Stress and Anxiety Effects on Overactive Bladder: A Controlled Study

项目摘要 膀胱过度活动症（OAB）（即尿急，伴有或不伴有尿急性尿失禁，尿频， 在美国，每7名男性和女性中就有1人患有此病，并导致生活质量（QOL）严重受损。到 为了帮助自我管理和科普OAB，许多人采取了补偿性膀胱行为，例如限制 液体，使用密封产品，战略规划和绘制洗手间通道，甚至减少 活动或旅行，这进一步对QOL产生不利影响。这些行为可能是由焦虑驱动的 以及与尿急和失禁发作相关的压力以及随之而来的痛苦和尴尬。 先前的研究已经将焦虑与OAB联系起来：高达40%的女性和30%的男性OAB也有 广泛性焦虑症压力和OAB之间的联系研究较少。在动物中，实验压力 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 研究表明，OAB女性可能有更大的生理和心理应激反应，急性应激可能 加剧尿急。然而，在OAB的背景下，压力如何影响膀胱， 影响OAB患者生活质量的补偿行为的心理因素尚不清楚， 焦虑与OAB关系的高度对照研究了解这些关系将是一个关键的进步， OAB患者的个性化护理。拟建项目将首次全面排查 压力、焦虑和OAB如何相互作用，包括对膀胱敏感性、泌尿系统症状的影响， 膀胱代偿行为我们提出了一个前馈回路，从而增加OAB症状增加 焦虑（通过应对压力情况的反应），这反过来又增加了OAB症状（通过增加 膀胱敏感性）。我们进一步提出补偿行为是由焦虑相关的学习驱动的 有助于维持这种关系的过程。我们将在男性和女性的样本中测试我们的假设 OAB和健康对照组。目的1将检验急性实验诱导的心理学 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， 具有口服水化和压力诱导程序的新型膀胱感觉计。Aim将检验假设 心理压力和焦虑会对日常泌尿系统症状产生并发和滞后影响 使用生态瞬时评估方法， （7天电子日记），以检查日常感知压力，焦虑和 泌尿系统症状目标3将检验以下假设，即： 排尿将与随后的焦虑水平降低相关，使用3天的感觉相关膀胱 记录并发膀胱行为和焦虑症状以及滞后症状30分钟的日记 后无效。描述这些关系和模式将允许识别潜在的可修改因素 或干预领域，我们设想将其作为未来的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.