Stress Urinary Incontinence as a Chronic Stress Model: Clinical Evidence and Emerging Epigenetic Implications for Mental Disorders.

Abstract

Stress urinary incontinence (SUI) is conventionally viewed as a peripheral mechanical disorder, yet its psychological burden suggests that a broader biopsychosocial interpretation may be warranted. This perspective considers whether recurrent leakage, anticipatory anxiety, behavioural avoidance, and social evaluative threat may allow SUI to function as a chronic psychosocial stressor. It integrates clinical observations with established concepts in stress physiology, hypothalamic-pituitary-adrenal (HPA) axis regulation, allostatic load, inflammation, and stress-related epigenetic mechanisms, including FKBP5 and NR3C1. Direct molecular evidence in SUI populations remains limited; therefore, the proposed links are presented as a hypothesis-generating framework rather than as established causal pathways. The framework further emphasises the heterogeneity of patient outcomes. Differences in perceived symptom burden, coping, stress responsivity, prior vulnerability, and resilience may help explain why psychological symptoms improve after treatment in some individuals yet persist in others. These interacting psychosocial and biological processes may reinforce a feedback loop between symptom-related threat, sustained stress activation, and affective vulnerability. By moving beyond a solely mechanical model, this perspective supports a more interdisciplinary approach combining urogynecological and psychological assessment. The proposed stress-epigenetic framework is intended to guide future longitudinal and biomarker-informed research and to encourage more integrated approaches to the prevention and management of psychological burden in SUI.