Overactive bladder and fibromyalgia

What is Overactive Bladder? It may also be called sensory bladder or Urgency or Irritable Bladder or neurogenic bladder. These are terms used to describe a bladder condition that causes more frequent and urgent urination. 

This need to urinate originates as a sensation in the bladder when the bladder fills. 

Many people who have fibromyalgia, and other chronic illnesses, do not get these messages.

The fibromyalgia connection with overactive bladder.

In July 2023 we did a Poll on irritable bladder in our Fibromyalgia group asking Do you get increase in urinary urgency or frequency (irritable bladder)? 33 said yes and 3 said no.

In this large 2012 study of 920 people they found overactive bladder (OAB) is associated with Fibromyalgia (FMS). Moreover FMS increases with severity of OAB.

This systematic controlled study in 2021 confirms that fibromyalgia is associated with overactive bladder symptoms. The relatively high prevalence of 93% indicates that overactive bladder is an important urological association of fibromyalgia and should be routinely assessed in these patients.

What goes wrong in Overactive bladder

Several muscles and nerves need to work together for our bladders to hold urine. Nerve muscles go back and forth between the brain and the muscles. If the nerves are damaged the muscles may not get the messages to relax or tighten at the right times. 

While this was not a large survey it does say that irritable bladder is experienced by a large percentage of people with Fibromyalgia.

Causes of Overactive Bladder.

There are many causes and you may have a combination of them:

• Hormonal changes during menopause
• Enlarged prostrate
• Some medications
• Kidney problems
• Herniated disc
• Neurological conditions
• Multiple pregnancies
• Vitamin D deficiency
• Aging
• Diabetes
• Extra weight
• Back or pelvic issues

What you should do if you have symptoms of Overactive bladder.

there are many treatment options so you should ask your doctor for a referal to a urologist if they cannot hel you. Below is an example of what would be the first options for treatment but there are also medications and surgical procedures. 

The following information is from The Urology Group which was founded in 1924, and provides Northern Virginia and Greater Washington area with the most up-to-date urologic care available.

First line treatments: Behavioral Therapy for Overactive Bladder

• Fluids: Normal intake is 64 ounces (two liters) daily.
• Avoid bladder irritants: Trial of Frequency/Urgency Diet, which includes caffeine, alcohol, spicy foods, acidic foods, carbonated beverages. Quit smoking.
• Weight loss: Weight loss of 8% decreases incontinence episodes in half.
• Bladder retraining: Training your bladder to hold urine for longer and learning how to suppress the urge.
• Pelvic Floor Physical Therapy: Four to six week course of therapy to identify and strengthen pelvic floor muscles. This often includes electrical stimulation of the muscles.
• 
  

RESOURCES:

Overactive bladder patient guide PDF from Urology Care Foundation

Overactive bladder assessment tool PDF

Overactive bladder diary PDF

Managing OAB at work and on the go Fact Sheet

SOURCES:

FIBRO CONNECT Facebook group poll.

The association between overactive bladder and fibromyalgia syndrome: a community survey.

The Urology Group First Line Treatments

Urology Care Foundation

What's going on in the Fibromyalgia Brain and Nervous System?

 In 'Key Milestones Contributing to the Understanding of the Mechanisms Underlying Fibromyalgia' two Australian researchers give a fascinating overview of what they consider to be the breakthrough findings in FM.

• Three nerves that transmit pain signals to the spinal cord have been found to be overactive in FM.

• Nerves should calm down and adjust to repeated stimulation, but in a process called windup the pain nerves that get activated in FM stay activated. They also respond more quickly to a stimulus and are apt to fire off spontaneously more.

• Twitchy nerves leading from around the spinal column could explain some of the upper body pain common in FM and the problems with bending, moving etc.

• Two neurotransmitters associated with pain, substance P and glutamate, have been found elevated in FM patients’ brains.

• The brain exerts enormous influence over the amount of pain we feel through a pain inhibition process which can reach all the way down the spinal cord.

• When one part of the body is exposed to pain, our sensitivity to pain in other parts of the body actually reduces. This process – called controlled pain modulation – is due to a pain inhibition process which begins in the brain.

• This process has been shown many times not to be working well in many, but not all, people with FM. Interestingly, although it’s not clear why, the low heart rate variability found in FM is associated with reduced pain inhibition. Mestinon is one drug that has proved helpful for some people with ME/CFS.

• Pain signals are believed to need to pass through a series of checkpoints or gates in order to make it to the brain. Those gates are believed to be opened wider than usual in FM.

• Some researchers, though, think that the pain inhibition process in FM is working just fine. They believe its signals are being overridden by a constant stream of pain signals emanating from the body.

