4. Discussion
OAB symptoms, urinary incontinence
STRESS URINARY INCONTINENCE, SYNDROME, URINARY INCONTINENCE, PATHOPHYSIOLOGY
The present study showed no clear improvements in the majority of OAB symptom parameters in postmenopausal women suffering from OAB following treatment with fermented RCE compared to a placebo. OAB is a complex syndrome, and its pathophysiology is not fully understood [By evaluating the ICIQ-OAB questionnaire, we saw tendencies, though not statistically significant, towards a reduced ICIQ-OAB score (The overall burden and bother of urinary incontinence evaluated by the ICIQ-UI-SF were not improved in either of the groups. A reason for this may be explained by the fact that a large part of the women in our study suffered from stress urinary incontinence (50% in the RCE group and almost 65% in the placebo group), which we do not expect the RCE to be effective against.No improvements in urinary frequency or other voiding parameters from the fluid intake and voiding diary were found in women taking RCE. However, women in the placebo group reported a significantly lower number of micturitions. A similar level of improvement (e.g., reduction of around one void/day) has been observed in the control group in other studies aiming to control OAB symptoms [Overall, we observe an agreement between the responses to the ICIQ-OAB items and parameters reported in the fluid intake and voiding diary. For example, although not statistically significant, a slight increase in urine volume was observed in the RCE group. This change may indicate a tendency toward decreased urgency, as demonstrated in the ICIQ-OAB responses. In contrast, a few observations from the ICIQ-OAB and diary do not agree. In the diary, we find a significant decrease in the numbers of micturitions for the placebo group, but this is not demonstrated in the ICIQ-OAB item 3a. Other clinical studies looking at the effect of isoflavones on symptoms suggestive of OAB are sparse and mainly focus on urinary incontinence or vaginal symptoms. Yet, our results are consistent with previous findings where intake of isoflavones was not associated with improvements in urinary incontinence, frequency, or urgency [There may be multiple reasons why we only detected a limited improvement in bladder symptoms. First, it may be attributed to insufficient ER expression in the bladder. Earlier studies have shown that ER-β is the dominant ER in the bladder [