Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Urogynecology Journal
Published in: International Urogynecology Journal 5/2020

01-05-2020 | Urinary Incontinence | Review Article

Urinary incontinence and cardiovascular disease: a narrative review

Author: Gregor John

Published in: International Urogynecology Journal | Issue 5/2020

Login to get access

Abstract

Introduction and hypothesis

Urinary incontinence (UI) has recently been associated with increased mortality. This observation deserves consideration, since UI is a frequent condition. Shared risk with cardiovascular disease and UI could offer part of the explanation.

Methods

In this narrative review, we explore the association between UI and some cardiovascular risk factors: obesity, diabetes, high blood pressure, tobacco smoking, alcohol, and caffeine intake. We also review the benefit of cardiovascular risk management on bladder health.

Results

Bladder function is affected by many cardiovascular risk factors. They can be protective or detrimental. Obesity, diabetes, and, to a lesser extent, high blood pressure and cigarette smoking have been associated with UI in different settings, precede new onset UI in longitudinal studies, have a dose effect, and have a biologic mechanism linked with UI. Thus, UI could be considered a possible consequence of metabolic syndrome. Furthermore, prevention programs aimed at decreasing weight, quitting smoking, healthy diet, and increasing physical activity have resulted in a decreased incidence, prevalence, and severity of UI.

