Stress and Anxiety Effects on Overactive Bladder: A Controlled Study

压力和焦虑对膀胱过度活动症的影响：一项对照研究

• 批准号: 10676251
• 负责人: William Stuart Reynolds
• 金额: $ 39.81万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676251
• 关键词: Acute; Adopted; Affect; Animals; Anxiety; Area; Behavior; Behavioral; Bladder; Clinical Trials; Containment; Controlled Study; Coping Behavior; Cross-Sectional Studies; Development; Discipline; Disease; Distress; Ecological momentary assessment; Electronics; Esthesia; Frequencies; Future; Generalized Anxiety Disorder; Genitourinary system; Goals; Health; Human; Hydration status; Hypersensitivity; Impairment; Incontinence; Individual; Interdisciplinary Study; Intervention; Knowledge; Laboratories; Learning; Left; Life; Link; Liquid substance; Maps; Measures; Mediating; Methods; Modeling; Nocturia; Oral; Outcome; Overactive Bladder; Pain Research; Pathway interactions; Patients; Pattern; Persons; Physiological; Procedures; Process; Psychological Factors; Psychological Stress; Psychology; Public Health; Quality of life; Research; Role; Sampling; Scientific Advances and Accomplishments; Self Management; Side; Strategic Planning; Stress; Symptoms; Testing; Time; Travel; Urinary Incontinence; Urology; Woman; acute stress; anxiety symptoms; behavioral impairment; chronic pain; coping; diaries; generalized anxiety; improved; innovation; men; meter; micturition urgency; novel; perceived stress; personalized care; prospective; psychologic; psychological stressor; response; self help; stress reactivity; stress symptom; urinary

PROJECT SUMMARY Overactive bladder (OAB) (i.e. urinary urgency, with or without urgency urinary incontinence, frequency, and nocturia) affects 1 in 7 U.S. men and women and results in substantial impairment to quality of life (QOL). To help self-manage and cope with OAB, many people adopt compensatory bladder behaviors, such as restricting fluids, using containment products, strategic planning and mapping restroom access, and even curtailing activities or travel altogether, which further adversely impact QOL. These behaviors may be driven by anxiety and stress related to urinary urgency and incontinence episodes as well as ensuing distress and embarrassment. Prior research has linked anxiety and OAB: up to 40% of women and 30% of men with OAB also have generalized anxiety disorder. The link between stress and OAB is less studied. In animals, experimental stress can cause OAB-like symptoms and behaviors as well as bladder and somatic hypersensitivity. In limited human studies, women with OAB may have greater physiologic and psychologic stress reactivity, and acute stress may exacerbate urinary urgency. However, how stress impacts on the bladder in the context of OAB or what psychological factors drive compensatory behaviors that impair QOL in OAB remain unknown, as there are no highly-controlled studies of anxiety-OAB links. Understanding these relationships would be a critical advance to individualizing care of patients with OAB. The proposed project will comprehensively investigate for the first time how stress, anxiety and OAB interact, including the impacts on bladder sensitivity, urinary symptoms, and compensatory bladder behaviors. We propose a feedforward loop, whereby increased OAB symptoms increase anxiety (via response to coping with stressful situations), which in turn increases OAB symptoms (via increased bladder sensitivity). We further propose that compensatory behaviors are driven by anxiety-related learning processes that help perpetuate this relationship. We will test our hypotheses in a sample of men and women with OAB and healthy controls. Aim 1 will test the hypothesis that acute, experimentally induced psychological stress will be more strongly associated with increased bladder sensitivity in OAB patients than in controls, using a novel bladder sensation meter with oral hydration and stress induction procedures. Aim will test the hypothesis that psychological stress and anxiety will have concurrent and lagged effects on day-to-day urinary symptoms that are stronger in individuals with OAB than in controls, using an ecological momentary assessment approach (7-day electronic diary) to examine prospective associations between everyday perceived stress, anxiety and urinary symptoms. Aim 3 will test the hypothesis that compensatory behaviors (i.e. coping) used at the time of voiding will be associated with subsequent reductions in anxiety levels, using a 3-day sensation-related bladder diary that captures concurrent bladder behaviors and anxiety symptoms as well as lagged symptoms 30 minutes post-void. Delineating these relationships and patterns will allow for identification of potentially modifiable factors or areas for intervention, which we envision as a future R01 clinical trial submission.

