Skip to main content

Advertisement

Log in

UROPSYCHIATRY: The Relationship Between Overactive Bladder and Psychiatric Disorders

  • Overactive Bladder (A Klausner, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

It has been informally observed that patients attending urology clinics specializing in overactive bladder and incontinence have high rates of psychiatric conditions. Hence, the evolution of the term “uropsychiatry” that describes the association between overactive bladder and incontinence with common psychiatric conditions including depression, anxiety, and sexual abuse. Epidemiologic and case-control studies have established links between these conditions. In addition, basic science and clinical pharmacologic studies of antidepressants and atypical antipsychotics provide evidence that dysregulation of neurotransmitters including norepinephrine, serotonin, and corticotropin releasing factor may be important in the pathophysiology underlying uropsychiatric disorders. Improved understanding of these complex interactions may help in the identification of novel targets that lead to improved treatments for patients with both urologic and psychiatric conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Engel WJ. Uropsychiatry. J Mich State Med Soc. 1964;63:273–7.

    PubMed  CAS  Google Scholar 

  2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.

    Article  PubMed  Google Scholar 

  3. Coyne KS, Sexton CC, Vats V, Thompson C, Kopp ZS, et al. National community prevalence of overactive bladder in the United States stratified by sex and age. Urology. 2011;77(5):1081–7.

    Article  PubMed  Google Scholar 

  4. Diokno AC, Burgio K, Fultz NH, Kinchen KS, Obenchain R, et al. Medical and self-care practices reported by women with urinary incontinence. Am J Manag Care. 2004;10(2 Pt 1):69–78.

    PubMed  Google Scholar 

  5. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trondelag. Scand J Prim Health Care. 2002;20(2):102–7.

    PubMed  Google Scholar 

  6. Penning-van Beest FJ, Sturkenboom MC, Bemelmans BL, Herings RM. Undertreatment of urinary incontinence in general practice. Ann Pharmacother. 2005;39(1):17–21.

    Article  PubMed  Google Scholar 

  7. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.

    Article  PubMed  Google Scholar 

  8. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    Article  PubMed  Google Scholar 

  9. Melville JL, Delaney K, Newton K, Katon W. Incontinence severity and major depression in incontinent women. Obstet Gynecol. 2005;106(3):585–92.

    Article  PubMed  Google Scholar 

  10. Felde G, Bjelland I, Hunskaar S. Anxiety and depression associated with incontinence in middle-aged women: a large Norwegian cross-sectional study. Int Urogynecol J. 2012;23(3):299–306.

    Article  PubMed  Google Scholar 

  11. • Melville JL, Fan MY, Rau H, Nygaard IE, Katon WJ. Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample. Am J Obstet Gynecol. 2009;201(5):490 e1–7. This article uses serial interviews to clarify the temporal relationship between depression and urinary incontinence. It provides evidence that depression leads to an increased likelihood of developing incontinence.

    Article  Google Scholar 

  12. • Bogner HR, O'Donnell AJ, de Vries HF, Northington GM, Joo JH. The temporal relationship between anxiety disorders and urinary incontinence among community-dwelling adults. J Anxiety Disord. 2011;25(2):203–8. This article uses serial interviews to clarify the temporal relationship between anxiety and urinary incontinence. It provides evidence that individuals with baseline anxiety have an increased likelihood of developing incontinence.

    Article  PubMed  Google Scholar 

  13. Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(3):352–60.

    Article  PubMed  Google Scholar 

  14. Coyne KS, Kaplan SA, Chapple CR, Sexton CC, Kopp ZS, et al. Risk factors and comorbid conditions associated with lower urinary tract symptoms: EpiLUTS. BJU Int. 2009;103 Suppl 3:24–32.