Conclusions

Knowing the association among UI, cardiovascular risk factors, and mortality should encourage UI screening in the population as well as cardiovascular risk factor screening among patients with UI. The secondary benefit for UI could be an important motivator for increasing adherence to cardiovascular prevention programs.
Literature
1.
Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int. 2011;108:1132–8.PubMed
2.
Sexton CC, Coyne KS, Vats V, Kopp ZS, Irwin DE, Wagner TH. Impact of overactive bladder on work productivity in the United States: results from EpiLUTS. Am J Manag Care. 2009;15:S98–S107.PubMed
3.
Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care. 2000;6:S580–90.PubMed
4.
Luppa M, Luck T, Weyerer S, Konig HH, Brahler E, Riedel-Heller SG. Prediction of institutionalization in the elderly. A systematic review. Age Ageing. 2010;39:31–8.PubMed
5.
Yang E, Lisha NE, Walter L, Obedin-Maliver J, Huang AJ. Urinary incontinence in a national cohort of older women: implications for caregiving and care dependence. J Women’s Health (Larchmt). 2018;27:1097–103.
6.
Goldfarb AI. Predicting mortality in the institutionalized aged: A seven-year follow-up. Arch Gen Psychiatry. 1969;21:172–6.PubMed
7.
John G, Bardini C, Megevand P, Combescure C, Dallenbach P. Urinary incontinence as a predictor of death after new-onset stroke: a meta-analysis. Eur J Neurol. 2016;23:1548–55.PubMed
8.
9.
Gacci M, Corona G, Sebastianelli A, Serni S, De Nunzio C, Maggi M, et al. Male lower urinary tract symptoms and cardiovascular events: a systematic review and meta-analysis. Eur Urol. 2016;70:788–96.PubMed
10.
Waetjen LE, Ye J, Feng WY, Johnson WO, Greendale GA, Sampselle CM, et al. Association between menopausal transition stages and developing urinary incontinence. Obstet Gynecol. 2009;114(5):989–98.PubMedPubMedCentral
11.
Khullar V, Sexton CC, Thompson CL, Milsom I, Bitoun CE, Coyne KS. The relationship between BMI and urinary incontinence subgroups: results from EpiLUTS. Neurourol Urodyn. 2014;33:392–9.PubMed
12.
Weinberg AE, Leppert JT, Elliott CS. Biochemical measures of diabetes are not independent predictors of urinary incontinence in women. J Urol. 2015;194(6):1668–74.PubMed
13.
Matthews CA, Whitehead WE, Townsend MK, Grodstein F. Risk factors for urinary, fecal, or dual incontinence in the Nurses’ Health Study. Obstet Gynecol. 2013;122:539–45.PubMedPubMedCentral
14.
Danforth KN, Townsend MK, Lifford K, Curhan GC, Resnick NM, Grodstein F. Risk factors for urinary incontinence among middle-aged women. Am J Obstet Gynecol. 2006;194:339–45.PubMedPubMedCentral
15.
Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG. 2003;110:247–54.PubMed
16.
Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing. 1997;26:367–74.PubMed
17.
Maserejian NN, Minassian VA, Chen S, Hall SA, McKinlay JB, Tennstedt SL. Treatment status and risk factors for incidence and persistence of urinary incontinence in women. Int Urogynecol J. 2014;25:775–82.PubMed
18.
Wang R, Lefevre R, Hacker MR, Golen TH. Diabetes, glycemic control, and urinary incontinence in women. Female Pelvic Med Reconstr Surg. 2015;21:293–7.PubMedPubMedCentral
19.
Doshi AM, Van Den Eeden SK, Morrill MY, Schembri M, Thom DH, Brown JS. Women with diabetes: understanding urinary incontinence and help seeking behavior. J Urol. 2010;184:1402–7.PubMedPubMedCentral
20.
Devore EE, Townsend MK, Resnick NM, Grodstein F. The epidemiology of urinary incontinence in women with type 2 diabetes. J Urol. 2012;188:1816–21.PubMedPubMedCentral
21.
Lee SJ, Karter AJ, Thai JN, Van Den Eeden SK, Huang ES. Glycemic control and urinary incontinence in women with diabetes mellitus. J Women’s Health (Larchmt). 2013;22:1049–55.
22.
Chuang CM, Lin IF, Horng HC, Hsiao YH, Shyu IL, Chou P. The impact of gestational diabetes mellitus on postpartum urinary incontinence: a longitudinal cohort study on singleton pregnancies. BJOG. 2012;119:1334–43.PubMed
23.
Abdel-Fattah M, Rizk DE. Diabetes mellitus and female urinary incontinence: a time for change. Int Urogynecol J. 2012;23:1481–2.PubMed
24.
Chang KM, Hsieh CH, Chiang HS, Lee TS. Risk factors for urinary incontinence among women aged 60 or over with hypertension in Taiwan. Taiwan J Obstet Gynecol. 2014;53:183–6.PubMed
25.
Townsend MK, Lajous M, Medina-Campos RH, Catzin-Kuhlmann A, Lopez-Ridaura R, Rice MS. Risk factors for urinary incontinence among postmenopausal Mexican women. Int Urogynecol J. 2017;28:769–76.PubMed
26.
27.
Van Oyen H, Van Oyen P. Urinary incontinence in Belgium; prevalence, correlates and psychosocial consequences. Acta Clin Belg. 2002;57:207–18.PubMed
28.
Davis NJ, Vaughan CP, Johnson TM 2nd, Goode PS, Burgio KL, Redden DT, et al. Caffeine intake and its association with urinary incontinence in United States men: results from National Health and Nutrition Examination Surveys 2005-2006 and 2007-2008. J Urol. 2013;189:2170–4.PubMed
29.
Morrisroe SN, Rodriguez LV, Wang PC, Smith AL, Trejo L, Sarkisian CA. Correlates of 1-year incidence of urinary incontinence in older Latino adults enrolled in a community-based physical activity trial. J Am Geriatr Soc. 2014;62:740–6.PubMedPubMedCentral
30.
Kim H, Yoshida H, Hu X, Yukawa H, Shinkai S, Kumagai S, et al. Risk factors associated with onset of urinary incontinence in a community-dwelling elderly population: a 4-year follow-up study. Nihon Koshu Eisei Zasshi. 2004;51:612–22.PubMed
31.
Miller YD, Brown WJ, Russell A, Chiarelli P. Urinary incontinence across the lifespan. Neurourol Urodyn. 2003;22:550–7.PubMed
32.
Frazier EP, Schneider T, Michel MC. Effects of gender, age and hypertension on beta-adrenergic receptor function in rat urinary bladder. Naunyn Schmiedeberg’s Arch Pharmacol. 2006;373:300–9.
33.
Bump RC, McClish DK. Cigarette smoking and urinary incontinence in women. Am J Obstet Gynecol. 1992;167:1213–8.PubMed
34.
Yokoi K, Ohmura M, Kondo A, Miyake K, Saito M. Effects of ethanol on in vivo cystometry and in vitro whole bladder contractility in the rat. J Urol. 1996;156:1489–91.PubMed
