Stress and Anxiety Effects on Overactive Bladder: A Controlled Study

项目总结 膀胱过度活动(OAB)(即尿急，伴有或不伴有尿失禁、尿频和尿失禁 夜尿症)影响七分之一的美国男性和女性，并导致生活质量(QOL)严重受损。至 帮助自我管理和应对OAB，许多人采取代偿性膀胱行为，如限制 液体，使用遏制产品，战略规划和绘制厕所通道图，甚至减少 活动或旅行，这进一步对生活质量产生不利影响。这些行为可能是由焦虑驱动的。 以及与尿急和大小便失禁发作以及随之而来的痛苦和尴尬有关的压力。 先前的研究已经将焦虑和OAB联系在一起：多达40%的女性和30%的男性OAB也有 广泛性焦虑症。关于压力和OAB之间的联系的研究较少。在动物身上，实验应激 可引起OAB样症状和行为，以及膀胱和躯体过敏。在有限的人类中 研究表明，患有OAB的女性可能有更强的生理和心理应激反应，而急性应激可能 加剧尿液紧迫症。然而，在OAB的背景下，压力对膀胱的影响是什么 心理因素驱动OAB患者损害生活质量的代偿性行为仍不清楚，因为没有 高度受控的焦虑症与OAB联系的研究。了解这些关系将是关键的进步， OAB患者的个体化护理。拟议中的项目将首次全面调查 压力、焦虑和OAB是如何相互作用的，包括对膀胱敏感性、尿路症状和 代偿性膀胱行为。我们提出了一个前馈环路，由此增加的OAB症状增加 焦虑(通过应对压力情况的反应)，这反过来会增加OAB症状(通过增加 膀胱敏感度)。我们进一步提出，补偿行为是由焦虑相关的学习驱动的。 有助于维持这一关系的过程。我们将在男性和女性的样本中检验我们的假设 与OAB和健康对照。目标1将检验这样一种假设，即急性的、实验诱导的心理 与对照组相比，OAB患者的压力与膀胱敏感性增加的相关性更强。 一种新型的具有口服补水和应激诱导程序的膀胱感觉测量仪。AIM将检验这一假设 心理压力和焦虑会对日常的尿路症状产生同步和滞后的影响 使用生态瞬时评估方法，在OAB患者中比对照组更强 (为期7天的电子日记)，以研究日常感知的压力、焦虑和 尿路症状。目标3将检验补偿行为(即应对)在以下情况下使用的假设 排尿将与随后焦虑水平的降低有关，使用3天感觉相关的膀胱 记录并发的膀胱行为、焦虑症状以及滞后症状的日记30分钟 后无效。描绘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，我们设想为未来的R01临床试验提交。

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.