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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Goldstein LA, Jakubowski KP, Huang AJ, Seal KH, Maguen S, Inslicht SS, Byers AL, Gibson CJ. Lifetime history of interpersonal partner violence is associated with insomnia among midlife women veterans. Menopause 2023; 30:370-375. [PMID: 36753121 PMCID: PMC10038868 DOI: 10.1097/gme.0000000000002152] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Over a third of women in the United States report a lifetime history of intimate partner violence. Although a recent review found that intimate partner violence is related to poor subjective sleep, the majority of studies involved reproductive-aged women and used suboptimal measures of interpersonal violence and/or insomnia. We examined the relationship between lifetime intimate partner violence and current clinical insomnia in a cross-sectional sample of midlife women veterans. METHODS Cross-sectional data were drawn from the Midlife Women Veterans Health Survey. Women Veterans (N = 232) aged 45 to 64 years enrolled in Department of Veterans Affairs health care in Northern California completed an adapted version of the Extended-Hurt, Insult, Threaten, Scream to assess lifetime history of intimate partner violence (screening threshold score and any physical, sexual, and psychological intimate partner violence) and the Insomnia Severity Index to assess current insomnia. RESULTS In multivariable analyses, lifetime history of intimate partner violence was associated with twofold to fourfold odds of current clinical insomnia, including overall intimate partner violence (odds ratio, 3.24; 95% confidence interval, 1.57-6.69), physical intimate partner violence (odds ratio, 2.01; 95% confidence interval, 1.09-3.70), psychological intimate partner violence (odds ratio, 3.98; 95% confidence interval, 2.06-7.71), and sexual intimate partner violence (odds ratio, 2.09; 95% confidence interval, 1.08-4.07). CONCLUSIONS Lifetime history of intimate partner violence is common and may be associated with clinical insomnia during midlife. Findings highlight the importance of screening midlife women for intimate partner violence and recognizing the potential role of this traumatic exposure on women's health.
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Selai C, Elmalem MS, Chartier-Kastler E, Sassoon N, Hewitt S, Rocha MF, Klitsinari L, Panicker JN. Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms. Int Urogynecol J 2023; 34:635-653. [PMID: 35751671 PMCID: PMC9947020 DOI: 10.1007/s00192-022-05277-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. METHODS A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. RESULTS Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. CONCLUSIONS The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.
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Affiliation(s)
- Caroline Selai
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Michael S Elmalem
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
| | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpêtrière, Medical School, Sorbonne University, AP-HP, 47-83, Bd de l'Hôpital, 75651, Paris cedex 13, France
| | - Natalia Sassoon
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sam Hewitt
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Maria Francisca Rocha
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Larisa Klitsinari
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
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Sebesta EM, Gleicher S, Kaufman MR, Dmochowski RR, Reynolds WS. Associations Between Unmet Social Needs and Overactive Bladder. J Urol 2022; 208:1106-1115. [PMID: 36106450 PMCID: PMC9987581 DOI: 10.1097/ju.0000000000002841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE There is growing interest in how social determinants of health may explain relationships between social conditions and health. Overactive bladder is common in the United States, posing a significant public health burden. It was the goal of the present study to assess whether overactive bladder was associated with unmet social needs in a large, cross-sectional sample of patients. MATERIALS AND METHODS A community-based sample of adults was recruited electronically to complete questionnaires on clinical and demographic information, urinary symptoms and unmet social needs. Multivariable logistic regression was used to assess for association between overactive bladder and multiple unmet social needs. RESULTS The sample of 3,617 participants had a mean±SD age of 47.9±17.3 years. The majority of participants identified as White, non-Hispanic (83.5%), and female (77.6%). A total of 1,391 patients (38.5%) were found to have overactive bladder. The presence of overactive bladder was associated with numerous unmet social needs, including housing instability, food insecurity, worry about utilities, lack of transportation, skipping medical appointments, needing legal help, stress in personal relationships, worry about toilet access and plumbing at home, and lack of social supports. On multivariable analysis adjusting for multiple covariates, all associations between overactive bladder and social needs remained significant. CONCLUSIONS Multiple unmet social needs were associated with overactive bladder, which may have implications for the overall management of overactive bladder patients. It is important for providers to consider these unmet social needs of patients, as highlighting and addressing these factors hopefully can help improve care of individuals with overactive bladder.
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Affiliation(s)
- Elisabeth M. Sebesta
- Department of Urology, Division of Reconstructive Urology and Pelvic Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephanie Gleicher
- Department of Urology, Division of Reconstructive Urology and Pelvic Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R. Kaufman
- Department of Urology, Division of Reconstructive Urology and Pelvic Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R. Dmochowski
- Department of Urology, Division of Reconstructive Urology and Pelvic Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - W. Stuart Reynolds
- Department of Urology, Division of Reconstructive Urology and Pelvic Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Demaree D, Lindner P, Tarsi E, Chescheir NC. Connect the Dots—November 2020. Obstet Gynecol 2020; 136:1059-1060. [DOI: 10.1097/aog.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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