Hypothesis / aims of study
Urinary symptoms in women have multifactorial etiology and vitamin D deficiency appears to be associated with the onset of these changes. In this context, the hypothesis appears that vitamin deficiency will be more common in women with urinary symptoms. The aim of this study is to determine the prevalence of hypovitaminosis D in women with urinary symptomatology and to compare rates of 25-Hydroxyvitamin D among women with and without symptoms
Study design, materials and methods
This is a cross-sectional study. We included female subjects aged 18-65 years and divided into two groups, the group of women with urinary symptoms, confirmed by ICIQ-SF or ICIQ-OAB, and a comparator group of women without this symptomatology. The following were excluded from the study: patients with neurological diseases; inflammatory bowel disease, history of bariatric surgery, stage 4 or 5 chronic kidney disease, advanced liver disease, history of stroke, diabetes mellitus, regular use of medications that interfere with the intracellular pathway P450 (phenytoin, phenobarbital, carbamazepine, isoniazid, theophylline, rifampsin and glucocorticoids). The validation instruments used to confirm urinary symptoms were: the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the International Consultation on Incontinence Overactive Bladder (ICIQ-OAB) questionnaire. Data collection was performed through an anamnesis containing socio-demographic and clinical information and self-administered questionnaires, filled in individually. After the questionnaires were carried out, serum levels of 25-hydroxy vitamin D were performed. For the categorization of hypovitaminosis, values below 29.9 ng / ml were considered.
168 women were collected, 84 woman had urinary symptoms and 84 without urinary symptoms. The prevalence of hypovitaminosis in women with urinary symptoms was 26 (31%) and in the group without urinary symptoms it was 8 (9.5%) (p = 0.001). The mean serum vitamin D content in the group of women with the symptomatology was higher than the comparator, with mean serum values of 44.15 (± 12.62) and 38.23 (± 12.42), respectively (p < 0.001). An association between vitamin D deficiency and the highest ICIQ-SF scores (p <0.003) and ICIQ-OAB (p <0.038) were observed. In the final model of logistic regression in the identification of predictors for urinary symptoms, vitamin D deficiency, presence of cystocele, high BMI, pregnancy and episiotomy were identified (Table 1).
Interpretation of results
Hypovitaminosis was more frequent in women with urinary symptoms confirming the hypothesis. In an observational study, the association of low serum vitamin D levels with pelvic floor disorders (1, 2) was demonstrated, justifying that vitamin D deficiency is more prevalent in symptomatic incontinent women, since one of the mechanisms that act on urinary continence is the pelvic floor musculature.