Recurrent urinary tract infections and psychological burden: mechanisms and integrative perspectives

Recurrent urinary tract infections (rUTIs) remain a global health concern with significant physical and psychological impacts, particularly in women. Recent evidence indicates a strong bidirectional association between rUTIs and psychological burden, yet the underlying mechanisms remain incompletely understood.This review integrates findings from biomedical and traditional Chinese medicine (TCM) perspectives to elucidate potential pathways linking rUTIs with anxiety and depression. Four major mechanisms-immune dysregulation, endocrine imbalance, microbiome alteration, and neuroendocrine dysfunction-are proposed to explain this complex interaction. In addition, TCM conceptualizes this relationship through the theory of the "coexistence of disease and depression syndromes" emphasizing that emotional regulation is a key determinant of both urinary and systemic health. By synthesizing these insights, this narrative review underscores the importance of integrative approaches in preventing and managing rUTIs while addressing concurrent psychological distress.