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Bladder Pain Sensitivity Is a Potential Risk Factor for Irritable Bowel Syndrome

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Abstract

Background

Although dysmenorrhea is a highly prevalent risk factor for irritable bowel syndrome (IBS), the factors underlying this risk are not fully understood. Prior studies support a hypothesis that repeated distressing menstrual pain promotes cross-organ pelvic sensitization with heightened visceral sensitivity.

Aims

To further explore cross-organ pelvic sensitization we examined the association of dysmenorrhea, provoked bladder pain, and other putative factors with self-reported IBS-domain pain frequency and new onset after 1-year follow up.

Methods

We measured visceral pain sensitivity with a noninvasive provoked bladder pain test in a cohort of reproductive-aged women, enriched for those reporting moderate-to-severe menstrual pain intensity but without any prior IBS diagnosis (n = 190). We analyzed the relationship between menstrual pain, provoked bladder pain, pain catastrophizing, anxiety, and depression with primary outcomes: (1) frequency of self-reported IBS-domain pain and (2) new onset of IBS-domain pain after 1-year follow up.

Results

All hypothesized factors correlated with the frequency of IBS-domain pain (p’s ≤ 0.038). In a cross-sectional model, only menstrual pain (standardized adjusted odds ratio 2.07), provoked bladder pain (1.49), and anxiety (1.90) were independently associated with IBS-domain pain ≥ 2 days/month (C statistic = 0.79). One year later, provoked bladder pain (3.12) was the only significant predictor of new onset IBS-domain pain (C statistic = 0.87).

Conclusion

Increased visceral sensitivity among women with dysmenorrhea could lead to IBS. Because provoked bladder pain predicted subsequent IBS, prospective studies should be performed to see if the early treatment of visceral hypersensitivity mitigates IBS.

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Data availability

Data is available at open science framework: https://doi.org/10.17605/OSF.IO/BMA4P

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Acknowledgments

The authors thank Dr. G.F. Gebhart for advice and editorial assistance. They are grateful to Ellen Garrison, Katlyn Dillane, and Genevieve Roth for technical assistance. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD098193) and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100368).

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, 60201, USA

    Arielle E. Shlobin, Frank F. Tu, Matthew J. Kmiecik & Kevin M. Hellman

  2. Department of Obstetrics & Gynecology, The University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, USA

    Frank F. Tu, Cody R. Sain, Matthew J. Kmiecik & Kevin M. Hellman

  3. Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA

    Diana Kantarovich

  4. Department of Biostatistics, Northshore University Health System, Evanston, IL, 60201, USA

    Lavisha Singh & Chi E. Wang

  5. Department of Obstetrics & Gynecology, Evanston Hospital, Walgreen’s Bldg 1507, 2650 Ridge Ave, Evanston, IL, 60201, USA

    Kevin M. Hellman

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  1. Arielle E. Shlobin
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Correspondence to Kevin M. Hellman.

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Conflict of interest

F.F. Tu reports personal fees from Myovant, Tremeau Pharmaceuticals, and UroShape, royalties from Wolters Kluwer, and Grant support from Dot Laboratories and Eximis outside the submitted work. The remaining authors have no conflicts of interest to declare.

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Shlobin, A.E., Tu, F.F., Sain, C.R. et al. Bladder Pain Sensitivity Is a Potential Risk Factor for Irritable Bowel Syndrome. Dig Dis Sci 68, 3092–3102 (2023). https://doi.org/10.1007/s10620-023-07868-7

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