项目摘要 过度活跃的膀胱（OAB）（即尿液紧迫，有或没有紧急尿失禁，频率和 Nocturia）影响了7分之一的美国男性，并导致对生活质量的重大损害（QOL）。到 帮助自我管理并应对OAB，许多人采用补偿性膀胱行为，例如限制 流体，使用遏制产品，战略计划和映射洗手间，甚至限制 活动或旅行，这进一步不利影响QOL。这些行为可能是由焦虑驱动的 以及与尿液紧迫和尿失禁发作以及随之而来的困扰和尴尬有关的压力。 先前的研究已将焦虑和OAB联系在一起：多达40％的女性和30％的OAB的男性也有 普遍的焦虑症。压力和OAB之间的联系较少。在动物中，实验压力 会导致OAB样症状和行为以及膀胱和体细胞超敏反应。在有限的人类中 研究，患有OAB的女性可能具有更大的生理和心理压力反应性，急性压力可能 加剧尿液紧急。但是，在OAB的背景下，压力如何影响膀胱或什么 心理因素驱动损害OAB中QoL的补偿行为仍然未知，因为没有 高度控制的焦虑 - oab链接研究。了解这些关系将是至关重要的 对OAB患者的个性化护理。拟议的项目将首次全面调查 压力，焦虑和OAB如何相互作用，包括对膀胱敏感性，泌尿症状和 补偿性膀胱行为。我们提出了一个前馈循环，从而增加OAB症状 焦虑（通过应对应对压力的情况），进而增加OAB症状（通过增加 膀胱灵敏度）。我们进一步提出，补偿行为是由与焦虑有关的学习驱动的 有助于延续这种关系的过程。我们将在男女样本中检验我们的假设 使用OAB和健康对照。 AIM 1将检验以下假设：急性，实验诱导的心理 与对照组相比，与对照组相比，压力与膀胱敏感性的提高将更紧密，使用 具有口服水合和应力诱导程序的新型膀胱感觉表。 AIM将检验假设 这种心理压力和焦虑将对日常泌尿症状产生同时和滞后的影响 使用生态瞬时评估方法，OAB的个体比对照组更强 （7天电子日记），以检查日常感知的压力，焦虑和 尿症状。 AIM 3将检验以下假设：代偿行为（即应对）在 使用3天的膀胱，空隙将与随后的焦虑水平降低有关 捕获并发膀胱行为和焦虑症状以及滞后症状的日记30分钟 多个后。描述这些关系和模式将允许识别潜在的可修改因素 或干预区域，我们将其视为未来R01临床试验提交的情况。

项目成果

Recurrent urinary tract infection management and prevention techniques among a population-based cohort of women.

基于人群的女性群体中复发性尿路感染的管理和预防技术。

• DOI: 10.1002/nau.25281
• 发表时间: 2023
• 期刊: Neurourology and urodynamics
• 影响因子: 2
• 作者: Gleicher,Stephanie;Sebesta,ElisabethM;Kaufman,MelissaR;Dmochowski,RogerR;Reynolds,WilliamStuart
• 通讯作者: Reynolds,WilliamStuart

Associations Between Unmet Social Needs and Overactive Bladder.

• DOI: 10.1097/ju.0000000000002841
• 发表时间: 2022-11
• 期刊: JOURNAL OF UROLOGY
• 影响因子: 6.6
• 作者: Sebesta, Elisabeth M. M.;Gleicher, Stephanie;Kaufman, Melissa R. R.;Dmochowski, Roger R. R.;Reynolds, W. Stuart
• 通讯作者: Reynolds, W. Stuart

The burdens of incontinence: Quantifying incontinence product usage and costs in women.

• DOI: 10.1002/nau.25007
• 发表时间: 2022-09
• 期刊: Neurourology and urodynamics
• 影响因子: 2

The cumulative effect of unmet social needs on noncancerous genitourinary conditions and severity of lower urinary tract symptoms.

• DOI: 10.1002/nau.25038
• 发表时间: 2022-11
• 期刊: Neurourology and urodynamics
• 影响因子: 2