Psychological and Behavioral Contributors to Lower Urinary Tract Dysfunction: Trauma, Stress, and Neurobiological Pathways

Purpose of Review Chronic pelvic pain and lower urinary tract dysfunction are associated with a high prevalence of depression, anxiety, trauma history, and stress-related disorders, with worsening of symptoms in these groups. This review characterizes the mechanisms behind these associations and the benefits of intervention. Recent Findings Trauma, stress, and neurobiological pathways interact as psychological and behavioral contributors to lower urinary tract symptoms and pelvic pain. The immune system and the neuraxis share pathways in chronic pain as it relates to stress regulation in urologic populations, with implications for symptom presentation. Trauma, including early life adverse experiences and later diverse stressors, can potentiate these pathways. Summary Co-occurrence of psychological factors with incontinence, retention, urinary urgency, frequency, nocturia, and bladder pain is common and clinically relevant to the urologist. Psychological interventions have been demonstrated to improve both quality of life and the symptoms themselves in concert with standard organ-based treatment approaches.