• Brain scans show more problems. Blood flows to various parts of the brain are altered. The pain processing areas of the brain are hyperactive. Even when the brain is resting, it still maintains its tight connection to those areas.

• The authors of this study believe that widespread neuroinflammation could explain all the symptoms in FM.

• With so many validated issues in just the brain and nervous systems of FM patients, it seems incredible that any doctor worth his or her salt could dismiss this disease.

Thank you so much to Cort Johnson at Health Rising for all he does to help people with fibromyalgia, ME and CFS understand the scientific side of things. The above is the gist of one of his great articles so if you want to read the full explanation of this 2020 research please visit Cort's site. His article is called 'Wound up, Overheated and Tweaked: A Look at the Fibromyalgia Brain and Nervous System.'

Blood biomarkers in patients with fibromyalgia

Fibromyalgia is a complex chronic pain condition. Because its symptoms are nonspecific it is difficult to diagnose.

There have been talks of a blood test for diagnosing fibromyalgia but unfortunately, the final stages of the clinical trials were never completed and the test is surrounded by controversy. Many people who do research into fibromyalgia dismiss the blood test. I have reached out to a few but at this point have had no responses.

According to the research study I am reporting today no objective test exists to confirm its diagnosis. This is of January 2, 2022. 

One potential diagnostic measure could be a blood test that showed biomarkers. This would be a way of detecting if someone had fibromyalgia through a blood test. This would provide an objective medical sign as opposed to how a person feels. Having a biomarker for Fibromyalgia would be a major step forward in both its diagnosis and acceptance. 

AIMS OF THE STUDY: This systematic review and meta-analysis aimed to review studies assessing blood biomarkers’ levels in patients with FM compared with a healthy control group. 

METHODS: 

• A systematic search of the PubMed, MEDLINE, EMBASE, and PsycINFO databases.
• Fifty-four studies reporting the levels of biomarkers in blood in patients with FM were included. 
• Data were extracted, and the methodological quality of the studies was assessed independently by 2 researchers.
• 40 of these studies were analyzed using a random-effects model. The rest were not included as they were not comparable given differences in methods and other reasons.

RESULTS: 

The meta-analysis showed that patients with FM had significantly different levels of certain blood markers compared with the healthy control groups:

• lower levels of interleukin-1 β 
• higher levels of IL-6, IL-8, tumor necrosis factor-alpha, interferon-gamma, C-reactive protein, and brain-derived neurotrophic factor. 

CONCLUSION: The researchers could not support the notion that these blood biomarkers are specific biomarkers of FM. Our literature review, however, revealed that these same individual biomarkers may have the potential role of identifying underlying pathologies or other conditions that often coexist with FM. Future research is needed to evaluate the potential clinical value for these biomarkers while controlling for the various confounding variables.

MY OPINION: I am pleased that there is continued research into Fibromyalgia and also many clinical trials are being conducted, even during the last two years. Research moves slowly but at least this is heading in the right direction. 

You can read some of the other research, into fibromyalgia, I have reported on here.

SOURCE: 

Potential role of blood biomarkers in patients with fibromyalgia: a systematic review with meta-analysis.

By Dinesh Kumbhare, Samah Hassan, Dion Diep, Felipe C K Duarte, Jasper Hung, Sreekant Damodara, Daniel W D West, P Ravi Selvaganapathy. Jan 3, 2022

Higher Risk for Sjögren’s Syndrome in Patients With Fibromyalgia

Medical professionals, and those with chronic illness, have noticed that many people with Fibromyalgia also get Sjögren’s Syndrome. A study is explained here that works out whether this is a reality. 

Sjögren’s Syndrome is an autoimmune condition that attacks the mucous membranes of the body. It is a systemic condition that can affect many parts of the body including the joints, lungs, and glands. 

Fibromyalgia typically causes multifocal and migratory pain and may be accompanied by comorbid symptoms associated with the central nervous system, particularly fatigue and sleep disturbances  

Sjögren’s syndrome is caused by inflammation of the exocrine glands.

The cause of Fibromyalgia is not known. There are suggestions that it may be autoimmune or a central nervous system disorder. 

There are common symptoms shared by fibromyalgia and Sjögren’s syndrome which include fatigue, pain, dryness of the mouth and/or eyes, and insufficient salivary secretions in the mouth.

Having both Fibromyalgia and Sjögren’s syndrome can make the autoimmune disease more severe. There is a connection between fibromyalgia and many forms of inflammatory arthritis, including ankylosing spondylitis, (AS) axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA), and rheumatoid arthritis (RA), as well as Sjögren’s. Having these with fibromyalgia appears to affect assessment of disease severity in these conditions, particularly patient-reported outcome measures, and may influence response to treatment. (The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis. S Steven Zhao, S J Duffield, N J Goodson).