    Article  PubMed  Google Scholar 

  15. Zorn BH, Montgomery H, Pieper K, Gray M, Steers WD. Urinary incontinence and depression. J Urol. 1999;162(1):82–4.

    Article  PubMed  CAS  Google Scholar 

  16. •• Coyne KS, Kvasz M, Ireland AM, Milsom I, Kopp ZS, et al. Urinary incontinence and its relationship to mental health and health-related quality of life in men and women in Sweden, the United Kingdom, and the United States. Eur Urol. 2012;61(1):88–95. This article looks at the association of both depression and anxiety with sub-groups of lower urinary tract symptoms in individuals of both genders. It is a very large population-based study with data from Europe and the United States.

    Article  PubMed  Google Scholar 

  17. Mehta KM, Simonsick EM, Penninx BW, Schulz R, Rubin SM, et al. Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings from the health aging and body composition study. J Am Geriatr Soc. 2003;51(4):499–504.

    Article  PubMed  Google Scholar 

  18. Bogner HR, Gallo JJ, Swartz KL, Ford DE. Anxiety disorders and disability secondary to urinary incontinence among adults over age 50. Int J Psychiatry Med. 2002;32(2):141–54.

    Article  PubMed  Google Scholar 

  19. Lutgendorf SK, Kreder KJ, Rothrock NE, Ratliff TL, Zimmerman B. Stress and symptomatology in patients with interstitial cystitis: a laboratory stress model. J Urol. 2000;164(4):1265–9.

    Article  PubMed  CAS  Google Scholar 

  20. Macaulay AJ, Stern RS, Stanton SL. Psychological aspects of 211 female patients attending a urodynamic unit. J Psychosom Res. 1991;35(1):1–10.

    Article  PubMed  CAS  Google Scholar 

  21. Koss MP, Gidycz CA, Wisniewski N. The scope of rape: incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. J Consult Clin Psychol. 1987;55(2):162–70.

    Article  PubMed  CAS  Google Scholar 

  22. Leserman J. Sexual abuse history: prevalence, health effects, mediators, and psychological treatment. Psychosom Med. 2005;67(6):906–15.

    Article  PubMed  Google Scholar 

  23. Suris A, Lind L. Military sexual trauma: a review of prevalence and associated health consequences in veterans. Trauma Violence Abuse. 2008;9(4):250–69.

    Article  PubMed  Google Scholar 

  24. •• Klausner AP, Ibanez D, King AB, Willis D, Herrick B, et al. The influence of psychiatric comorbidities and sexual trauma on lower urinary tract symptoms in female veterans. J Urol. 2009;182(6):2785–90. This article highlights extremely high rates of psychiatric comorbidities and sexual abuse in women veterans with incontinence/overactive bladder. The authors use validated instruments to show that quality of life impact from a similary degree of urinary symptoms is worse in patients with a history of psychiatric disorders and abuse and also identifies a history of miscarriages as an independent risk factor for greater quality of life impact from incontinence.

    Article  PubMed  Google Scholar 

  25. Dingle K, Alati R, Clavarino A, Najman JM, Williams GM. Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study. Br J Psychiatry. 2008;193(6):455–60.

    Article  PubMed  Google Scholar 

  26. Davila GW, Bernier F, Franco J, Kopka SL. Bladder dysfunction in sexual abuse survivors. J Urol. 2003;170(2 Pt 1):476–9.

    Article  PubMed  Google Scholar 

  27. Jundt K, Scheer I, Schiessl B, Pohl K, Haertl K, et al. Physical and sexual abuse in patients with overactive bladder: is there an association? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(4):449–53.

    Article  PubMed  Google Scholar 

  28. Drossman DA, Leserman J, Nachman G, Li ZM, Gluck H, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113(11):828–33.

    PubMed  CAS  Google Scholar 

  29. Lee KS, Na YG, Dean-McKinney T, Klausner AP, Tuttle JB, et al. Alterations in voiding frequency and cystometry in the clomipramine induced model of endogenous depression and reversal with fluoxetine. J Urol. 2003;170(5):2067–71.

    Article  PubMed  CAS  Google Scholar 

  30. Sweeney DD, Chancellor MB. Treatment of stress urinary incontinence with duloxetine hydrochloride. Rev Urol. 2005;7(2):81–6.

