Proposing a reasoned path along this new avenue of research is a review conducted at Maastricht University in the Netherlands, published in the journal Nature Reviews Urology.
Functional disorders of the urogenital tract include various clinical forms such as overactive bladder, cystitis interstitial or bladder pain syndrome, chronic prostatitis or chronic pelvic pain syndrome, which have more to be elucidated in terms of pathophysiology and share several traits with disorders of gastrointestinal function such as irritable bowel syndrome and dyspepsia: in addition to sharing the same visceral anatomical origin, they are equally prevalent, tend to assume a chronic course, and are characterized by frequent refractoriness to treatment. In addition, urinary tract disorders often coexist with gastrointestinal disorders, suggesting a common origin.
Many symptoms such as visceral pain and pelvic floor dysfunction are also largely overlapping, suggesting that these are forms belonging to the same continuum of pathologies that have in common a kind of central hypersensitivity of nervous origin that results in the somatic disorder. It is precisely this latter aspect-the possible involvement of the emotional sphere-that provides the basis for a new line of research calling into question the hypothetical bladder-gut-brain axis, outlined by a review conducted at Maastricht University and published in the journal Nature Reviews Urology.
Anxiety, depression and neurosis fuel the symptoms
As the authors point out, the bladder-gut-brain axis represents a hypothesis that allows for a deeper understanding of the possible interactions between these districts of the body and a better understanding of the mechanisms that fuel various urogenital and gastrointestinal tract disorders, consequently improving the diagnostic-therapeutic approach. For example, it is pointed out in the review that in many of these functional disorders, the concomitance of anxiety and depression and the experience of stressful events lead to an aggravation of symptoms. The same goes for neurosis, which in turn can help trigger a vicious cycle fueled by treatment failures: the less treatment works the more neurosis grows, which further fuels symptomatic manifestations and so on. In the face of this evidence, the new hypothesis suggests that functional abnormalities represent a kind of response to a concomitant-and often undiagnosed-emotional problem that results in subsequent neural sensitization and thus paves the way for functional symptoms.
Need for multidisciplinary approach as early as diagnosis
While it is true that underlying the symptomatology may be intrinsic bladder abnormalities, possible gut-bladder interactions with reciprocal visceral sensitization, neuroendocrine imbalances, sympathetic nervous system activation, or factors such as generalized inflammation, genetic and/or epigenetic susceptibility, infectious etiologies, or microbiota alterations, the authors of the Dutch review emphasize the decisive role played by the emotional sphere and elaborate on its interactions with other possible motives along with the mechanisms at play. What emerges is an intricate and complex mosaic in which the bladder-gut-brain axis serves as an ideal guide, with important practical implications: first and foremost, the need for a multidisciplinary approach as early as the diagnostic stage. Especially in patients who continue to present with symptoms even after appropriate treatments, in fact, an integrated care model that also takes into account neuro-emotional aspects can make a difference.
Reference
Leue C, Kruimel J, Vrijens D, Masclee A, van Os J, van Koeveringe G. Functional urological disorders: a sensitized defense response in the bladder-gut-brain axis. Nat Rev Urol. 2017;14(3):153-163.
