The Female Overactive Bladder in our Beverage-Centered Society: An Evolutionary Perspective

Abstract

Abstract Over recent decades, chronic disease has trended upwards, associated with the mismatch between our modern nutritional environment and our paleolithic genome. The beverage industry has exploded in sync with chronic conditions, including bladder symptomatology. This dissertation uses the logic and paradigm of evolutionary medicine to examine the modern beverage culture as a cause of the current high overactive bladder prevalence rates (17-31%, age dependent). A natural experiment exemplar concludes the dissertation with proof of concept that societal-wide influences to hyper-hydrate by drinking beyond thirst influences non-pathological changes to bladder state. The study is a secondary analysis with main outcome measure as void frequency. In this natural experiment, the preventative treatment group is considered to be 40 women who at 8 months postpartum are not breastfeeding and hence not receiving same degree of societal messaging to hyper-hydrate, as compared to 52 breastfeeding women . The preventative treatment group (non-breastfeeding women) show significantly lower daily beverage intake (62.6 oz) than the breastfeeding group (77.6 oz), p = 0.01. Results show a strong trend towards a significantly lower average number of daily voids in the preventative treatment group who have less societal messaging compared to the control group with high societal messaging (6.3 voids/day versus 7.2 voids/day respectively), p = .04. This natural experiment provides first evidence-based proof of concept for the argument that in terms of evolutionary perspective, the new (50 years) cultural milieu of the beverage driven society may be driving the contemporaneous increase in bladder symptoms, and that its prevalence may lessen without conscious individual effort if societal messages to hyper-hydrate (drink beyond thirst) decrease. The dissertation concludes with recommendation for more research to test the theoretical construct that non-pathological but bothersome and costly symptoms of overactive bladder occur when our evolutionarily designed bladder is exposed to the modern beverage driven society.