Circulates blood around the body via the heart, arteries and veins, delivering oxygen and nutrients to organs and cells and carrying their waste products away, as well as keeping the body's temperature in a safe range.
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1. The effectiveness of antimuscarinic agents in the treatment of the overactive bladder (OAB) syndrome is thought to arise through blockade of bladder muscarinic receptors located on detrusor smooth muscle cells, as well as on nondetrusor structures. 2. Muscarinic M3 receptors are primarily responsible for detrusor contraction. Limited evidence exists to suggest that M2 receptors may have a role in mediating indirect contractions and/or inhibition of detrusor relaxation. In addition, there is evidence that muscarinic receptors located in the urothelium/suburothelium and on afferent nerves may contribute to the pathophysiology of OAB. Blockade of these receptors may also contribute to the clinical efficacy of antimuscarinic agents. 3. Although the role of muscarinic receptors in the bladder, other than M3 receptors, remains unclear, their role in other body systems is becoming increasingly well established, with emerging evidence supporting a wide range of diverse functions. Blockade of these functions by muscarinic receptor antagonists can lead to similarly diverse adverse effects associated with antimuscarinic treatment, with the range of effects observed varying according to the different receptor subtypes affected. 4. This review explores the evolving understanding of muscarinic receptor functions throughout the body, with particular focus on the bladder, gastrointestinal tract, eye, heart, brain and salivary glands, and the implications for drugs used to treat OAB. The key factors that might determine the ideal antimuscarinic drug for treatment of OAB are also discussed. Further research is needed to show whether the M3 selective receptor antagonists have any advantage over less selective drugs, in leading to fewer adverse events.
With sudden onset stress, the muscles tense up all at once, and then release their tension when the stress passes. Chronic stress causes the muscles in the body to be in a more or less constant state of guardedness. When muscles are taut and tense for long periods of time, this may trigger other reactions of the body and even promote stress-related disorders.
For example, both tension-type headache and migraine headache are associated with chronic muscle tension in the area of the shoulders, neck and head. Musculoskeletal pain in the low back and upper extremities has also been linked to stress, especially job stress.
Millions of individuals suffer from chronic painful conditions secondary to musculoskeletal disorders. Often, but not always, there may be an injury that sets off the chronic painful state. What determines whether or not an injured person goes on to suffer from chronic pain is how they respond to the injury. Individuals who are fearful of pain and re-injury, and who seek only a physical cause and cure for the injury, generally have a worse recovery than individuals who maintain a certain level of moderate, physician-supervised activity. Muscle tension, and eventually, muscle atrophy due to disuse of the body, all promote chronic, stress-related musculoskeletal conditions.
Relaxation techniques and other stress-relieving activities and therapies have been shown to effectively reduce muscle tension, decrease the incidence of certain stress-related disorders, such as headache, and increase a sense of well-being. For those who develop chronic pain conditions, stress-relieving activities have been shown to improve mood and daily function.
The respiratory system supplies oxygen to cells and removes carbon dioxide waste from the body. Air comes in through the nose and goes through the larynx in the throat, down through the trachea, and into the lungs through the bronchi. The bronchioles then transfer oxygen to red blood cells for circulation.
Stress and strong emotions can present with respiratory symptoms, such as shortness of breath and rapid breathing, as the airway between the nose and the lungs constricts. For people without respiratory disease, this is generally not a problem as the body can manage the additional work to breathe comfortably, but psychological stressors can exacerbate breathing problems for people with pre-existing respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD; includes emphysema and chronic bronchitis).
In addition, the blood vessels that direct blood to the large muscles and the heart dilate, thereby increasing the amount of blood pumped to these parts of the body and elevating blood pressure. This is also known as the fight or flight response. Once the acute stress episode has passed, the body returns to its normal state.
