22 June 2019

How stress and anxiety affect your bladder

Ever uttered the words 'I’m so nervous I could pee'? This may not be far from the truth. Stress and anxiety can lead to urinary incontinence.

Have you ever felt yourself going to the toilet more frequently than usual when you are stressed? Or does your bladder play up when you are anxious?

As soon as you become anxious or stressed, your body releases adrenaline and cortisol, two stress hormones which can cause a "fight-or-flight" response.

The need to urinate when feeling panicked may be an evolutionary effect – it’s easier to flee or fight with an empty bladder. The exact mechanisms behind this explanation are not fully understood, but when you are stressed out or feeling anxious, the nervous system operates at a higher intensity, meaning that it takes less to activate the reflex, according to Dr Alan Wein, a professor of urology at Penn Medicine at the University of Pennsylvania.

Another explanation could also be that your muscles tense up more, including your bladder muscles.

Research shows that there is a strong correlation between stress and anxiety and your bladder. A clinical study published in Urology investigated urinary symptoms among patients with overactive bladder syndrome who also suffered from anxiety. Those with anxiety had more frequent urination patterns than those who didn’t.

A vicious cycle

Unfortunately, in those who suffer from an overactive bladder or urinary incontinence, the condition itself may spur anxiety or stress, as you are constantly worried that you may not make it to the toilet in time. This anxiety makes your bladder more reactive – a vicious cycle.

A study published in the Journal of Anxiety Disorders investigated the temporal relationships between urinary incontinence and anxiety in adults. Adults with urinary incontinence were more likely to newly develop an anxiety disorder than those without the condition.

Manage anxiety

Whether you are suffering from urinary incontinence and you experience anxiety, or whether you just find that your bladder becomes more overactive from anxiety or stress, there are ways to manage the situation.

  • Seek treatment to find the underlying cause of your urinary incontinence if you haven’t yet done so. The better you understand your condition, the better you will be able to manage it.
  • Keep a bladder diary to understand what triggers your incontinence and to figure out when it is at its worst.
  • Limit caffeine and alcohol – not only do these substances irritate your bladder, increasing the possibility of a leak, but may also increase anxiety.
  • Teach yourself a coping mechanism such as meditation, breathing techniques or a calming mantra whenever you feel panicked.
  • Be prepared for unfamiliar situations – find the toilet before you do anything else and pack a spare set of underwear and wet wipes. You might not need these, but knowing that you are prepared for an accident will make you feel calmer.
  • Find professional help if your anxiety is crippling. It's important to know that it can be managed with the right medication and therapy. 

Image credit: iStock


Ask the Expert

Incontinence Expert

Dr Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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