    PubMed  Google Scholar 

  31. Hunsballe JM, Djurhuus JC. Clinical options for imipramine in the management of urinary incontinence. Urol Res. 2001;29(2):118–25.

    Article  PubMed  CAS  Google Scholar 

  32. Ohmura Y, Yoshioka M. The roles of corticotropin releasing factor (CRF) in responses to emotional stress: is CRF release a cause or result of fear/anxiety? CNS Neurol Disord Drug Targets. 2009;8(6):459–69.

    Article  PubMed  CAS  Google Scholar 

  33. Binder EB, Nemeroff CB. The CRF system, stress, depression and anxiety-insights from human genetic studies. Mol Psychiatry. 2010;15(6):574–88.

    Article  PubMed  CAS  Google Scholar 

  34. Holsboer F, Ising M. Central CRH system in depression and anxiety—evidence from clinical studies with CRH1 receptor antagonists. Eur J Pharmacol. 2008;583(2–3):350–7.

    Article  PubMed  CAS  Google Scholar 

  35. Coric V, Feldman HH, Oren DA, Shekhar A, Pultz J, et al. Multicenter, randomized, double-blind, active comparator and placebo-controlled trial of a corticotropin-releasing factor receptor-1 antagonist in generalized anxiety disorder. Depress Anxiety. 2010;27(5):417–25.

    Article  PubMed  CAS  Google Scholar 

  36. Sweetser S, Camilleri M, Linker Nord SJ, Burton DD, Castenada L, et al. Do corticotropin releasing factor-1 receptors influence colonic transit and bowel function in women with irritable bowel syndrome? Am J Physiol Gastrointest Liver Physiol. 2009;296(6):G1299–306.

    Article  PubMed  CAS  Google Scholar 

  37. Imaki T, Nahan JL, Rivier C, Sawchenko PE, Vale W. Differential regulation of corticotropin-releasing factor mRNA in rat brain regions by glucocorticoids and stress. J Neurosci. 1991;11(3):585–99.

    PubMed  CAS  Google Scholar 

  38. Grill WM, Erokwu BO, Hadziefendic S, Haxhiu MA. Extended survival time following pseudorabies virus injection labels the suprapontine neural network controlling the bladder and urethra in the rat. Neurosci Lett. 1999;270(2):63–6.

    Article  PubMed  CAS  Google Scholar 

  39. Kergozien S, Menetrey D. Environmental influences on viscero(noci)ceptive brain activities: the effects of sheltering. Brain Res Cogn Brain Res. 2000;10(1–2):111–7.

    Article  PubMed  CAS  Google Scholar 

  40. Koyama K. Effects of amygdaloid and olfactory tubercle stimulation on efferent activities of the vesical branch of the pelvic nerve and the urethral branch of the pudendal nerve in dogs. Urol Int. 1991;47 Suppl 1:23–30.

    Article  PubMed  Google Scholar 

  41. Vincent SR, Satoh K. Corticotropin-releasing factor (CRF) immunoreactivity in the dorsolateral pontine tegmentum: further studies on the micturition reflex system. Brain Res. 1984;308(2):387–91.

    Article  PubMed  CAS  Google Scholar 

  42. Skofitsch G, Zamir N, Helke CJ, Savitt JM, Jacobowitz DM. Corticotropin releasing factor-like immunoreactivity in sensory ganglia and capsaicin sensitive neurons of the rat central nervous system: colocalization with other neuropeptides. Peptides. 1985;6(2):307–18.

    Article  PubMed  CAS  Google Scholar 

  43. Pavcovich LA, Valentino RJ. Central regulation of micturition in the rat the corticotropin-releasing hormone from Barrington's nucleus. Neurosci Lett. 1995;196(3):185–8.

    Article  PubMed  CAS  Google Scholar 

  44. Kiddoo DA, Valentino RJ, Zderic S, Ganesh A, Leiser SC, et al. Impact of state of arousal and stress neuropeptides on urodynamic function in freely moving rats. Am J Physiol Regul Integr Comp Physiol. 2006;290(6):R1697–706.

