Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis

Carsten Leue*, Joanna Kruimel, Desiree Vrijens, Adrian Masclee, Jim van Os, Gommert van Koeveringe

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

51 Citations (Web of Science)

Abstract

Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.

Original languageEnglish
Pages (from-to)153-163
Number of pages11
JournalNature Reviews Urology
Volume14
Issue number3
DOIs
Publication statusPublished - Mar 2017

Keywords

  • IRRITABLE-BOWEL-SYNDROME
  • CHRONIC PELVIC PAIN
  • URINARY-TRACT SYMPTOMS
  • UROPATHOGENIC ESCHERICHIA-COLI
  • EARLY-LIFE ADVERSITY
  • INTERSTITIAL CYSTITIS/PAINFUL BLADDER
  • CHRONIC-FATIGUE-SYNDROME
  • POPULATION-BASED COHORT
  • MAPP RESEARCH NETWORK
  • LOW-COUNT BACTERIURIA

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