Stress has been associated with lower urinary tract symptoms (LUTS) but little research has been conducted in this area, especially among Latina women. Psychological stress has a well-established relationship with urinary-related pain in the context of interstitial cystitis/bladder pain syndrome (IC/BPS). Studies have demonstrated the interplay between symptom severity and levels of psychological stress as more severe IC/BPS symptoms are observed among those with higher levels of psychological stress. Similarly, animal studies have confirmed the dose-dependent relationship between stress and IC/BPS. Early data has suggested the mediating behavior of stress on the severity of urinary symptoms and its interplay with avoidant behaviors for management of OAB/UUI. In addition to psychological stress, social stress—the stress associated with one’s social position and environment—has also been explored in the context of general health, chronic health conditions and mental health, particularly in minority populations most likely to experience discrimination. To date, these social stressors have not been evaluated in the context of lower urinary tract symptoms and pelvic pain. We evaluated the relationship between social stress exposures and urinary symptoms among Latina women in Los Angeles. Specifically, we evaluated the role of stress caused by daily discrimination on LUTS

We conducted analyses using data from a cross-sectional study of Spanish and English-speaking Latina women with and without pelvic floor disorders (PFDs) who were recruited from either the Female Pelvic Medicine and Reconstructive Surgery clinic at a large private or public hospital as well as community dwelling Latinas in Los Angeles. The study participants completed psychometric measures such as the Everyday Discrimination Scale (EDS), and the Perceived Stress Scale (PSS). We identified women who had urinary symptoms based on the Urogenital Distress Inventory (UDI-6) portion of the Pelvic Floor Disorders Inventory (PFDI-20) questionnaire. We conducted multinomial logistic regression to test the association between PSS and EDS average scores and urinary symptom severity (scale 1-5), adjusting for age, and testing for statistical significance at p-value <0.05.

We identified a total of 344 women with urinary symptoms (191 from the community, 153 in clinic). Clinic women had higher average scores on social stress metrics than community women (p<0.01). Among community women we observed positive associations for PSS and EDS with frequency (U1), urge incontinence (U2) and urinary pain (U6) (p<0.05), plus urinary leakage with activity (U3) for EDS (p<0.05). Among clinic women we observed positive associations between PSS and all urinary symptoms and for difficulty urinating (U5) for EDS, with a positive trend for the association between urinary symptom severity score and PSS among clinic women (p<0.05).

In community and clinic populations of Latina women with urinary symptoms, a relationship exists between urinary symptoms and social stress exposures, such as perceived stress and discrimination, which seems stronger for urinary pain in clinic women and for urge incontinence for community women.

The divergent psychometric measures highlight the complexity of the biopsychosocial model for LUTS in Latina women. In populations of Latina women with urinary symptoms, a relationship exists between urinary symptoms and social stress exposures, such as perceived stress and discrimination. The relationship is stronger for irritative voiding symptoms, including urinary pain. Further study is needed in understand the relationship between social stress exposure and urinary symptoms