Stress and symptomatology in patients with interstitial cystitis: A laboratory stress model

Purpose: Although patients with interstitial cystitis frequently report sym ptom exacerbation due to stress, to our knowledge this association has not been empirically examined. We evaluated the effects of a laboratory mental stress challenge on symptoms of urgency and pain in patients with interstit ial cystitis and healthy controls. Materials and Methods: A total of 14 females with interstitial cystitis and 14 age matched controls participated in a laboratory session, including a 60-minute baseline measurement, 25 minutes of mental stress tasks and 75 mi nutes of recovery. Acute symptoms of pain and urgency were assessed at void ing 15 minutes before the stressor, and 25, 70 and 100 minutes after stress or onset. Chronic symptoms were evaluated by questions from the Interstitia l Cystitis Data Base survey. Results: Patients reported significantly greater pain and urgency than cont rols at all 4 voidings (p <0.005). Pain increased in patients from the pres tressor point to 25 minutes after stressor onset (p <0.005), remained eleva ted at 70, and decreased between 70 and 100. At 100 minutes patient pain re mained significantly elevated above baseline (p = 0.018). Patient urgency w as significantly elevated over baseline by 70 minutes after stressor onset (p <0.001) and significantly decreased between 70 and 100 minutes (p <0.002 ). Controls had no symptom changes with stress. Conclusions: These findings indicate that an acute stressor evokes increase d symptoms of pain and urgency in patients with interstitial cystitis but n ot in controls. Findings are consistent with sympathetic effects on inflamm atory processes in interstitial cystitis. However, further evaluation of th e mechanisms underlying stress related interstitial cystitis symptom exacer bation is needed to provide a more comprehensive understanding of these phe nomena.