Correlation between psychological stress levels and the severity of overactive bladder symptoms

Abstract

BackgroundThe relationship between psychological stress and interstitial cystitis/bladder pain syndrome (IC/BPS) has been well described. Even though there is some overlapping of symptoms between overactive bladder (OAB) and IC/BPS, there have been very few studies that specifically investigated the relationship between psychological stress and urinary symptoms in OAB patients who do not have pelvic pain. Here we examined the relationship between psychological stress levels and the severity of overactive bladder (OAB) symptoms.MethodsPatients diagnosed with OAB (n=51), IC/BPS (n=27), and age-matched healthy controls (n=30) participated in a case control study that inquired about their psychological stress levels using the perceived stress scale (PSS). PSS reported by the three patient groups were compared. Among OAB patients, their responses on the PSS was correlated to OAB symptoms using the following questionnaires: 1) international consultation on incontinence – urinary incontinence (ICIQ-UI), 2) international consultation on incontinence – overactive bladder (ICIQ-OAB), 3) OAB-q short form, 4) urogenital distress inventory (UDI-6), 5) incontinence impact questionnaire (IIQ-7), 6) urgency severity scale (USS), 7) numeric rating scales of urgency symptom, and 8) frequency symptom. Spearman’s correlation tests were performed to examine the relationship between psychological stress levels and the severity of OAB symptoms.ResultsOAB patients reported psychological stress levels that were as high as IC/BPS patients (median 17.0 versus 18.0, p=0.818, Wilcoxon sum rank test), and significantly higher than healthy controls (17.0, versus 7.5, p=0.001). Among OAB patients, there was a positive correlation between perceived stress levels and urinary incontinence symptoms (ICIQ-UI, Spearman’s correlation coefficient=0.39, p=0.007), and impacts on quality of life (UDI-6, IIQ-7, OAB-q quality of life subscale; Spearman’s correlation coefficient=0.32, 0.31, 0.39, and p=0.028, 0.005, 0.029, respectively). No significant correlation was observed between perceived stress levels and urgency or frequency symptoms (ICIQ-OAB, USS, numeric ratings of urgency and frequency).ConclusionsOAB patients reported psychological stress levels that were as high as IC/BPS patients, and significantly higher than healthy controls. There was a positive correlation between perceived stress levels and urinary incontinence symptoms, and its impacts on quality of life among OAB patients.

The Relationship Between Anxiety and Overactive Bladder or Urinary Incontinence Symptoms in the Clinical Population

“…However in previous studies we have also examined other psychosocial issues such as stress levels and exposure to childhood sexual trauma in the OAB population. 17,29 Collectively our studies demonstrated the significant psychosocial morbidities experienced by OAB patients. It is possible that psychosocial factors may cause, maintain, and modulate OAB/incontinence and other lower urinary tract symptoms (LUTS) through these shared biological pathways.…”

Sleep Disturbance and Fatigue Are Associated With More Severe Urinary Incontinence and Overactive Bladder Symptoms

“…We have also previously shown that higher anxiety symptoms, depressive symptoms, and psychological stress levels are associated with more severe UI/OAB symptoms. 18–20 Feeling sleep deprived and exhausted may disrupt daily functioning, decrease daytime alertness, impair coping skills and cognitive function, making it more difficult for UI/OAB patients to plan their daily routine to mitigate the effects of UI/OAB (e.g., bathroom mapping, pelvic floor exercises). Sleep disturbance has also been shown to be a significant risk factor for cardiovascular and metabolic disorders (e.g., obesity, diabetes), 3 and the literature available to date appears to support a link between metabolic disorders and OAB.…”

A Stress-Related Peptide Bombesin Centrally Induces Frequent Urination through Brain Bombesin Receptor Types 1 and 2 in the Rat

“…In addition, patients with bladder pain syndrome reported that stress worsens their symptoms (Lutgendorf et al, 2000;Rothrock et al, 2001), and Lai et al (2015) recently reported that there was a positive correlation between stress levels and severity of overactive bladder symptoms. Stress-related information is conveyed to the brain, which recruits neuronal and neuroendocrine systems for adaptation to stressful conditions (Ulrich- Lai and Herman, 2009); therefore, bladder dysfunction characterized by increased urinary frequency and urgency can share complex interactions of neuronal and hormonal factors in the brain.…”