Ecological Momentary Assessment Reveals Greater Anxiety and Marked Instability of Urinary Urgency in Overactive...

Overactive bladder (OAB) is highly prevalent and frequently co-occurs with anxiety. Although cross-sectional studies associate anxiety and OAB symptoms, anxiety and lower urinary tract symptoms (LUTS) vary in daily life. We applied ecological momentary assessment (EMA), consisting of four brief surveys administered via participants' smartphones over 7-14 days, to characterize severity and variability of anxiety and LUTS among individuals with and without OAB, and by sex among those with OAB.

Three hundred thirty-one participants with active OAB symptoms and healthy controls (HC) (271 OAB, 60 HC) (M age = 47.0, 69% White) from two studies of OAB completed baseline measures and 322 completed EMA evaluating affective symptoms (e.g., anxiety) and LUTS (e.g., urgency, frequency). Analyses compared OAB to HC, and sexes within OAB on aggregated momentary affective and LUTS ratings reflecting symptom intensity, variability, and instability.

Despite equivalent cross-sectional anxiety ratings, OAB participants displayed significantly more severe, variable, and unstable anxiety than HC in EMA, with medium effects (p < 0.001, d = .48-.55). Urinary urgency was the most unstable LUTS in OAB, fluctuating roughly 7 points on an 11-point scale. While women reported more incontinence-related symptoms, men reported greater average frequency.

Our findings confirm cross-sectional evidence for increased psychological and urinary burden and provide novel evidence of substantial fluctuations in distress and urinary symptoms in OAB patients. Findings suggest exploring mechanistic links between psychological and urinary symptoms and highlight the utility of EMA as an assessment tool in OAB.