Introduction: Childhood adversity is associated with increased risk for multiple medical and behavioral health conditions in adulthood.  Impact of such experiences on risk for lower urinary tract symptoms (LUTS) is unknown, despite the relationship between early life stress and affective disorder symptoms and the relationship between LUTS and depression and anxiety.

Objective: To determine whether childhood adversity measured using the 10-item Adverse Childhood Experiences (ACE) Questionnaire is associated with self-report of LUTS among older women.

Hypothesis: High levels of childhood adversity before the age of 18 years-old programs is associated with increased risk of LUTS among mid-life and older women.  Those in the high ACE group will be more bothered by their LUTS.

Methods: Women who participated in a previous study of urological health or presented for evaluation of LUTS to the urology service at a large academic center were asked to complete the LUTS Tool (Coyne et al 2012) to assess frequency and bother of 18 LUTS in the previous month. In addition, they completed demographic and health questionnaires, ACE Questionnaire, Perceived Stress Scale (PSS), Spielberger State Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D). Data were analyzed for total LUTS Tool score and number of symptoms by ACE levels 0,1,2,3 or >4. LUTS Tool scores and number of LUTS were log transformed.

Results: The average age (SD) of participants (n=135) was 65.3 (6.9) years and the vast majority were graduates of college (49.6%) or graduate/professional school (35.6%). ACE groups did not significantly differ on demographic variable, number of vaginal deliveries, or use of hormones, but body mass index (BMI) increased with ACE level (p=0.029). Average scores for the STAI, PSS, and CES-D were within the asymptomatic range for the entire group, though there was a significant effect of ACE level in the expected direction for the STAI (p=0.015), the PSS (p=0.003) and the CES-D (p<0.0001).  Controlling for important demographic and behavioral variables including STAI, PSS and CES-D, ACE level was significantly associated with total LUTS Tool score (Beta=.115, p=.040) and number of LUTS meeting our frequency threshold (Beta=.13; p=.017), but not symptom bother. Individual LUTS associated with ACE level were “feeling bladder not empty after voiding” (p=.037), “delay in urine flow” (p=.011), urine leakage with “laughing, sneezing, coughing” (p=.005) and “physical activity” (p=.0009).

Conclusions: Childhood adversity has enduring impact on risk for LUTS in this educated sample of older women even when controlling for affective symptoms which are common among women who experience urinary incontinence and other LUTS.   Mechanism(s) underlying this relationship require further study. The lack of an association with ACE level and LUTS “bother” may be secondary to participant accommodation and management of symptoms.

These data support the growing evidence that childhood adversity adversely impacts numerous adult health outcomes, leading to a lower quality of life for our growing elderly population.  Health care providers working with women who complain of LUTS should assess the presence of early life stress and consider interventions to improve well-being.  Neuroscientists should collaborate with urologists and urogynecologists to identify mutable factors to decrease risk and enhance resilience for LUTS among women with history of childhood adversity.

Basal and stress-activated hypothalamic pituitary adrenal axis function in postmenopausal women with overactive bladder. Smith AL, Hantsoo L, Malykhina AP, File DW, Valentino R, Wein AJ, Sammel MD, Epperson CN. Int Urogynecol J. 2016 Sep;27(9):1383-91.