Adverse childhood experiences and lower urinary tract symptoms in adolescence: the mediating effect of inflammation

There is evidence that adverse childhood experiences (ACEs) are associated with lower urinary tract symptoms (LUTS) in adulthood, but few studies have explored these associations in adolescence. Little is known about the biological mechanisms that could explain these associations.

We used data from the Avon Longitudinal Study of Parents and Children (n = 4745) on ACEs (from birth to age 8 years), LUTS at age 14 years [any urinary incontinence (UI), daytime and bedwetting, urgency, nocturia, frequent urination, voiding postponement, and low voiding volume], and inflammatory biomarkers interleukin-6 (IL-6) and C-reactive protein (CRP) measured at age 9 years. We examined associations between the summed ACE score and LUTS, and inflammation and LUTS. We then evaluated the mediating effects of IL-6 and CRP.

Higher ACE scores were associated with increased odds of LUTS, e.g. a one-unit increase in the ACE score was associated with an increased odds of any UI [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.03-1.30]. Higher levels of IL-6 were associated with increased odds of LUTS, e.g. any UI (OR 1.24, 95% CI 1.05-1.47). There was weak evidence that the associations between ACE score and LUTS were mediated by IL-6 (e.g. any UI ORnatural_indirect_effect 1.03, 95% CI 1.00-1.06). There was no evidence that CRP was associated with LUTS or mediated the association between ACE score and LUTS.

This study reports novel findings that point to inflammation as being a possible mechanism on the causal pathway from ACEs to LUTS. Early intervention is needed in childhood to prevent LUTS persisting into adolescence.