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Vitamin D and urinary incontinence

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Urgent urinary incontinence reduced about 40% by 50,000 IU Vitamin D weekly – RCT April 2018

The Journal of Urology, Vol 199, Issue 4, Sup, April 2018, Pages e648, AUA Annual Meeting, https://doi.org/10.1016/j.juro.2018.02.1551
Alayne Markland, T. Mark Beasley, Kathryn BurgioCamille Vaughan, Vin Tangpricha Patricia Goode

  • Probably would have had more improvement and statistical significance if enough vitamin D had been given to achieve >30 ng/mL
  • Perhaps 50,000 IU of Vitamin D every 4 days instead of every 7 days
  • Perhaps more benefits if use a form of Vitamin D which is gut-friendly

Urgency urinary incontinence (UUI) is a very common, distressing condition. First-line behavioral and drug therapies are effective but novel therapies are needed. The primary aim of this study was to evaluate the efficacy of vitamin D supplementation compared to placebo to improve UUI in postmenopausal women with vitamin D insufficiency.

This was a single-site pilot randomized trial conducted 2013-2017. Participants were community-dwelling postmenopausal women, 50 years of age or older, with at least 3 UUI episodes on 7-day bladder diary and 25(OH)D≤30 ng/mL (insufficiency). They were randomized to 12 weeks of weekly 50,000 IU vitamin D3 or placebo. Using Wilcoxon tests, we calculated the percent reduction in 24-hour UUI episodes (primary outcome), along with urinary frequency and nocturia episodes from the diaries for the overall group and for African American (AA) and obese women (higher-risk subgroups). Secondary outcomes included scores on validated bladder symptom questionnaires.

We randomized 56 women (50 to 84 years of age; mean age = 60.5 ±8.2; 70% AA; 64% obese), 28 to vitamin D and 28 to placebo; 51 completed treatment. For the completer analysis, mean 25(OH)D at baseline (21.2 ±5.2 and 18.2 ±5.6, p=0.30) improved to 57.9 ±16.3 for the vitamin D3 group and to 21.9 ±8.2 in the placebo group, p<0.001. UUI episodes per 24-hour day decreased 52.4% with vitamin D3 compared to 30.9% with placebo (p=0.09). Among Black women, changes in UUI episodes decreased 63.2% with vitamin D3 compared to 23.0% with placebo (p=0.03). There were no group differences among obese women (p=0.29). For all women, no differences between D3 and placebo were found for improvements in voiding frequency (p=0.40), nocturia (p= 0.40), incontinence symptom severity (p=0.80), or overactive bladder symptom severity (p=0.47).

Post-menopausal women with UUI and vitamin D insufficiency recorded a >50% decrease in UUI episodes that did not reach statistical significance compared to placebo, except in the subset of AA women. Based on these pilot study estimates for efficacy, further investigation of vitamin D3 alone or in combination with other treatments for UUI is warranted, particularly for women in higher-risk subgroups.

Source of Funding: 1R21DK096201

Urinary incontinence 3.2X less likely in elderly if OK level of vitamin D – Sept 2016

Vitamin D and incident urinary incontinence in older adults.
Eur J Clin Nutr. 2016 Sep;70(9):987-9. doi: 10.1038/ejcn.2016.20. Epub 2016 Mar 16.
Vaughan CP1,2,3, Tangpricha V2,3, Motahar-Ford N2,3, Goode PS4,5,6, Burgio KL4,5,6, Allman RM7, Daigle SG4, Redden DT4,8, Markland AD4,5,6.

The aim of this study is to determine whether vitamin D status is associated with incident urinary incontinence (UI) among community-dwelling older adults.

The University of Alabama at Birmingham Study of Aging is a prospective cohort study of community-dwelling Medicare enrollees. Standardized assessment of UI was conducted using the validated Incontinence Severity Index. The analysis of 25-hydroxyvitamin D [25(OH)D] levels was performed on stored baseline sera. UI was assessed every 6-12 months for up to 42 months. The analyses included multivariable logistic regression and Cox proportional hazard models.

Of 350 participants (175 male, 147 black, mean age 73.6±5.8), 54% (189/350) were vitamin D deficient (25(OH)D <20 ng/ml) and 25% (87/350) were vitamin D insufficient (25(OH)D: 20 ng/ml to <30 ng/ml). Among the 187 subjects with no UI at baseline, 57% (107/187) were vitamin D deficient and 24% (45/187) were vitamin D insufficient. A total of 175 of the 187 subjects had follow-up evaluation for incident UI over 42 months, and incident UI occurred in 37% (65/175). After adjustment, cumulative incident UI at 42 months was associated with baseline vitamin D insufficiency (P=0.03) and demonstrated a trend association with deficiency (P=0.07). There was no association between baseline vitamin D status and the time to incident UI.