Chronic stress, or a constant stress experienced over a prolonged period of time, can contribute to long-term problems for heart and blood vessels. The consistent and ongoing increase in heart rate, and the elevated levels of stress hormones and of blood pressure, can take a toll on the body. This long-term ongoing stress can increase the risk for hypertension, heart attack, or stroke.
Repeated acute stress and persistent chronic stress may also contribute to inflammation in the circulatory system, particularly in the coronary arteries, and this is one pathway that is thought to tie stress to heart attack. It also appears that how a person responds to stress can affect cholesterol levels.
The risk for heart disease associated with stress appears to differ for women, depending on whether the woman is premenopausal or postmenopausal. Levels of estrogen in premenopausal women appears to help blood vessels respond better during stress, thereby helping their bodies to better handle stress and protecting them against heart disease. Postmenopausal women lose this level of protection due to loss of estrogen, therefore putting them at greater risk for the effects of stress on heart disease.
The HPA axis
During times of stress, the hypothalamus, a collection of nuclei that connects the brain and the endocrine system, signals the pituitary gland to produce a hormone, which in turn signals the adrenal glands, located above the kidneys, to increase the production of cortisol.
Cortisol increases the level of energy fuel available by mobilizing glucose and fatty acids from the liver. Cortisol is normally produced in varying levels throughout the day, typically increasing in concentration upon awakening and slowly declining throughout the day, providing a daily cycle of energy.
Stress and health
Glucocorticoids, including cortisol, are important for regulating the immune system and reducing inflammation. While this is valuable during stressful or threatening situations where injury might result in increased immune system activation, chronic stress can result in impaired communication between the immune system and the HPA axis.
This impaired communication has been linked to the future development of numerous physical and mental health conditions, including chronic fatigue, metabolic disorders (e.g., diabetes, obesity), depression, and immune disorders.
Esophagus
When stressed, individuals may eat much more or much less than usual. More or different foods, or an increase in the use of alcohol or tobacco, can result in heartburn or acid reflux. Stress or exhaustion can also increase the severity of regularly occurring heartburn pain. A rare case of spasms in the esophagus can be set off by intense stress and can be easily mistaken for a heart attack.
Contrary to popular belief, stress does not increase acid production in the stomach, nor causes stomach ulcers. The latter are actually caused by a bacterial infection. When stressed, ulcers may be more bothersome.
Bowel
Stress can also make pain, bloating, or discomfort felt more easily in the bowels. It can affect how quickly food moves through the body, which can cause either diarrhea or constipation. Furthermore, stress can induce muscle spasms in the bowel, which can be painful.
The intestines have a tight barrier to protect the body from (most) food related bacteria. Stress can make the intestinal barrier weaker and allow gut bacteria to enter the body. Although most of these bacteria are easily taken care of by the immune system and do not make us sick, the constant low need for inflammatory action can lead to chronic mild symptoms.
Stress especially affects people with chronic bowel disorders, such as inflammatory bowel disease or irritable bowel syndrome. This may be due to the gut nerves being more sensitive, changes in gut microbiota, changes in how quickly food moves through the gut, and/or changes in gut immune responses.
The SNS signals the adrenal glands to release hormones called adrenalin (epinephrine) and cortisol. These hormones, together with direct actions of autonomic nerves, cause the heart to beat faster, respiration rate to increase, blood vessels in the arms and legs to dilate, digestive process to change and glucose levels (sugar energy) in the bloodstream to increase to deal with the emergency.
Both the SNS and the PNS have powerful interactions with the immune system, which can also modulate stress reactions. The central nervous system is particularly important in triggering stress responses, as it regulates the autonomic nervous system and plays a central role in interpreting contexts as potentially threatening.
The male reproductive system is influenced by the nervous system. The parasympathetic part of the nervous system causes relaxation whereas the sympathetic part causes arousal. In the male anatomy, the autonomic nervous system, also known as the fight or flight response, produces testosterone and activates the sympathetic nervous system which creates arousal. 152ee80cbc
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