Functional urological disorders: a sensitized defence response in the bladder–gut–brain axis

Abstract

Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.

Demonstrating the reliability of transdiagnostic mHealth Routine Outcome Monitoring in mental health services using experience sampling technology

“…The ESM procedure allows for patient-reported outcome measures that index adaptive daily life functioning, avoiding potentially biased data collection methods based on clinical interviews conducted by the treating therapist. Self-reports of mental states can have their own biases; the ESM sampling procedure is designed to avoid these risks, which may be especially advantageous in general hospital patients with somatic complaints due to underlying mental conditions [38, 39]. …”

Clinical and Psychosocial Predictors of Urological Chronic Pelvic Pain Symptom Change in 1 Year: A Prospective Study from the MAPP Research Network

“…Presence of more widespread, non-urological problems may be a marker for ‘centralization’ of symptoms thought to involve a greater role of failing central nervous system modulatory mechanisms vs worsening peripheral symptom generators. 22, 23 A significant role for ‘centralization’ has been previously suggested for UCPPS based on the persistence of symptoms in the absence of obvious peripheral pathophysiology and the high degree of co-morbidity with other chronic pain conditions such as fibromyalgia and irritable bowel syndrome (IBS) 24, 25 and affective disorders. 26 …”

The development of a patient‐reported outcome measure for real‐time symptom assessment in a population with functional urologic complaints—A focus group study

“…However, there is a large variety of measurement tools, all retrospective in nature, and often measuring only a few symptoms of the OAB complex. Thus, a new assessment method is needed that fully captures the multifactorial complexity of the OAB syndrome as a whole . “Uromate” may prove to be the assessment method with the potential to overcome these limitations and meet these requirements.…”

“…Additionally, OAB is associated with fibromyalgia, migraine, chronic fatigue, eating disorders, and affective disorders . Recent studies suggest that a spectrum or continuum of functional urological and intestinal disorders across organ systems is present, with a shared underlying central hypersensitivity or alarm falsification pathway . This theory is supported by activation or reduced deactivation of the anterior cingulate cortex that is seen in OAB patients as well as in IBS patients or affective conditions …”