The objectives of this study were to evaluate whether fibromyalgia is associated with a higher risk of getting Sjögren’s syndrome and to further evaluate the risk of Sjögren’s syndrome between different ages and men and women.

This study, Higher Risk for Sjögren’s Syndrome in Patients With Fibromyalgia: A Nationwide Population-Based Cohort Study, comes to the conclusion that people with fibromyalgia, have a higher risk for developing Sjögren’s syndrome. It concludes that doctors "should be aware of the bidirectional association between the two diseases", and its impact on both diagnosis and disease activity. 

METHODS: The study was done on a large Taiwanese database. Of the 149,706 patients whose data were extracted from the Longitudinal Health Insurance Database (LHID) of the Taiwan National Health Insurance, 74,853 subjects had fibromyalgia and 74,853 control subjects were without fibromyalgia. To be coded as having fibromyalgia the patients had to have visited a hospital and be treated with fluoxetine, duloxetine, milnacipran, pregabalin, amitriptyline or tramadol after the diagnosis of fibromyalgia. For patients with Sjögren’s syndrome, all submitted information was assessed by a review committee in accordance with the criteria of the American-European Consensus Group. 74,853 fibromyalgia patients and 74,853 non-fibromyalgia control patients were included in this study. The proportions of male and female patients were the same in both cohorts.

RESULTS:  

More patients with fibromyalgia in the case cohort had comorbidities and took medication compared to patients without fibromyalgia in the control cohort.

The cumulative incidence curve for Sjögren’s syndrome in fibromyalgia patients was significantly higher than that for non-fibromyalgia patients. 

The incidence rates of Sjögren’s syndrome in patients with and without fibromyalgia were 3.39 and 1.24 per 10,000 person-years, respectively. After adjustment, patients with fibromyalgia had double the risk of Sjögren’s syndrome compared to controls. 

The relationship between age and Sjögren’s syndrome was not significant after controlling for gender and comorbidities. Compared to men, the risk for Sjögren’s syndrome in women was 3.56 times higher. 

Patients with chronic urticaria, osteoporosis, ankylosing spondylitis, depression, or sleep disorder had an increased risk for developing Sjögren’s syndrome compared to those without these comorbidities.

CONCLUSION: In conclusion, both males and females with fibromyalgia are at higher risk of developing Sjögren’s syndrome than the general population without fibromyalgia, especially adults aged 20-49 years. For clinicians managing patients with either fibromyalgia or Sjögren’s syndrome, the potential association between these two diseases should be considered.

GLOSSARY:

Cohort - a group of people with a shared characteristic.

Comorbidities - diseases or medical conditions that are present in one person at the same time.

Cumulative incidence estimates the risk of someone developing a disease.

Migratory - Moving from one part to another. 

Multifocal - arising from or occurring in more than one location. 

SOURCES: 

Higher Risk for Sjögren’s Syndrome in Patients With Fibromyalgia: A Nationwide Population-Based Cohort Study

The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis. 

RESOURCES FOR YOU:

You may also be interested in another article, I have written, about Sjogren's syndrome and Fibromyalgia. It talks about fatigue in both conditions. 

If you are on Facebook check out Sjogren's blog for daily information about Sjogren's from thousands of people living with it.

If you are looking for fibromyalgia information please join FIBRO CONNECT our private Facebook group.

Sjogren's Syndrome Info Newsletter is a weekly newsletter with tips about Sjogren's and you can sign up here. 

Trial results of new treatment for Fibromyalgia targeting non-restorative sleep

Here I explain new data that was presented at the American College of Rheumatology (ACR) 2021 Convergence showing that a sublingual tablet may reduce central sensitization in people with fibromyalgia who have non-restorative sleep. 

According to the Institute for ChronicPain central sensitization is a condition of the nervous system that is associated with the development and maintenance of chronic pain. When central sensitization occurs, the nervous system goes through a process called wind-up and gets regulated in a persistent state of high reactivity.

Fibromyalgia and GERD and one proven home treatment

I am a great believer in doing everything I can to support myself in reducing symptoms. Sometimes there are easy things we can do instead of taking medications or as well as taking medications. Things that are actually evidence-based and therefore proven to work. This post discusses GERD and one such important and studied simple approach to reducing GER and GERD symptoms. 

Fibromyalgia often coexists with gastroesophageal reflux disease (GERD). A connection has been made through research into 35,000 patients discovering that people with fibromyalgia have a high incidence of GERD and also that there is a high percentage of people who have GERD that go on to later develop fibromyalgia. 

WHAT IS GERD?

