Chronic psychological stress and lower urinary tract symptoms.
Russ Chess-WilliamsCatherine McDermottDonna J SellersEliza G WestKylie A MillsPublished in: Lower urinary tract symptoms (2021)
It is well established that lower urinary tract symptoms (LUTS), particularly urinary urgency and incontinence, cause stress and anxiety for patients. However, there is mounting evidence that the relationship between these two factors is bidirectional and that chronic psychological stress itself can result in the development of symptoms such as urinary frequency, urgency, incontinence, and pelvic pain. This review considers the evidence that such a relationship exists and reviews the literature from clinical and animal studies to identify some of the mechanisms that might be involved. Inflammatory responses induced by chronic stress appear to offer the strongest link to bladder dysfunction. There is overwhelming evidence, both in patients and animal models, for a release of pro-inflammatory cytokines and chemokines during periods of chronic stress. Furthermore, cytokines have been shown to cause bladder dysfunction and pain via actions in the central nervous system and locally in the bladder. In the brain and spinal cord, pro-inflammatory cytokines influence the regulation of micturition pathways by corticotropin-releasing factor (CRF) and its receptors, while peripherally cytokines affect bladder function, directly causing detrusor hypertrophy and afferent nerve hypersensitivity. There is little information on which treatments may have most benefit for stressed/anxious patients with LUTS, but animal studies suggest traditional drugs for overactive bladder (solifenacin, mirabegron) are more effective on LUTS than anxiolytic drugs (fluoxetine, imipramine). The preliminary preclinical data for CRF receptor antagonists is not consistent. A clearer understanding of the mechanisms involved in stress-induced LUTS should provide a basis for improved treatment of this condition.
Keyphrases
- lower urinary tract symptoms
- benign prostatic hyperplasia
- stress induced
- spinal cord injury
- end stage renal disease
- spinal cord
- newly diagnosed
- chronic kidney disease
- neuropathic pain
- chronic pain
- drug induced
- oxidative stress
- prognostic factors
- pain management
- sleep quality
- systematic review
- patient reported outcomes
- randomized controlled trial
- depressive symptoms
- anti inflammatory
- stem cells
- healthcare
- mesenchymal stem cells
- electronic health record
- big data
- rectal cancer
- data analysis
- white matter
- botulinum toxin
- patient reported