35.
Bae WJ, Choi YS, Kim SJ, Cho HJ, Hong SH, Kim SW, et al. Effects of moderate alcohol intake in the bladder of the Otsuka Long Evans Tokushima Fatty diabetic rats. J Korean Med Sci. 2015;30:1313–20.PubMedPubMedCentral
36.
Malysz J, Afeli SA, Provence A, Petkov GV. Ethanol-mediated relaxation of guinea pig urinary bladder smooth muscle: involvement of BK and L-type Ca2+ channels. Am J Phys Cell Phys. 2014;306:C45–58.
37.
Phelan S, Kanaya AM, Subak LL, Hogan PE, Espeland MA, Wing RR, et al. Prevalence and risk factors for urinary incontinence in overweight and obese diabetic women: action for health in diabetes (look ahead) study. Diabetes Care. 2009;32:1391–7.PubMedPubMedCentral
38.
Kincade JE, Dougherty MC, Carlson JR, Wells EC, Hunter GS, Busby-Whitehead J. Factors related to urinary incontinence in community-dwelling women. Urol Nurs. 2007;27:307–17.PubMed
39.
Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D. Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol. 1996;87:715–21.PubMed
40.
Lee AH, Hirayama F. Is alcohol consumption associated with male urinary incontinence? Low Urin Tract Symptoms. 2011;3:19–24.PubMed
41.
Bortolotti A, Bernardini B, Colli E, Di Benedetto P, Giocoli Nacci G, Landoni M, et al. Prevalence and risk factors for urinary incontinence in Italy. Eur Urol. 2000;37:30–5.PubMed
42.
Zhu L, Li L, Lang JH, Xu T. Prevalence and risk factors for peri- and postpartum urinary incontinence in primiparous women in China: a prospective longitudinal study. Int Urogynecol J. 2012;23:563–72.PubMed
43.
Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671.PubMedPubMedCentral
44.
Roerecke M, Rehm J. Alcohol use disorders and mortality: a systematic review and meta-analysis. Addiction. 2013;108:1562–78.PubMed
45.
46.
Jura YH, Townsend MK, Curhan GC, Resnick NM, Grodstein F. Caffeine intake, and the risk of stress, urgency and mixed urinary incontinence. J Urol. 2011;185:1775–80.PubMedPubMedCentral
47.
Tettamanti G, Altman D, Pedersen NL, Bellocco R, Milsom I, Iliadou AN. Effects of coffee and tea consumption on urinary incontinence in female twins. BJOG. 2011;118:806–13.PubMedPubMedCentral
48.
Crippa A, Discacciati A, Larsson SC, Wolk A, Orsini N. Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis. Am J Epidemiol. 2014;180:763–75.PubMed
49.
Brown JS, Wing R, Barrett-Connor E, Nyberg LM, Kusek JW, Orchard TJ, et al. Lifestyle intervention is associated with lower prevalence of urinary incontinence: the Diabetes Prevention Program. Diabetes Care. 2006;29:385–90.PubMedPubMedCentral
50.
Suskind AM, Cawthon PM, Nakagawa S, Subak LL, Reinders I, Satterfield S, et al. Urinary incontinence in older women: the role of body composition and muscle strength: from the Health, Aging, and Body Composition Study. J Am Geriatr Soc. 2017;65:42–50.PubMed
51.
Subak LL, King WC, Belle SH, Chen JY, Courcoulas AP, Ebel FE, et al. Urinary incontinence before and after bariatric surgery. JAMA Intern Med. 2015;175:1378–87.PubMedPubMedCentral
52.
Lenherr SM, Clemens JQ, Braffett BH, Dunn RL, Cleary PA, Kim C, et al. Glycaemic control and risk of incident urinary incontinence in women with type 1 diabetes: results from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabet Med. 2016;33:1528–35.PubMedPubMedCentral
53.
Chiu AF, Huang MH, Wang CC, Kuo HC. Higher glycosylated hemoglobin levels increase the risk of overactive bladder syndrome in patients with type 2 diabetes mellitus. Int J Urol. 2012;19:995–1001.PubMed
54.
Ebbesen MH, Hunskaar S, Rortveit G, Hannestad YS. Prevalence, incidence and remission of urinary incontinence in women: longitudinal data from the Norwegian HUNT study (EPINCONT). BMC Urol. 2013;13:27.PubMedPubMedCentral
55.
Jackson SL, Scholes D, Boyko EJ, Abraham L, Fihn SD. Predictors of urinary incontinence in a prospective cohort of postmenopausal women. Obstet Gynecol. 2006;108:855–62.PubMed
56.
Ebbesen MH, Hannestad YS, Midthjell K, Hunskaar S. Diabetes related risk factors did not explain the increased risk for urinary incontinence among women with diabetes: The Norwegian HUNT/EPINCONT study. BMC Urol. 2009;9:11.PubMedPubMedCentral
57.
Breyer BN, Phelan S, Hogan PE, Rosen RC, Kitabchi AE, Wing RR, et al. Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with type 2 diabetes: results from the Look AHEAD trial. J Urol. 2014;192:144–9.PubMedPubMedCentral
58.
59.
Rapp K, Lamb SE, Buchele G, Lall R, Lindemann U, Becker C. Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial. J Am Geriatr Soc. 2008;56:1092–7.PubMed
60.
Chiarelli P, Brown W, McElduff P. Leaking urine: prevalence and associated factors in Australian women. Neurourol Urodyn. 1999;18:567–77.PubMed
61.
Lewis CM, Schrader R, Many A, Mackay M, Rogers RG. Diabetes and urinary incontinence in 50- to 90-year-old women: a cross-sectional population-based study. Am J Obstet Gynecol. 2005;193:2154–8.PubMed
Metadata
Title
Urinary incontinence and cardiovascular disease: a narrative review
Author
Gregor John
Publication date
01-05-2020
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 5/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-019-04058-w

Other articles of this Issue 5/2020

International Urogynecology Journal 5/2020 Go to the issue

Original Article

Pelvic examination: an iatrogenic cause of microscopic hematuria in women?

Commentary

Commentary on “Effect of an exercise programme for reducing abdominal fat on overactive bladder symptoms in young overweight women”

Commentary

A commentary on “8 versus 12 weeks of percutaneous tibial nerve stimulation and response predictors for overactive bladder”

Original Article

Urinary tract morbidity after nerve-sparing radical hysterectomy in women with cervical cancer

Original Article

Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy

Editorial

Combination pharmacotherapy for the treatment of the overactive bladder syndrome: a new solution for an old problem?