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.
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.
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.
Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
Neurourology and urodynamics. 2023 Dec 11 [Epub ahead of print]
Ariana L Smith, Amanda Berry, Linda Brubaker, Shayna D Cunningham, Sheila Gahagan, Lisa Kane Low, Margaret Mueller, Siobhan Sutcliffe, Beverly R Williams, Sonya S Brady, the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium
Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California, USA., Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA., Department of Pediatrics, University of California, San Diego, California, USA., Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA., Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA., Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA., Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.