Cognition, Emotion, and the Bladder: Psychosocial Factors in Bladder Pain Syndrome and Interstitial Cystitis (BPS/IC)

Abstract

Purpose of Review

To review findings from empirical studies assessing the role of psychosocial factors in bladder pain syndrome and interstitial cystitis (BPS/IC).

Recent Findings

There is a high rate of psychosocial comorbidity in BPS/IC, including elevated levels of anxiety and depression. Recent studies assessing the role of illness perceptions in BPS/IC relate poorer illness perceptions to more unhelpful illness coping patterns. Conversely, positive illness perceptions including self-efficacy in illness management are associated with more adaptive coping behaviors such as exercising and acceptance. New research is investigating the role of trauma in BPS/IC and the impact of suicidality. There is a paucity of psychosocial interventions for BPS/IC over the last 5 years. The three small-scale studies reviewed included a mindfulness-based stress reduction (MBSR) intervention tailored for BPS/IC, a brief self-management intervention designed to increase patient knowledge and symptom management techniques and a 90-min interview aimed at increasing awareness about physiological affective relationship in IC.

Summary

Illness-related cognitions impact illness-related coping behavior, distress, symptom severity, and QoL in BPS/IC. Positive illness perceptions can positively impact behavioral responses to illness and illness outcomes. Trauma, emotion regulation, and suicidality in BPS/IC are important factors for psychosocial interventions and multidisciplinary treatments to address. Insight from the existing evidence base and other functional illness areas such as IBS can be used to inform the design and assessment of interventions aimed to understand and treat BPS/IC as a biopsychosocial illness. The role of healthcare practitioners is fundamental to informing patient perceptions of their illness and providing adequate support for their own self-management approaches.

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References

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

  1. 1.

    Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes: a report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn. 2017;36(4):984–1008.

    PubMed  Google Scholar 

  2. 2.

    Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011;186(2):540–4.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Malde S, Palmisani S, Al-Kaisy A, Sahai A. Guideline of guidelines: bladder pain syndrome. BJU Int. 2018;122(5):729–43.

    PubMed  Google Scholar 

  4. 4.

    Kanter G, Volpe KA, Dunivan GC, Cichowski SB, Jeppson PC, Rogers RG, et al. Important role of physicians in addressing psychological aspects of interstitial cystitis/bladder pain syndrome (IC/BPS): a qualitative analysis. Int Urogynecol J. 2017;28(2):249–56.

    PubMed  Google Scholar 

  5. 5.

    Payne CK, Joyce GF, Wise M, Clemens JQ, Project UD in A. Interstitial cystitis and painful bladder syndrome. J Urol. 2007;177(6):2042–9.

    PubMed  Google Scholar 

  6. 6.

    Nickel JC, Tripp DA, Beiko D, Tolls V, Herschorn S, Carr LK, et al. The interstitial cystitis/bladder pain syndrome clinical picture: a perspective from patient life experience. Urol Pract. 2018;5(4):286–92.

    Google Scholar 

  7. 7.

    Hanno PM, Erickson D, Moldwin R, Faraday MM. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193(5):1545–53.

    PubMed  Google Scholar 

  8. 8.

    Cashman S, Biers S. Chronic pelvic pain in benign and functional urological conditions: a review and comparison of the UK and European guidelines. J Clin Urol. 2018;11(2):115–21.

    Google Scholar 

  9. 9.

    Dellis AE, Kostakopoulos N, Papatsoris AG. Is there an effective therapy of interstitial cystitis/bladder pain syndrome? Expert Opin Pharmacother. 2019:1–3.

  10. 10.

    Tripp DA. Managing psychosocial correlates of urologic chronic pelvic pain syndromes: advice from a urology pain psychologist. Can Urol Assoc J. 2018;12(6 Suppl 3):S175–7.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Clemens JQ, Mullins C, Kusek JW, Kirkali Z, Mayer EA, Rodríguez LV, et al. The MAPP research network: a novel study of urologic chronic pelvic pain syndromes. BMC Urol. 2014;14:57.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Kinsey D, Pretorius S, Glover L, Alexander T. The psychological impact of overactive bladder: a systematic review. J Health Psychol. 2016;21(1):69–81.

    PubMed  Google Scholar 

  13. 13.

    •• McKernan LC, Walsh CG, Reynolds WS, Crofford LJ, Dmochowski RR, Williams DA. Psychosocial co-morbidities in interstitial cystitis/bladder pain syndrome (IC/BPS): a systematic review. Neurourol Urodynam. 2018;37(3):926–41 This review comprehensively collates studies assessing the role of psychosocial factors in IC/BPS.

    Google Scholar 

  14. 14.

    McKernan LC, Nash M, Carr ER. An integrative trauma-based approach toward chronic pain: specific applications to interstitial cystitis/bladder pain syndrome. J Psychother Integr. 2016;26(4):378.

    Google Scholar 

  15. 15.

    Peters KM, Kalinowski SE, Carrico DJ, Ibrahim IA, Diokno AC. Fact or fiction—is abuse prevalent in patients with interstitial cystitis? Results from a community survey and clinic population. J Urol. 2007;178(3):891–5.

