous gynecological surgery, parity, and menopausal duration (P < 0.001), where 52, 61, and 52.5% of postmenopausal women who underwent previous gynecological surgery, had living children more than two, and with menopausal duration more than 5 years, respectively, experienced OAB. However, there was no statistically significant difference between OAB and daily intake of fluids (water, soda, tea, and coffee) (P > 0.05) [Table 2].
Table 2: Comparison between the studied groups regarding past history, menopausal duration, and fluid intake

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A logistic regression was performed to ascertain the effects of age, BMI, menopausal duration, parity, and history of previous gynecological surgery on the likelihood that participants had OAB. The logistic regression model was statistically significant. The most statistically variable sign was previous gynecological surgery [P < 0.001; odds ratio (OR): 33.04], followed by frequent parity more than two times (P < 0.001; OR: 27.94) and menopausal duration more than 5 years (P < 0.001; OR: 25.7) [Table 3].
Table 3: Binary logistic regression for prediction of overactive bladder in postmenopausal women

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  Discussion Top


This is a case–control study nested in a cross-sectional design that was carried out on 200 postmenopausal women attending the Kafr El-Bramoon Family Health Unit in Dakahlia Governorate for promotion of health among postmenopausal female through assessment of the prevalence and risk factors of OAB among the studied group.

The present study shows that the frequency of OAB among studied postmenopausal women in the selected unit was 38.5%. This is similar to the study carried out in USA among postmenopausal women, which reported 41.7% [16]. The prevalence is lower in the study conducted in Portugal, which was 29.4% [17]. This variation in OAB prevalence may be attributed to differences in confounding risk factors such as parity and the difference in sociodemographic criteria of the studied population (BMI and educational level).

On the contrary, the prevalence is higher in the Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS) survey, where it was 43.1% [18]. This may be because of the variation of the type of tools used for OAB classification or the characteristics of the studied group.

Regarding age, this study shows that a significantly higher percentage of postmenopausal women older than 60 years experienced OAB (63.6%). This result is in agreement with the finding of Honjo et al. [19], who found that the prevalence of OAB was reported to increase with age. This is explained by the fact that bladder ageing may cause OAB symptoms through decreased bladder capacity, increased nocturnal fluid secretions, and alteration of the bladder contractile apparatus [20]. On the contrary, Teloken et al. [21] found that OAB prevalence was not correlated with age.

Regarding education, there was a statistically significant difference between the studied groups and educational level, where 42.1% of the studied women who had literate certificate level of education experienced OAB symptoms. This may be explained by the fact that individuals with a higher educational level are more likely to seek better healthy behaviors and may have healthier lifestyles, whereas those with a lower educational level may have a higher prevalence of poor diet, frequent labor, and exposure to more toxins.

This is consistent with a study conducted in South Korea which found that the prevalence of OAB was less than 10% in those with an educational status of high school graduate or above, whereas in those with less than high school level of education, the prevalence of OAB was more than 90% [22].

This current study showed that there was statistical significant difference between the studied groups regarding BMI, where about half of the studied obese postmenopausal women experienced OAB.

This is consistent with Hunskaar [23] who found that BMI, where BMI from 25 to 29.9 and more than or equal to 30 corresponds to overweight and obesity, respectively, was an independent risk factor for OAB in women. This can be explained because excess body weight increases intra-abdominal pressure, which in turn increases bladder pressure and intravesical pressure, thus leading to overactivity [24]. On the contrary, a study carried out in Turkey found that BMI was not a significant risk factor for the presence of OAB in women [25].

Regarding past history, this present study showed that there was a highly statistically significant difference between the studied groups regarding previous gynecological surgery, where approximately half of the postmenopausal women who underwent previous gynecological surgery experienced OAB. This is similar to the result obtained by Juliato et al. [26], who found that women with a history of hysterectomy and bilateral oophorectomy had a higher prevalence of OAB. The association between hysterectomy and OAB was explained by Juliato et al. [26] who stated that pelvic surgery, hysterectomy, and oophorectomy can induce lower urinary tract symptoms because of peripheral neuropraxia induced by the surgery besides lowered estrogen levels [26].

Considering parity, this current study showed that there was a highly statistically significant difference between the studied groups regarding parity, where 61% of postmenopausal women who had more than two children experienced OAB. This is consistent with Zhang et al. [27], who found in a study carried out in Fuzhou, China, that parity more than two times is a common potential risk factor for OAB. This is explained by Mc Grouther et al. [28] that a hypothetical explanation describing the possible neuropathic changes increasing the sensitivity of the detrusor muscles of the bladder during its filling sensation in pregnancy can thus be stipulated. On the contrary, parity has been associated more with stress urinary incontinence than with OAB [28].

In this current study, there was a highly statistical significant difference between the studied groups regarding menopausal duration, where 52.5% of the studied postmenopausal women with menopausal duration more than 5 years experienced OAB. This is similar to a study carried out in Malaysia; it showed significant association of OAB with menopausal status of the women when the occurrence of menopause is more than 5 years [29]. On the contrary, a study conducted in Brazil by Juliato et al. [26], found no association between menopausal status and OAB [26].

This study shows that there was no statistically significant difference between the studied groups regarding daily intake of fluids (water, soda, tea, and coffee). This is similar to Segal et al. [30] who found no association between increased fluid intake and increased lower urinary tract symptoms (which included urgency, frequency, and urge incontinence). On the contrary, Elstad et al. [31] found that women with greater fluid intake reported more frequency and women with urgency restricted their fluids intake with expectation to improve symptoms [31].


  Conclusion Top


This study concluded that approximately one-third of postmenopausal had OAB. The main risk factors for OAB in postmenopausal women were found to be advanced age, higher parity, past history of gynecological surgery, and obesity. Therefore, the study recommends application of educational programs for postmenopausal women aimed to improve awareness of OAB as an embarrassing condition and treatment of the modifiable risk factors such as obesity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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