    Article  PubMed  CAS  Google Scholar 

  45. Wood SK, Baez MA, Bhatnagar S, Valentino RJ. Social stress-induced bladder dysfunction: potential role of corticotropin-releasing factor. Am J Physiol Regul Integr Comp Physiol. 2009;296(5):R1671–8.

    Article  PubMed  CAS  Google Scholar 

  46. LaBerge J, Malley SE, Zvarova K, Vizzard MA. Expression of corticotropin-releasing factor and CRF receptors in micturition pathways after cyclophosphamide-induced cystitis. Am J Physiol Regul Integr Comp Physiol. 2006;291(3):R692–703.

    Article  PubMed  CAS  Google Scholar 

  47. Klausner AP, Steers WD. Corticotropin releasing factor: a mediator of emotional influences on bladder function. J Urol. 2004;172(6 Pt 2):2570–3.

    Article  PubMed  CAS  Google Scholar 

  48. Klausner AP, Streng T, Na YG, Raju J, Batts TW, et al. The role of corticotropin releasing factor and its antagonist, astressin, on micturition in the rat. Auton Neurosci. 2005;123(1–2):26–35.

    Article  PubMed  CAS  Google Scholar 

  49. Hullfish KL, Fenner DE, Sorser SA, Visger J, Clayton A, et al. Postpartum depression, urge urinary incontinence, and overactive bladder syndrome: is there an association? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(10):1121–6.

    Article  PubMed  Google Scholar 

  50. Movig KL, Leufkens HG, Belitser SV, Lenderink AW, Egberts AC. Selective serotonin reuptake inhibitor-induced urinary incontinence. Pharmacoepidemiol Drug Saf. 2002;11(4):271–9.

    Article  PubMed  CAS  Google Scholar 

  51. Asplund R, Johansson S, Henriksson S, Isacsson G. Nocturia, depression and antidepressant medication. BJU Int. 2005;95(6):820–3.

    Article  PubMed  Google Scholar 

  52. Verdoux H, Tournier M, Begaud B. Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies. Acta Psychiatr Scand. 2010;121(1):4–10.

    Article  PubMed  CAS  Google Scholar 

  53. Hall SA, Maserejian NN, Link CL, Steers WD, McKinlay JB. Are commonly used psychoactive medications associated with lower urinary tract symptoms? Eur J Clin Pharmacol. 2012;68(5):783–91.

    Article  PubMed  CAS  Google Scholar 

  54. Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry. 2006;14(3):191–210.

    PubMed  Google Scholar 

  55. Herguner S, Mukaddes NM. Risperidone-induced double incontinence. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(4):1085–6.

    Article  PubMed  Google Scholar 

  56. Herguner S, Mukaddes NM. Risperidone-induced enuresis in two children with autistic disorder. J Child Adolesc Psychopharmacol. 2007;17(4):527–30.

    Article  PubMed  Google Scholar 

  57. Jeong SH, Kim JH, Ahn YM, Lee KY, Kim SW, et al. A 2-year prospective follow-up study of lower urinary tract symptoms in patients treated with clozapine. J Clin Psychopharmacol. 2008;28(6):618–24.

    Article  PubMed  CAS  Google Scholar 

  58. •• Hall SA, Yang M, Gates MA, Steers WD, Tennstedt SL, et al. Associations of commonly used medications with urinary incontinence in a community based sample. J Urol. 2012;188(1):183–9. This article uses data from the Boston Area Community Health (BACH) study to demonstrate that patients taking atypical antipscyhotics (AAPs) for the treatment of depression have higher rates of overactive bladder and incontinence.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adam P. Klausner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dolat, M.T., Klausner, A.P. UROPSYCHIATRY: The Relationship Between Overactive Bladder and Psychiatric Disorders. Curr Bladder Dysfunct Rep 8, 69–76 (2013). https://doi.org/10.1007/s11884-012-0164-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-012-0164-5

Keywords

Navigation