    PubMed  Google Scholar 

  16. 16.

    McKernan LC, Johnson BN, Reynolds WS, Williams DA, Cheavens JS, Dmochowski RR, et al. Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: relationship to patient phenotype and clinical practice implications. Neurourol Urodynam. 2019b;38(1):353–62.

    Google Scholar 

  17. 17.

    Chiu C-D, Lee M-H, Chen W-C, Ho HL, Wu H-C. Childhood trauma perpetrated by close others, psychiatric dysfunction, and urological symptoms in patients with interstitial cystitis/bladder pain syndrome. J Psychosom Res. 2017b;93:90–5.

    PubMed  Google Scholar 

  18. 18.

    Hepner KA, Watkins KE, Elliott MN, Clemens JQ, Hilton LG, Berry SH. Suicidal ideation among patients with bladder pain syndrome/interstitial cystitis. Urology. 2012;80(2):280–5.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Tripp DA, Nickel JC, Krsmanovic A, Pontari M, Moldwin R, Mayer R, et al. Depression and catastrophizing predict suicidal ideation in tertiary care patients with interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016;10(11–12):383–8.

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Vasudevan V, Moldwin R. Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome. Asian J Urol. 2017;4(1):50–4.

    PubMed  Google Scholar 

  21. 21.

    Beckett MK, Elliott MN, Clemens JQ, Ewing B, Berry SH. Consequences of interstitial cystitis/bladder pain symptoms on women’s work participation and income: results from a National Household Sample. J Urol. 2014;191(1):83–8.

    PubMed  Google Scholar 

  22. 22.

    Katz L, Tripp DA, Carr LK, Mayer R, Moldwin RM, Nickel JC. Understanding pain and coping in women with interstitial cystitis/bladder pain syndrome. BJU Int. 2017;120(2):286–92.

    PubMed  Google Scholar 

  23. 23.

    Muere A, Tripp DA, Nickel JC, Kelly K-L, Mayer R, Pontari M, et al. Depression and coping behaviors are key factors in understanding pain in interstitial cystitis/bladder pain syndrome. Pain Manag Nurs. 2018;19(5):497–505.

    PubMed  Google Scholar 

  24. 24.

    Holmes H, Carty J, Lumley M, Tomakowsky J, Pegram S, Dove-Medows E, et al. (508) Self-sacrificing moderates the relationship between emotional distress and pain among women with chronic urogenital pain. J Pain. 2016;17(4):S101–2.

    Google Scholar 

  25. 25.

    Katz L, Tripp DA, Nickel JC, Krsmanovic A, Muere A, Carr L, et al. What works? Coping and emotion regulation on mental health in women with IC/BPS. Pain Res Manag. 2015;20(3):e28.

    Google Scholar 

  26. 26.

    Katz L, Tripp DA, Nickel JC, Krsmanovic A, Muere A, Carr LK, et al. P94: illness perceptions mediate the relationship between pain and depression in women with IC/BPS. Pain Res Manag J Can Pain. 2014;19:e31.

    Google Scholar 

  27. 27.

    Tripp D, Crawford A, Curtis Nickel J, Moldwin R, Carr L, Mayer R, et al. MP39-20 the longitudinal role of catastrophizing and emotion regulation in the relationship between depression and pain in women with interstitial cystitis/bladder pain syndrome. J Urol. 2018;199:e518.

    Google Scholar 

  28. 28.

    Chiu C-D, Lee M-H, Chen W-C, Ho HL, Wu H-C. Alexithymia and anesthetic bladder capacity in interstitial cystitis/bladder pain syndrome. J Psychosom Res. 2017a;100:15–21.

    PubMed  Google Scholar 

  29. 29.

    Leue C, Kruimel J, Vrijens D, Masclee A, Van Os J, Van Koeveringe G. Functional urological disorders: a sensitized defence response in the bladder–gut–brain axis. Nat Rev Urol. 2017;14(3):153–63.

    CAS  PubMed  Google Scholar 

  30. 30.

    Grundy L, Caldwell A, Brierley S. Mechanisms underlying overactive bladder and interstitial cystitis/bladder pain syndrome. Front Neurosci. 2018;12:931.

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Maixner W, Fillingim R, Williams D, Smith S. Overlapping chronic pain conditions: implications for diagnosis and classification. J Pain. 2017;17(9):T93–T107.

    Google Scholar 

  32. 32.

    McKernan LC, Johnson BN, Crofford LJ, Lumley MA, Bruehl S, Cheavens JS. Posttraumatic stress symptoms mediate the effects of trauma exposure on clinical indicators of central sensitization in patients with chronic pain. Clin J Pain. 2019a;35(5):385–93.

    PubMed  Google Scholar 

  33. 33.

    Lai HH, Jemielita T, Sutcliffe S, Bradley CS, Naliboff B, Williams DA, et al. Characterization of whole body pain in urological chronic pelvic pain syndrome at baseline: a MAPP Research Network Study. J Urol. 2017;198(3):622–31.

