title: Self-report of difficult defecation is associated with overactive bladder symptoms.
abstract: OBJECTIVE
  The association of dysfunctional bowel elimination with lower urinary tract symptoms is well known in children, but not in adults. It was our objective to assess lower urinary tract symptoms (LUTS) in women who report difficult defecation (DD).
  
  
  METHODS
  This is a secondary analysis of 2,812 women, aged 35-64, who participated in a telephone interview. All subjects were asked "When you move your bowels, does the stool come out easily?" DD was considered present in those answering "no." All subjects were queried regarding LUTS, urinary infections in the past year, self-perceived health status, medical history, and demographics. Symptoms of stress incontinence (five items), urge incontinence (five items), and the impact of these symptoms on their quality of life were solicited from subjects reporting more than 12 episodes of incontinence in 1 year.
  
  
  RESULTS
  DD was reported by 10.4% (290/2,790) of women. Women with DD had higher LUTS than those who did not: nocturia (mean 1.8 ± 0.1 vs. 1.3 ± 0.0), urgency (47.6% vs. 29.2%), increased daytime frequency (mean 8.2 ± 0.3 vs. 7.2 ± 0.1), dysuria (22.9% vs. 13.7%), and a sensation of incomplete bladder emptying (55.6% vs. 28.2%). DD women were more often menopausal, reported a fair or poor self-reported health status, and had a higher number of comorbidities, less formal education, and lower annual household income.
  
  
  CONCLUSIONS
  Women with symptoms of DD have an increased rate of LUTS, consistent with the diagnosis of overactive bladder without incontinence. The pathophysiology underlying this association is worthy of future research.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA. annepell@med.umich.edu
authors.forename: Anne
authors.initials: A
authors.lastname: Cameron
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
authors.forename: John O L
authors.initials: JO
authors.lastname: DeLancey
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Morgan
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003672:Defecation; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008824:Michigan; D008875:Middle Aged; D016017:Odds Ratio; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires; D013997:Time Factors; D001743:Urinary Bladder / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000503:physiopathology* / Q000523:psychology; D014563:Urodynamics