Overactive bladder and autonomic dysfunction: Lower urinary tract symptoms in females with postural tachycardia syndrome

Abstract

Aims Postural Tachycardia Syndrome (POTS) represents an autonomic disorder predominantly affecting females between 15 and 50 years of age. POTS is a chronic disorder (>6 months) characterized by an excessive heart rate increment on standing (>30 beats/min) in the presence of characteristic symptoms of cerebral hypoperfusion or sympathetic activation. Patients have clinically been noted to describe lower urinary tract symptoms (LUTS), although urologic symptoms have not been methodically assessed in the POTS population. Herein we present data from a pilot study designed to identify and quantitate overactive bladder (OAB) in patients diagnosed with POTS. Methods Patients admitted to the Vanderbilt Autonomic Dysfunction Center between June 2009 and October 2010 for evaluation for the potential diagnosis of POTS completed a validated, standardized questionnaire for OAB (OAB-q) at presentation. Symptom score and subscale analyses were conducted. Subscale health related quality of life (HRQL) scores were transformed into a 0–100 scale, with higher scores reflecting superior HRQL. Data are presented as mean ± SD. Results Thirty-two females presented for evaluation of symptoms consistent with POTS. Twenty-nine women were subsequently diagnosed with POTS with 19 of these patients completing the OAB-q questionnaire (65.5% response rate). Average age was 33.5 ± 8.3 years. Symptom severity transformed score was 26.0 ± 16.4, with 13 of 19 patients (68.4%) meeting clinical criteria for diagnosis of probable clinically significant OAB. Nocturia was the most bothersome symptom, followed by frequency and urgency. Conclusions This pilot study describes bothersome lower urinary tract dysfunction in patients presenting with POTS as assessed by patient-reported questionnaire data. Nocturia demonstrated the greatest negative impact on health-related quality of life (HRQL), while social interaction was the least affected HRQL domain. In patients with dysautonomia, this data provides a critical baseline for mechanistic insight into both disease-specific and global pathophysiology of nocturia and OAB.

The Central Autonomic Network and Regulation of Bladder Function

“…Various other autonomic disorders such as postural tachycardia syndrome (POTS) (Kaufman et al, 2017) and pure autonomic failure (PAF) (Singer et al, 2017) also have associated bladder dysfunction. This reflects the intimate relationship between the lower urinary tract system and the ANS.…”

An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes

“…It is known that CFS, POTS, TMJ, migraines, fibromyalgia, IBS, and interstitial cystitis are heavily inter-linked. 6,[15][16][17][18][19][20][21][22][23][24][25][26] Ehlers-Danlos syndrome is linked with most of these disorders and early development of varicose veins is a known consequence of the connective tissue laxity in that condition. 27 Although drawn from subjects motivated to join a PCS support group and to answer a survey, prevalence of diagnoses other than PCS was remarkably high-up to 10 times more for the dysautonomia of hyperhidrosis than estimates for the general population.…”

Pathophysiology of refractory overactive bladder

“…while standing, accompanied by symptoms including chest pain, palpitations, dyspnea, and difficulty concentrating, in the absence of orthostatic hypotension . Nearly 70% of POS patients met the criteria for significant OAB according to the Overactive bladder questionnaire, which indicates the importance of ANS dysfunction and the pathogenesis of OAB …”