title: Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis.
abstract: Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Carsten
authors.initials: C
authors.lastname: Leue
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kruimel
authors.affiliation: Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Desiree
authors.initials: D
authors.lastname: Vrijens
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Adrian
authors.initials: A
authors.lastname: Masclee
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.affiliation: Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.|Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Gommert
authors.initials: G
authors.lastname: van Koeveringe
mesh_terms: D000339:Affect / Q000502:physiology; D001921:Brain / Q000502:physiology*; D041981:Gastrointestinal Tract / Q000294:innervation / Q000502:physiology*; D006801:Humans; D009434:Neural Pathways / Q000502:physiology; D001743:Urinary Bladder / Q000294:innervation / Q000502:physiology*; D014570:Urologic Diseases / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology