Depression, Anxiety and the Bladder

Abstract

Depression and anxiety are common mental illnesses. It is recognized that depression/anxiety causes physical changes, including insomnia, anorexia, and bladder dysfunction. We aimed to delineate bladder dysfunction in patients with depression/anxiety by reviewing the literature. We performed a systematic review of the literature to identify the frequency, lower urinary tract symptoms (LUTS), urodynamic findings, putative underlying pathology, and management of bladder dysfunction in patients with depression/anxiety. From a recent survey of a depression cohort (at a psychiatry clinic), the frequency of bladder dysfunction in depression is lower (up to 25.9%) than that in Parkinson's disease (up to 75%) and stroke (up to 55%), whereas it is significantly higher than that in age-matched controls (around 10%). In both the depression cohort and the psychogenic bladder dysfunction cohort (at a urology clinic), the most common LUTS was overactive bladder (OAB), followed by difficult urination and infrequent voiding. Compared with severe LUTS, urodynamic findings were dissociated; i.e. urodynamic findings were normal except for increased bladder sensation without detrusor overactivity for OAB (50% of all patients), followed by underactive detrusor without post-void residual for difficult urination. The effectiveness of serotonergic or anti-cholinergic medication for ameliorating OAB in the patients awaits further study. In conclusion, although the frequency of LUTS among the depression cohort is not elevated, depression/anxiety is obviously a risk factor for OAB. This finding presumably reflects that the bladder is under emotional control. Amelioration of bladder dysfunction is an important target in treating patients with depression/anxiety.

Analysis of the prevalence and associated factors of overactive bladder in adult Korean men

“…Indeed, bladder function is somewhat controlled by emotion. It is known that depression and anxiety cause bladder dysfunction [15]. Moreover, this study and prior studies demonstrated that stressful events had a negative impact on voiding function [45].…”

“…Additionally, the urothelium of the bladder is presumed to play a key role in the mechanosensory transduction and causes of OAB [14]. Bladder function is also regulated by central mechanisms [15]. Thus, central neurologic problems, such as an ischemic cortical brain lesion, could induce OAB.…”

Survey and Risk Factors for Lower Urinary Tract Storage Symptoms in Middle‐Aged and Older Stroke Patients in Urban China

“…Sakakibara et al recently showed that depression and anxiety were risk factors for OAB and proposed that the bladder can be emotionally controlled. 70 Park et al also showed that depression was associated with modest to severe LUTS in community-dwelling elderly Korean men. 71 Living with close family members therefore may reduce depression and allow stroke patients to be taken good care of by their children.…”

“…After controlling other variables, we found an inverse correlation between LUTS and living with children, but not with a spouse or living alone. Sakakibara et al recently showed that depression and anxiety were risk factors for OAB and proposed that the bladder can be emotionally controlled . Park et al also showed that depression was associated with modest to severe LUTS in community‐dwelling elderly Korean men .…”

Increased bladder sensation without detrusor overactivity revisited: Use of a five‐grade sensory measure

“…Recent studies have suggested that the basal ganglia play a role in sensory gating . Finally, psychogenic bladder dysfunction (depression/anxiety) is known to cause IBS without DO . In mental disorders, biological changes do occur, particularly in brain areas associated with emotion .…”