Association of Lower Urinary Tract Symptoms with Irritable Bowel Syndrome in Adult Men - An Internet-based Survey

Jong Pil Im; Byeong Gwan Kim; Ji Won Kim; Kook Lae Lee; Hwancheol Son; Joo Sung Kim; Hyun Chae Jung; In Sung Song

doi:10.4166/kjg.2009.53.6.348

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Im, Kim, Kim, Lee, Son, Kim, Jung, and Song: Association of Lower Urinary Tract Symptoms with Irritable Bowel Syndrome in Adult Men - An Internet-based Survey

Original Article

Korean J Gastroenterol 2009;53(6):348-354.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.53.6.348

Association of Lower Urinary Tract Symptoms with Irritable Bowel Syndrome in Adult Men - An Internet-based Survey

Jong Pil Im, M.D., Byeong Gwan Kim, M.D.^∗,^†,, Ji Won Kim, M.D.^∗,^‡, Kook Lae Lee, M.D.^∗, Hwancheol Son, M.D.^†, Joo Sung Kim, M.D.^‡, Hyun Chae Jung, M.D.^‡, In Sung Song, M.D.^‡

Seoul National University Hospital Kangnam Center, Seoul National University Boramae Hospital, Seoul, Korea

^∗Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea

^†Department of Urology, Seoul National University College of Medicine, Seoul, Korea

^‡Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: Byeong Gwan Kim, M.D. Department of Internal Medicine, Seoul National University Boramae Hospital, 425, Shindaebang 2-dong, Dongjak-gu, Seoul 156-707, Korea Tel: +82-2-840-2217, Fax: +82-2-870-3866 E-mail: caskim@brm.co.kr

Received 17 April 2008 Accepted 13 May 2008

Abstract

Background/Aims

Patients with irritable bowel syndrome (IBS) are more likely to experience certain urinary symptoms. The aims of this study were to investigate the association between lower urinary tract symptoms (LUTS) and IBS, and to determine their impact on the quality of life.

Methods

E-mails were sent to 23,594 men who were registered at an internet survey company. Subjects were requested to fill out the questionnaires re-garding IBS and LUTS assessed by the International Prostate Symptom Score (IPSS).

Results

Among 601 subjects (mean age, 35.5±8.4) included in the final analysis, 118 (19.6%) fulfilled the Rome II criteria for the diagnosis of IBS. The total mean IPSS of IBS subjects was 9.6, which was significantly higher than the 7.0 of non-IBS subjects (p＜0.01). When IPSS was subcategorized into mild, moderate, and severe symptom categories, the proportions with the moderate and severe symptoms among IBS subjects were 33.9% and 13.6% respectively, which were significantly higher than those of non-IBS subjects; (26.9 and 5.2%) (p＜0.01). In multivariate analysis, statistically significant association was found between IBS and moderate to severe LUTS (OR, 1.91; 95% CI, 1.27-2.88). IBS subjects also showed a poorer quality of life score than non-IBS subjects (2.24 vs. 1.65, p＜ 0.001).

Conclusions

LUTS in adult men with IBS are more severe and have a more negative impact on the quality of life than in non-IBS subjects.

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Keywords: Irritable bowel syndrome, Lower urinary tract symptom, Quality of life

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Fig. 1.

Severity of lower urinary tract symptoms (LUTS) in subjects with or without IBS. The proportions of IBS subjects in the ‘moderate’ and ‘severe’ LUTS categories were 33.9% and 13.6%, respectively, which were significantly higher than those of non-IBS subjects. ∗ p＜0.01 vs. Non-IBS. IBS, irritable bowel syndrome.

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Table 1.

Questionnaire Used to Diagnose Irritable Bowel Syndrome Based on the Rome II Criteria and to Evaluate Lower Urinary Tract Symptoms according to International Prostate Symptom Score

Over the past year (12 months), have you had abdominal discomfort or pain for more than 12 weeks (3 months) (need not to be consecutive) that has the following feature?						Yes	No
1. Abdominal discomfort or pain is relieved with defecation.
2. Onset of abdominal discomfort or pain is associated with a change in frequency of stool.
3. Onset of abdominal discomfort or pain is associated with a change in form (appearance) of stool.
Please answer the following questions about your urinary symptoms.
Over the past month,		Not at all	Less than 1 time in 5	Less than half the time	About half the time	More than half the time	Almost always
1. How often have you had a sensation of not emptying		0	1	2	3	4	5
your bladder completely after you finish urinating?
2. How often have you had to urinate again less than 2		0	1	2	3	4	5
hours after urinating?
3. How often have you found you stopped and started		0	1	2	3	4	5
again several times when you urinate?
4. How often have you found it difficult t	to postpone	0	1	2	3	4	5
urination?
5. How often have you had a weak urinary	stream?	0	1	2	3	4	5
6. How often have you had to push or stra	in to begin	0	1	2	3	4	5
urination?
7. How many times did you most typically	y get up to	0	1	2	3	4	5
urinate from the time you went to bed at	night until						or more
you got up in the morning? (time/night)
8. If you were to spend the rest of your life with your urinary condition as it is	Delighted	Pleased	Mostly satisfied	Mixed^∗	Mostly dissatisfied	Unhappy	Terrible
now, how would you feel about that?	0	1	2	3	4	5	6

^∗ About equally satisfied and dissatisfied.

Table 2.

Subjects Characteristics

Characteristics	IBS n=118	Non-IBS n=483	p-value
Age (yr), n (%)			0.58
20-29	31 (26.3)	131 (27.1)
30-39	49 (41.5)	219 (45.3)
40-59	38 (32.2)	1 33 (27.6)
BMI (kg/m²), Mean (SD)	24.1 (2.6)	23.9 (2.3)	0.48
Education, n (%)			0.92
High school	15 (12.7)	56 (11.6)
Undergraduate	11 (9.3)	48 (9.9)
Graduate	80 (67.8)	320 (66.3)
Post graduate	12 (10.2)	59 (12.2)
Income (10,000 won/month)	348	352	0.86
Smoking, n (%)			0.29
Non-smoker	41 (34.7)	202 (41.8)
Ex-smoker	16 (13.6)	49 (10.1)
Current smoker	61 (51.7)	232 (48.1)

IBS, irritable bowel syndrome; BMI, body mass index; SD, standard deviation.

Table 3.

Total IPSS and Quality of Life Index Scores of Subjects with or without IBS (Non-IBS)

	IBS n=118	Non-IBS n=483	p-value
Total IPSS, Mean (SD)	9.64 (7.44)	6.97 (6.36)	＜0.01
Obstructive symptom score	5.64 (4.38)	3.90 (3.92)	＜0.01
Incomplete emptying	1.42 (1.26)	1.21 (1.21)	0.08
Intermittency	1.60 (1.37)	1.37 (1.21)	0.09
Weak stream	1.41 (1.36)	0.89 (1.12)	＜0.01
Hesitancy	1.24 (1.21)	0.90 (1.12)	＜0.01
Irritable symptom score	3.99 (3.33)	3.07 (2.83)	＜0.01
Frequency	1.45 (1.40)	0.98 (1.20)	＜0.01
Urgency	1.35 (1.40)	0.82 (1.01)	＜0.01
Nocturia	1.15 (1.30)	0.80 (1.01)	＜0.01
Quality of life index score	2.24 (1.58)	1.65 (1.34)	＜0.01

IBS, irritable bowel syndrome; IPSS, international prostate symptom score; SD, standard deviation.

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