Basal and stress-activated hypothalamic pituitary adrenal axis function in postmenopausal women with overactive bladder

Ariana L. Smith, Liisa Hantsoo, Anna P. Malykhina, Daniel W. File, Rita Valentino, Alan J. Wein, Mary D. Sammel, C. Neill Epperson

Research output: Contribution to journalArticlepeer-review


Introduction and hypothesis: The aim of this study was to measure physiologic and psychologic stress reactivity in women with overactive bladder (OAB). There is growing evidence in preclinical models that central nervous system dysregulation, particularly in response to psychological stress, may contribute to lower urinary tract symptoms in women with OAB. Methods: Postmenopausal women with OAB and healthy controls underwent Structured Clinical Interview for DSM-IV Axis I disorders (SCID) to identify those without identifiable psychiatric disease. Eligible participants underwent physiologic measures including basal (cortisol-awakening response; CAR) and stress-activated salivary cortisol levels, heart rate (HR), urinary metanephrines and neurotrophins, as well as validated symptom assessment for stress, anxiety, depression, and bladder dysfunction at baseline and during, and following an acute laboratory stressor, the Trier Social Stress Test (TSST). Results: Baseline measures of cortisol reactivity measured by CAR showed blunted response among women with OAB (p = 0.015), while cortisol response to the TSST was greater in the OAB group (p = 0.019). Among OAB patients, bladder urgency as measured by visual analog scale (VAS) increased from pre- to post-TSST (p = 0.04). There was a main effect of TSST on HR (p < 0.001), but no group interaction. Conclusions: Preliminary findings suggest that women with OAB have greater physiologic and psychologic stress reactivity than healthy controls. Importantly for women with OAB, acute stress appears to exacerbate bladder urgency. Evaluation of the markers of stress response may suggest targets for potential diagnostic and therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)1383-1391
Number of pages9
JournalInternational Urogynecology Journal
Issue number9
StatePublished - Sep 1 2016
Externally publishedYes


  • Cortisol
  • Hypothalamic–pituitary–adrenal axis
  • Overactive bladder
  • Stress

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology


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