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Basal and stress-activated hypothalamic pituitary adrenal axis function in postmenopausal women with overactive bladder

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Abstract

Introduction and hypothesis

The aim of this study was to measure physiologic and psychologic stress reactivity in women with overactive bladder (OAB). There is growing evidence in preclinical models that central nervous system dysregulation, particularly in response to psychological stress, may contribute to lower urinary tract symptoms in women with OAB.

Methods

Postmenopausal women with OAB and healthy controls underwent Structured Clinical Interview for DSM-IV Axis I disorders (SCID) to identify those without identifiable psychiatric disease. Eligible participants underwent physiologic measures including basal (cortisol-awakening response; CAR) and stress-activated salivary cortisol levels, heart rate (HR), urinary metanephrines and neurotrophins, as well as validated symptom assessment for stress, anxiety, depression, and bladder dysfunction at baseline and during, and following an acute laboratory stressor, the Trier Social Stress Test (TSST).

Results

Baseline measures of cortisol reactivity measured by CAR showed blunted response among women with OAB (p = 0.015), while cortisol response to the TSST was greater in the OAB group (p = 0.019). Among OAB patients, bladder urgency as measured by visual analog scale (VAS) increased from pre- to post-TSST (p = 0.04). There was a main effect of TSST on HR (p < 0.001), but no group interaction.

Conclusions

Preliminary findings suggest that women with OAB have greater physiologic and psychologic stress reactivity than healthy controls. Importantly for women with OAB, acute stress appears to exacerbate bladder urgency. Evaluation of the markers of stress response may suggest targets for potential diagnostic and therapeutic interventions.

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Acknowledgments

Dina H. Appleby, M.S. for her statistical assistance.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, 800 Walnut Street, 19th Floor, Philadelphia, PA, 19107, USA

    Ariana L. Smith & Alan J. Wein

  2. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19107, USA

    Liisa Hantsoo & C. Neill Epperson

  3. Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19107, USA

    C. Neill Epperson

  4. Penn Center for the Study of Sex and Gender in Behavioral Health, Philadelphia, PA, 19107, USA

    Liisa Hantsoo & C. Neill Epperson

  5. Penn Center for Women’s Behavioral Wellness, Philadelphia, PA, 19107, USA

    Liisa Hantsoo & C. Neill Epperson

  6. Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, 80045, USA

    Anna P. Malykhina

  7. Department of Mathematics & Computer Science, Muhlenberg College, Allentown, PA, 18104, USA

    Daniel W. File

  8. Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA

    Rita Valentino

  9. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19107, USA

    Mary D. Sammel

Authors
  1. Ariana L. Smith
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  4. Daniel W. File
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  5. Rita Valentino
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Corresponding author

Correspondence to Ariana L. Smith.

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Funding

This work was funded by NIH/NIDDK O’Brien Urology Center Grant P50 DK052620-15, Penn Center for Women’s Behavioral Wellness (NIH P50 MH099910, R01 AG048839, K24 DA030301, R01 DA037289).

Conflict of interest

ALS receives research grants from NIH and Allergan and honoraria from Gray’s Anatomy. APM receives research grants from NIH and University of Colorado Department of Surgery. RV receives research grants from NIH, is an editorial board member for Elsevier, a Lecturer for SUFU, Drexel, University of Colorado, New York Medical College, and Rutgers, and an unpaid advisory board member for Brain and Behavioral Research Foundation, Society for Neuroscience and University of Michigan Health System. AJW is a consultant for Medtronic, Axonics and Allergan. CNE receives research grants from NIH and Shire, consults for Forest Laboratories, and has personal investments in Pfizer, Johnson and Johnson, Merck, Abbott, and Abbvie. LH, DWF and MDS declare that they have no conflict of interest.

Appendix 1

Appendix 1

Table 3 Timing of study procedures and questionnaires
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Smith, A.L., Hantsoo, L., Malykhina, A.P. et al. Basal and stress-activated hypothalamic pituitary adrenal axis function in postmenopausal women with overactive bladder. Int Urogynecol J 27, 1383–1391 (2016). https://doi.org/10.1007/s00192-016-2988-6

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  • DOI: https://doi.org/10.1007/s00192-016-2988-6

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