Over the past decade, more and more people have learned how mental health challenges pervade society, reducing stigma and opening up avenues for treatment and change. Those with chronic anxiety disorders such as Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD) feel this relief

Despite this fact, we’re still learning about the mental health complexities of these disorders and must grasp how anxiety symptoms extend to every aspect of life to treat these disorders adequately. One symptom that is particularly related to anxiety is an overactive bladder (OAB), but it’s one that still carries a significant stigma among people who suffer from it daily. By reading about the relationship between anxiety and incontinence, including how to manage your incontinence symptoms, you can find hope in the midst of this stigmatized struggle.

Anxiety Symptoms

It’s first helpful to briefly touch on what chronic anxiety looks like before relating it to incontinence. Chronic anxiety, diagnosable as an anxiety disorder, is different from occasional feelings of fear or worry. In general, anxiety is a positive bodily response, pushing us to protect ourselves against potential negative outcomes. It’s good in small doses, but it can also be chronic and harmful when feelings of fear, worry, and the body’s corresponding response are severe.

Practically, chronic anxiety disorders share several commonalities. People experience:

Enduring Worries (For six months or longer)

Limited Sense of Control

Edginess and/or Hypervigilance

Significant Fatigue

Trouble Sleeping

Poor Concentration

Irritability

Muscle Soreness

Though people with chronic anxiety don’t typically experience every symptom, most experience enduring worry and have a limited sense of control, with some combination of the other symptoms.

The Fight or Flight Response

With an overview of anxiety under your belt, it’s important to learn about the fight or flight response and its mechanisms relating to anxiety. Meanwhile, understanding this neurological response gives a window into how people develop an overactive bladder.

Fight or Flight & Anxiety

The fight of flight response happens as a means of helping you escape and stay safe when your sympathetic nervous system activates, which typically occurs when you sense danger. This happens when you hear an unusual sound at night, lose track of your child in a public place, or come upon a large animal when camping. Importantly, this response also occurs when you experience distressing feelings of anxiety without an external cause you can address, such as before giving a speech. When you chronically have this fight or flight experience due to internal anxiety and cannot directly act on it, this can result in great distress.

Specifically, the fight or flight response involves several physiological reactions. Your body quickly causes your adrenal glands to secrete adrenaline and other hormones which elevate your heart rate, quicken your breathing, dilate your pupils, flush your face, and induce trembling and tunnel vision. When this occurs excessively due to psychological causes, your body has an elevated level of the stress hormone cortisol and struggles to relax. This arousal is similar to the edginess of chronic anxiety, and likely plays a part in many hallmark anxiety symptoms, including fatigue when you cannot recover from repeated feelings of distress.

Fight or Flight & Incontinence

Therelationship between anxiety and incontinence lies partly in how the sympathetic nervous system functions. Another sign of sympathetic activation is bladder relaxation and voiding readiness. This likely isn’t too surprising—many feel the need to go to the bathroom before giving a speech due to nerves. And so, if someone repeatedly experiences this fight or flight feeling when experiencing psychological distress, this can naturally result in an overactive bladder.

What Causes What?

Unsurprisingly, a study out of Washington University in St. Louis found that half of the subjects with an overactive bladder also had anxiety symptoms, and one quarter exhibited moderate to severe anxiety. What’s difficult to know is whether an overactive bladder causes anxious feelings (e.g. worrying about an accident in public leads to anxiety), if anxiety causes more frequent urination, neither, or both.

The same study assessed for cause and found there could be a causal link based on the factors’ consistently strong association with each other, as well as their relative dose-response. This dose-response connection shows that as bladder overactivity goes up, anxiety increases by the same degree, and vice versa.

In addition, they hypothesize OAB and anxiety share a biological pathway involving serotonin. This means that when serotonin, a hormone associated with feelings of happiness, is low, someone is more likely to experience both anxiety and OAB.

What You Can Do About Incontinence

In light of these factors, it may feel overwhelming to address your anxiety and incontinence problems. In reality, understanding anxiety’s connection with incontinence gives you a source of hope about lessening your urinary symptoms. Here are some helpful strategies that afford you much-needed relief.

Be Brave and Talk About It

Just as anxiety is easier to tackle when it doesn’t carry a stigma, reducing the stigma to incontinence is vital for treating the condition. Talk about your struggle with trusted loved ones—you may find that more people share your symptoms than you know. Sharing may help you feel less alone, which can also reduce some of your stress.

Visit a Doctor

One of your first steps, especially if you experience both anxiety and incontinence, is to visit your doctor. They can help you address your anxiety symptoms, and the doctor can potentially refer you to a counseling center and psychiatrist. The best way to treat anxiety is with a combination of therapy and medication if the symptoms require these measures. Also, if your anxiety does center on your fear of having an accident while away from a bathroom, you can constructively process through this fear with your counselor and experience relief. In addition to these referrals, your doctor can also suggest specific strategies to otherwise address your issues.

Exercises

One of these recommendations may be to do exercises that focus on relaxation and limiting urinary incontinence. To cope with anxiety, try meditating regularly or doing yoga or other similar exercises. As you do this, engage your pelvic muscles through Kegel exercises. By tightening and relaxing your pelvic muscles for ten or more repetitions a day, you can gain control over urination as you relax.

Avoid Stimulants

Also, specifically stay away from stimulants, which include nicotine products and coffee, soda, and some teas. A sense of heightened energy that comes with these stimulants may feel good, but over time it can lead to more anxiety. Also, these substances irritate the bladder, increasing your risk of incontinence if you regularly consume caffeine. Eliminating smoking and most or all caffeine from your diet will help lessen both symptoms.

Use Incontinence Products

Also, you can use incontinence products to limit the effects of an incontinence episode. For example, TotalDry maximum pads have high absorbency and specifically fit to prevent leakage. Using these products gives you a backup plan and thus more freedom to go about your life without constantly worrying about where you can go to the bathroom.