    PubMed  PubMed Central  Google Scholar 

  34. 34.

    McKernan L, Cohn J, Bruehl S, Dmochowski R, Reynolds WS. MP29-11 overactive bladder and co-occuring interstitial cystitis/bladder pain syndrome: the role of central sensitization in clinical presentation. J Urol. 2017;4(197):e384.

    Google Scholar 

  35. 35.

    Tripp DA, Nickel JC, Wong J, Pontari M, Moldwin R, Mayer R, et al. Mapping of pain phenotypes in female patients with bladder pain syndrome/interstitial cystitis and controls. Eur Urol. 2012;62(6):1188–94.

    PubMed  Google Scholar 

  36. 36.

    • Naliboff BD, Stephens AJ, Lai HH, Griffith JW, Clemens JQ, Lutgendorf S, et al. Clinical and psychosocial predictors of urological chronic pelvic pain symptom change in 1 year: a prospective study from the MAPP Research Network. J Urol. 2017;198(4):848–57 This study presents the key longitudinal findings from the MAPP network regarding the role of psychosocial factors in IC/BPS.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Lowder JL, Bavendam TG, Berry A, Brady SS, Fitzgerald CM, Fok CS, et al. Terminology for bladder health research in women and girls: prevention of lower urinary tract symptoms transdisciplinary consortium definitions. Neurourol Urodynam. 2019;38(5):1339–52.

    Google Scholar 

  38. 38.

    Birder LA. Bladder/pelvic pain and neurogenic inflammation. Neurourol. Springer. 2019:433–46.

  39. 39.

    Jhang J-F, Kuo H-C. Pathomechanism of interstitial cystitis/bladder pain syndrome and mapping the heterogeneity of disease. Int Neurourol J. 2016;20(Suppl 2):S95–104.

    PubMed  PubMed Central  Google Scholar 

  40. 40.

    Graziottin A, Skaper SD, Fusco M. Mast cells in chronic inflammation, pelvic pain and depression in women. Gynecol Endocrinol. 2014;30(7):472–7.

    CAS  PubMed  Google Scholar 

  41. 41.

    Nickel JC, Irvine-Bird K, Jianbo L, Shoskes DA. Phenotype-directed management of interstitial cystitis/bladder pain syndrome. Urol. 2014;84(1):175–9.

    PubMed  Google Scholar 

  42. 42.

    Wu P, Chen Y, Zhao J, Zhang G, Chen J, Wang J, et al. Urinary microbiome and psychological factors in women with overactive bladder. Front Cell Infect Microbiol. 2017;7:488.

    PubMed  PubMed Central  Google Scholar 

  43. 43.

    Shoskes DA, Nickel JC, Rackley RR, Pontari MA. Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis. 2009;12(2):177–83.

    CAS  PubMed  Google Scholar 

  44. 44.

    Meijlink JM. Bladder pain: the patient perspective. Urologia J. 2017;84(1_suppl):5–7.

    Google Scholar 

  45. 45.

    O’Hare PG, Hoffmann AR, Allen P, Gordon B, Salin L, Whitmore K. Interstitial cystitis patients’ use and rating of complementary and alternative medicine therapies. Int Urogynecol J. 2013;24(6):977–82.

    PubMed  Google Scholar 

  46. 46.

    Epstein RM, Shields CG, Meldrum SC, Fiscella K, Carroll J, Carney PA, et al. Physicians’ responses to patients’ medically unexplained symptoms. Psychosom Med. 2006;68(2):269–76.

    PubMed  Google Scholar 

  47. 47.

    Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, et al. Person-centered care — ready for prime time. Eur J Cardiovasc Nurs. 2011;10(4):248–51.

    PubMed  Google Scholar 

  48. 48.

    Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. Health Expect. 2006;9(1):25–36.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Kanter G, Komesu YM, Qaedan F, Jeppson PC, Dunivan GC, Cichowski SB, et al. Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial. Int Urogynecol J. 2016;27(11):1705–11.

    PubMed  PubMed Central  Google Scholar 

  50. 50.

    Lee M-H, Wu H-C, Tseng C-M, Ko T-L, Weng T-J, Chen Y-F. Health education and symptom flare management using a video-based m-health system for caring women with IC/BPS. Urol. 2018;119:62–9.

    PubMed  Google Scholar 

  51. 51.

    Carty J, Lumley M, Holmes H, Tomakowsky J, Schubiner H, Dove-Medows E, et al. (516) The effects of a stress and emotion interview for women with urogenital pain: a randomized trial. J Pain. 2016;17(4):S103.

    Google Scholar 

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Funding

This project was conducted with support from the National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases award DK118118-01A1.

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Correspondence to Lindsey McKernan.

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Windgassen, S., McKernan, L. Cognition, Emotion, and the Bladder: Psychosocial Factors in Bladder Pain Syndrome and Interstitial Cystitis (BPS/IC). Curr Bladder Dysfunct Rep 15, 9–14 (2020). https://doi.org/10.1007/s11884-019-00571-2

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Keywords

  • Interstitial cystitis
  • Psychosocial factors
  • Burden of illness
  • Coping behavior