Association Between Fibromyalgia and Lower Urinary Tract Pain and Storage Symptoms in Women: A Systematic Review and Meta‑analysis.

Fibromyalgia (FM), a chronic centralized pain syndrome, has been associated with lower urinary tract pain and lower urinary tract symptoms (LUTS) in women, but quantitative evidence remains limited. We searched PubMed/MEDLINE, Embase, Web of Science Core Collection, and CINAHL from January 1990 to December 2025 for observational studies. Fourteen studies involving 17,139 women were included. Random-effects meta-analysis showed increased odds of lower urinary tract pain (OR = 2.92, 95% CI: 1.41-6.06) and lower urinary tract symptoms (OR = 2.83, 95% CI: 1.98-4.03), but the certainty of evidence was very low. For lower urinary tract pain, the association was concentrated in studies using validated interstitial cystitis/painful bladder syndrome definitions; the clinician-based FM subgroup yielded a more conservative estimate (OR = 1.45, 95% CI: 1.15-1.83), whereas the larger self-reported estimate (OR = 5.84, 95% CI: 2.16-15.79) may have inflated the overall pooled estimate. The overall LUTS association appeared to be driven predominantly by urgency-related storage symptoms, including overactive bladder (OR = 2.65, 95% CI: 1.88-3.74) and urge urinary incontinence (OR = 2.95, 95% CI: 1.05-8.28); no significant association was found for stress urinary incontinence (OR = 1.00, 95% CI: 0.63-1.59). Heterogeneity was substantial for both primary outcomes (I 2 = 79.07% and 79.05%). Outlier exclusion reduced the lower urinary tract pain OR to 1.66, while LUTS heterogeneity remained substantial (I 2 = 73.50%). These findings are preliminary and hypothesis-generating and require confirmation in prospective studies with standardized outcome assessment.