Did you know there is GER and GERD? According to NIDDK Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus. Doctors also call GER  acid indigestion, acid reflux, heartburn, or reflux. 

Gastroesophageal reflux disease (GERD) is a more severe and long-lasting condition in which GER causes repeated symptoms or leads to complications over time.

WHAT ARE THE SYMPTOMS OF GERD?

• acid reflux
• heartburn
• some people have GERD without heartburn
• chest pain
• pain when swallowing
• difficulty swallowing
• nausea
• chronic cough
• a hoarse voice
• bad breath

Heartburn is that uncomfortable burning feeling or pain in your chest that can move up to your neck and throat. 

LONG TERM GERD SYMPTOMS

On-going GERD can lead to more serious problems such as Esophagitis, an inflammation in the lining of the esophagus; Barrett's esophagus which changes the cells in the lining of the esophagus and can lead to cancer of the esophagus; and strictures that can interfere with eating and drinking due to scarring and narrowing of the esophagus. These are all the reasons why you must have the help of a medical professional if you have GERD.

ONE PROVEN HOME TREATMENT FOR GERD

It has been proven that eating 3 hours before lying down reduces the symptoms of GERD in the following study aptly named Association between dinner-to-bed time and gastroesophageal reflux disease.

Objective: It is generally recommended that patients with gastroesophageal reflux disease (GERD) refrain from eating within 3 hours of going to sleep. In addition to a remarkable lack of supporting clinical evidence, whether GERD patients have shorter dinner-to-bed time is unknown. This study was designed to determine a possible association between dinner-to-bed time and GERD, compared with healthy adults.

Conclusion: In this matched case-control study, shorter dinner-to-bed time was significantly associated with an increased odds ratio (OR) for GERD.

This is why when our doctor tells us to refrain from eating 3 hours before bedtime we should actually do it as it can reduce GERD. You would have to agree that it is a strategy that we can do at no extra cost to us and probably has other health benefits.

I'm sure there are many other proven strategies for GERD and I will investigate them and report back here.

Are you following your doctors' instructions for GERD and have they helped? Let's chat in the comments.

RESOURCES

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Cleveland Clinic

The study: Association between dinner-to-bed time and gastroesophageal reflux disease.

Epsom salt baths for fibromyalgia pain

 Soak on it

More and more research indicates that Fibromyalgia patients suffer from magnesium deficiency. Magnesium is extremely important to many functions in the body, and a deficiency can cause several of the symptoms associated with Fibromyalgia. There are great benefits in taking an Epsom salt bath, rich in hydrated magnesium sulfate, which is easily absorbed through the skin.

Clinical trials into Fibromyalgia 2021

 August 13, 2021. 

Here is a 2021 list of some current trials into fibromyalgia, and related conditions, that are recruiting for participants in various parts of the world. As the byline of this blog is 'Discovering what works to help Fibromyalgia' it would be remiss of me to not include information about clinical trials into fibromyalgia. I have in fact posted about trials previously... Here is a post I did about them in 2020. 

Clinical trials can help us discover and confirm so many things about a condition -  it causes, connections, preventatives and treatments. 

What has helped my migraines

I am writing about my experience with what has reduced my migraines to help others who are living with migraine. Obviously my experience does not replace the advise of a medical expert. What I am suggesting has been suggested by a neurologist and you can run it by your doctor. 

Fibromyalgia explained by the experts (what 12 organisations say)

Here is what the reliable and recommended experts say to explain what fibromyalgia is. I thought it would be good to put them altogether here in one place.

My doctor dilemma when living with chronic illness

Something that has been coming up for me recently has been why my GP does not give me the support that I need. Here I am exploring my feelings about it as I believe it may be something that helps other people living with chronic illness. 

Treating Fibromyalgia migraines

Lately I have been experience more migraines than normal and any extra pain when living with fibromyalgia is upsetting. This sent me in search of both information and help about migraine relief and I have found some wonderful resources that I wanted to share for anyone experiencing migraines.

Image thanks to to Nik Shuliahin

What is the Fibromyalgia Impact Questionnaire (FIQ)

The Fibromyalgia Impact Questionnaire is something that I encounter a lot when reviewing research into fibromyalgia as it is often used in studies to see how something affects a person's fibromyalgia symptoms. This explains what it is, what it scores and how it is measured and you can also get a copy. 

Can fibromyalgia affect your hand skills?

Many people mention that they have reduced hand skills and more hand pain when they have fibromyalgia. This includes skills such as handwriting, chopping vegetables, opening cans and using keys to open the door.  It includes pain in the joints, nerves and muscles of the hand and wrist. Find out more from this summary on a study done into fibro and hand skills.