The role of environmental stress on lower urinary tract symptoms

Purpose of review Lower urinary tract symptoms (LUTS) have been associated with comorbid conditions such as anxiety and depression. In addition, stress appears to influence the development or exacerbation of LUTS. This article seeks to review literature regarding the role of environmental stress on LUTS, focusing on findings presented in the last year. Recent findings Numerous authors have published on the impact early childhood experiences, acute and chronic stress, and psychiatric illness play in the development of LUTS. The exact nature of the association between bladder symptoms and psychosocial measures remains unknown and is likely due to a complex interplay between heritability, psychosocial factors, and environmental stress. The proposed pathophysiological pathways involved in emotional states such as anxiety and depression, stress, and bladder function include activation of the hypothalamic- pituitary axis, dysregulation of the serotonergic pathways, and central sensitization. Recent work has additionally suggested that urinary syndromes involving abnormal or augmented sensory input, such as overactive bladder and interstitial cystitis/bladder pain syndrome, may be a spectrum of the same disorder. Summary There are numerous developments in our understanding of the role of environmental stress on the development and exacerbation of LUTS with new developments both clinically and in translational basic science work. Clinicians must acknowledge the high prevalence of affective disorders in patients with LUTS and realize their potential therapeutic influence. Simply addressing mechanisms at the level of the bladder alone may fail in a subpopulation of patients with LUTS who may have significant psychosocial drivers of their symptoms.