Exploring Overactive Bladder: Mental Health and Cardiovascular Connections

This episode discusses the often-overlooked overactive bladder (OAB) condition and its associations with other health conditions. The discussion is centered around two key studies based on survey data from the U.S. National Health and Nutrition Examination Survey. The first study examines the significant correlation between OAB and depression, highlighting the importance of recognizing mental health issues in patients with OAB. The second study investigates the relationship between cardiovascular health and stress urinary incontinence, emphasizing how better overall health can reduce the likelihood of incontinence. Due to its broader health implications, these findings underscore the importance of taking incontinence seriously.

For more information on these studies:

https://pubmed.ncbi.nlm.nih.gov/38642902/

https://pubmed.ncbi.nlm.nih.gov/39169591/

Timeline:

00:00 Introduction to Overactive Bladder

00:32 Study 1: Overactive Bladder and Depression

02:25 Study 1: Findings and Implications

05:19 Study 2: Overactive Bladder and Cardiovascular Health

07:14 Study 2: Findings and Implications

08:43 Conclusion and Final Thoughts

Transcript

Hi there. So today I wanted to talk to you about overactive bladder and some of the other health conditions that overactive bladder is associated with. So a lot of times, both patients and different practitioners will minimize incontinence and say, you know, this isn't really an important medical condition, but it is associated with so many other Medical conditions that I think it's important to think about those things and, and recognize the downstream effects that incontinence can have. 

So, uh, the two, I'm going to talk to you about two studies today, and they're both studies that were taken from survey data that was part of the U. S. National Health. And nutrition examination survey and the first one looked at overactive bladder and depression.  So the data was collected from people that were living in their homes.

They collected the data from 2005 to 2018. They, um, in this particular study, they looked at the data from 6,612. women. They diagnosed OAB or overactive bladder based on the OAB symptom score. You had to have symptoms or a score of greater or equal to three. And then they looked at depressive symptoms and The depressive symptoms were determined by a questionnaire called the Patient Health Questionnaire.

Um, it's a version of a primary care evaluation of mental health disorders. It's a diagnostic instrument. And a score of greater or equal to 10 was called depression in this particular study.  So the team looked at the correlation between overactive bladder and mental health, and then they also looked at different confounders.

So they looked at socio demographic factors to see if, you know, these factors were the ones that were more likely to be associated with this. either the overactive bladder or depression. So those factors included age, sex, um, education level, et cetera, behavioral factors, and that included smoking and alcohol use.

And then they looked at four different chronic diseases. So diabetes, hypertension, um, coronary vascular disease and hyperlipidemia.  Out of the 600, or 6, 612 women, 1, 005 had overactive bladder, and 5, 607 did not have overactive bladder.  What they found was that 15. 6 percent of the women, or the um, Respondents, because it was male and female with overactive bladder, had depression versus 4.

6 in the population that did not have overactive bladder, right? So 15. 6 percent of patients with overactive bladder also had depression. 4. 6 of people who did not have overactive bladder had depression. So there was found to be a significant association between overactive bladder and depression.  And when they looked at the adjusted odds ratio for depression and overactive bladder,  they found that with mild OAB, the risk of depression was 2.

76. With moderate, it was 3. 79. And with severe, it was 5. 21. So you were much more likely, your odds of having depression with severe overactive bladder was over five. So this study was by Zhang et al. It was published in 2024 in the Journal of Affective Disorders. There are some limitations to it. There is some recall bias.

These are self reported measures. There could be selection bias.  You know, not everyone completed the questionnaire with the overactive bladder. There's no ability to talk about causality here, so you can't say that overactive bladder causes the depression, but you can say that they're more likely to be seen together.

And the authors postulated that, you know, when you're stressed, when you're depressed, there's chronic inflammation, and that can have a negative impact on the bladder. Their other kind of conclusion here was that bladder problems, um, may not cause depression, but, you know, patients that have bladder issues should definitely be screened for depression, right?

We should be looking at these patients and making sure that their mental health is okay and supporting them in, in more ways. And, you know, the, the other thing that they The authors found here was that there was a bidirectionality of the relationship. So if you're depressed, you're more likely to have overactive bladder.

If you're overactive bladder, you're more likely to be depressed, right? So those things kind of go hand in hand.  So You know, it's survey information, but it, it speaks to how overactive bladder can dramatically impact mental health. And that's something that we need to be thinking about and, and not  just assuming that those patients are okay.

Um, the next study that I want to talk about is from the same survey. So the U. S. National Health and Nutrition Examination Survey. And this author, Dr. Xiaoping, published this article in August of 2024, um, in the International Journal of Gynecology and Obstetrics. And what they did is they looked at Self reported stress urinary incontinence, and they looked at life, life's essential eight and life's essential aid is, um, eight key measures for improving and maintaining cardiovascular health.

These measures have been developed, um, by the American Heart Association.  And, um, these measures have been found to lower the risk of heart disease, of strokes, and other major health problems.  The eight measures are, one, eating better, so eating more whole foods, lots of fruits and vegetables, lean protein.

Two is being more active. And, The suggestions are  150 minutes of moderate exercise or 75 minutes of vigorous exercise per week. Three is quitting tobacco, which includes all inhaled nicotine products. Four is getting healthy sleep, which for most adults is seven to nine hours per night. Five is managing your weight, and you want an ideal BMI of less than 25, but greater than 18.

5. Six is controlling cholesterol.  7 is managing your blood sugar, and then 8 is managing your blood pressure. So an optimal blood pressure would be less than 120 over 80.  So when they look at this life's essential 8, you get a score. The score goes from 0 to 100, and the higher the score, the higher your cardio respiratory fitness.

So in this study, they looked at 900 9, 332 participants, and what they found is that when patients scored higher on Life's Essential 8, they had less stress urinary incontinence.  So a 10 point increase. Right. And life's essential aids, which, you know, is a sign of better cardiovascular health. The odds ratio for developing stress incontinence was 0.

83. So it was protective. So people that had higher life's essential aid had a 57 percent lower probability of developing stress urinary incontinence. So this is a different way of thinking about things, right? If we're healthier in general, um, eating better, more active. of not having bad habits like smoking, making sure we're sleeping, you know, blood pressure, blood sugar, all of those things are okay.

Stress incontinence is less likely to happen. So is that because of weight? Is that because of just general fitness? Is it because these patients are oxygenating better? And so those small muscles in the urethra are getting more oxygen. And so they're just working better. It's not really clear, but that correlation is, is definitely there, right?

So showing us. That, um, being careful about your overall health and monitoring these things, which are good for your health in general will also help to minimize stress incontinence.  So I think these studies are, you know, super interesting, but also just indicative of  the impact stress incontinence can have, or incontinence can have in our lives and other medical conditions.

Um, and how important it is to take them seriously so that you can age gracefully.