These preliminary results support an association between vitamin D and incident UI in community-dwelling older adults. Future studies may target specific at-risk groups, such as men with BPH or women with pelvic floor disorders for evaluation of the impact of vitamin D supplementation on urinary symptoms.

PMID: 26979990 PMCID: PMC5014687 DOI: 10.1038/ejcn.2016.20

Syracuse gynecologist shows how vitamin D deficiency leads to urinary incontinence - April 2010

By Amber Smith/The Post-Standard April 20, 2010,

We know vitamin D is important for keeping our bones healthy.
In recent years we've heard how it boosts our immune functioning, improves blood flow by relaxing our blood vessels and helps our insulin work better so we can lose belly fat.
Now a Syracuse gynecologist says the prevalence of vitamin D deficiency helps explain why so many women suffer pelvic floor disorders including urinary incontinence.
Dr. Samuel Badalian's study, "Vitamin D and Pelvic Floor Disorders" is published in this month's journal of Obstetrics & Gynecology.
He began wondering about the role of vitamin D when he realized so many of his patients with osteoporosis also had pelvic problems. Because those pelvic disorders are "connective tissue disorders, same as osteoporosis," he was not surprised to find a connection.
Using data from the 2005-2006 National Health and Nutrition Examination Study, he looked at the vitamin D measurements for 1,881 nonpregnant women with pelvic floor disorders. One in four American women have a pelvic floor disorder, which includes urinary incontinence, pelvic organ prolapse and other problems.
Badalian's work builds on previous research that has connected vitamin D deficiency with bladder dysfunction. He found that women of all ages with pelvic floor disorders or urinary incontinence had significantly lower levels of vitamin D. Women age 20 and older, with high levels of vitamin D, had a significantly lower incidence of pelvic floor disorders; and women age 50 and older, with high levels of vitamin D, had a significantly lower incidence of urinary incontinence.
"Given the increase in the number of patients with pelvic floor disorders, further evaluation of the role of vitamin D is warranted, particularly future research to assess the relationship between vitamin D levels and pelvic muscle strength in women of all ages and racial/ethnic groups," he writes in his summary.
Badalian says vitamin D levels should be checked annually. Taking 2,000 international units per day of vitamin D3 can provide healthy levels for most people, but those who are elderly, obese or who have renal insufficiency need more.
"People need to realize, they need their vitamin D."
You can eat foods fortified with vitamin D, you can take supplements. Or, you can spend 15 or 20 minutes in the sun to get your daily dose of vitamin D.

Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. - April 2010

Obstet Gynecol. 2010 Apr;115(4):795-803.
Badalian SS, Rosenbaum PF.
Department of Obstetrics and Gynecology, SUNY Upstate Medical University, and Gynecology and Urogynecology Center, St. Joseph's Hospital Health Center, Syracuse, New York 13203, USA. badalian at netzero.com

OBJECTIVE: To estimate the prevalence of vitamin D deficiency in women with pelvic floor disorders and to evaluate possible associations between vitamin D levels and pelvic floor disorders. METHODS: Using 2005-2006 National Health and Nutrition Examination Survey data, we performed a cross-sectional analysis of nonpregnant women older than 20 years of age with data on both pelvic floor disorders and vitamin D measurements (n=1,881). Vitamin D levels lower than 30 ng/mL were considered insufficient. The prevalence of demographic factors, pelvic floor disorders, and vitamin D levels were determined, accounting for the multi-stage sampling design; odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate associations between vitamin D levels and pelvic floor disorders with control for known risk factors.

RESULTS: One or more pelvic floor disorders were reported by 23% of women. Mean vitamin D levels were significantly lower for women reporting at least one pelvic floor disorder and for those with urinary incontinence, irrespective of age. In adjusted logistic regression models, we observed significantly decreased risks of one or more pelvic floor disorders with increasing vitamin D levels in all women aged 20 or older (OR, 0.94; 95% CI, 0.88-0.99) and in the subset of women 50 years and older (OR, 0.92; 95% CI, 0.85-0.99). Additionally, the likelihood of urinary incontinence was significantly reduced in women 50 and older with vitamin D levels 30 ng/mL or higher (OR, 0.55; 95% CI, 0.34-0.91).

CONCLUSION: Higher vitamin D levels are associated with a decreased risk of pelvic floor disorders in women.


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