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Coordinated Care of Bladder, Gut, and Brain May Lead to Treatment Success

Leue C, Kruimel J, Vrijens D, Masclee A, van Os J, van Koeveringe G. Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis. Nat Rev Urol. 2016 Dec 6. doi: 10.1038/nrurol.2016.227. [Epub ahead of print]

In this paper, a group of Dutch researchers propose a concept they call the “bladder-gut-brain axis” as a way to understand, and study, urological disorders such as interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder, and chronic prostatitis/chronic pelvic pain syndrome. In particular, these researchers are concerned that sometimes, treatment of the urological disorder may yield poor results because of an underlying psychological/psychiatric disorder that contributes to the symptoms and remains untreated. Of note, anxiety and depression are both associated with more severe symptoms and increased burden of illness in certain urological or gastrointestinal disorders. In order to receive the best care, patients who have a combination of urologic and psychological/psychiatric conditions might receive the best care from a multidisciplinary team, rather than a single specialist. In integrated care, the researchers say, the “whole becomes larger than its parts” as specialists collaborate to ensure the patient has the best treatment, not only medically, but also with regard to psychological and social aspects of care. Thus, they recommend this type of multidisciplinary care as a standard for patients with visceral pain and other symptoms, particularly if the patient is resistant to previous treatments.