Smoking and Higher Risk of Overactive Bladder

Urge incontinence is a urological condition that is marked by a sudden and strong need to pass the urine. Urge incontinence is a symptom of overactive bladder that is reported far more frequently in smokers when compared to non-smokers. According to a new study that was conducted on 2,000 women, investigators were able to determine a dose-response relationship, based on which women who smokes frequently are three times more prone to develop overactive bladder than non-smokers (1).

The exact pathophysiology is unknown, but investigators have proposed several theories that may explain how excessive smoking can cause overactive bladder. A few most notable ones are briefly discussed below:

• Irritation of bladder musculature: Cigarette smoke is loaded with hundreds of irritants and carcinogens that may cause inflammation of the bladder lining; thereby leading to overactive bladder and frequent urination. According to latest statistics, the prevalence of overactive bladder due to instability of detrusor muscles is as high as 27% in women under 65 years of age and about 38% in women over 65 years of age (2).
• Nicotine induced contractility of muscles: Smoking can induce nicotine mediated contractility in the bladder lining. The hyper contractility makes bladder musculature more sensitive and irritated; thereby causing a more frequent urge to urinate.
• Chronic obstructive pulmonary disease: Smokers are very likely to develop chronic obstructive pulmonary disease (COPD) due to irritation of respiratory passageways. Recurrent outbursts of forceful coughing can increase the intraabdominal pressure to cause urinary incontinence.

What to do to resolve overactive bladder secondary to cigarette smoking?

Smokers are advised to quit smoking as early as possible to control the symptoms of overactive bladder. Quitting the smoking or weaning off the frequency of smokes has been shown to reduce the intensity of symptoms in the setting of overactive bladder. In fact, a number of studies have also suggested that smoking cessation can help in regaining the bladder activity efficiently; without needing any other treatment. Discussed below are some interventions that may aid in regaining bladder control (besides quitting smoking).

• Social support: Support from friends, family can play a vital role in smoking cessation. Due to nicotine withdrawal, a lot of people may develop serious withdrawal that may range from irritability and mood swings to serious adverse effects such as tremors and palpitations. The support from loved ones is equally important to the treatment a pati

• ent receive for smoking cessation. Spending more time with friends or family who are non-smokers can also help the person to quit smoking.
• Use smoking aids: Going cold turkey is very difficult, especially if you have been a chronic and chain smoker. Therefore, proper help is of utmost importance and can be obtained via Nicotine patches and gums (in addition to other delivery systems that aims to deliver smaller quantities of nicotine to make quitting easier.
• Try again and again: Most of the time people fail to quit smoking in the initial attempts; they should not be discouraged and should try again for a more effective and practical response.

Strategies for overactive bladder:

Besides smoking cessation, simple bladder retraining interventions can also help. For example:

• Change in diet: For better bladder control, it is recommended to remove caffeinated drinks, artificial sweetening agents and spicy foods from your diet. Study reported in Obstetrics & Gynecology (2) suggested that high caffeine intake exceeding 200 mg/ day can directly affect the contractility of detrusor muscles of urinary bladder.
• Bladder retraining: Set e specific time frame for bladder emptying and gradually increase the interval to improve the bladder capacity. This help in improving the activity of bladder
• Exercises: Physical exercises that strengthen the muscles of pelvic floor should be employed to regain the strength of pelvic floor muscles.
• Fluid intake: Maintaining appropriate hydration by consuming at least 6-8 glasses of water per day is vital to bladder health. Unfortunately, most people assume that drinking less water will decrease the urinary frequency and improve the symptoms of overactive bladder. In reality, inadequate water intake can cause bladder irritation and may worsen the symptoms of overactive bladder.
• Manage constipation: If you are experiencing other symptoms besides overactive bladder, it is highly recommended to speak to a healthcare professional for optimal management. For example, a lot of people experiences constipation and other symptoms of poor digestive health; which may also lead to secondary overactive bladder.
• Medications: For control of overactive bladder symptoms, a variety of pharmacological agents can also be utilized after consulting with your doctor. Most promising agents are; oxybutynin and related drugs.

Speak to your primary care provider to learn about the pathogenesis of smoking and bladder over-activity.

References:

1. Dallosso, H. M., McGrother, C. W., Matthews, R. J., & Donaldson, M. M. K. (2003). The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU international, 92(1), 69-77.

2. Arya, L. A., Myers, D. L., & Jackson, N. D. (2000). Dietary Caffeine Intake and the Risk for Detrusor Instability: A Case‐Control Study. Obstetrics & Gynecology, 96(1), 85-89.

3. Wyman, J. F., Burgio, K. L., & Newman, D. K. (2009). Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence. International journal of clinical practice, 63(8), 1177-1191.