How anxiety could explain why you need to pee all the time

anxiety need to pee all the time

In a normally functioning bladder, the organ fills with urine like an expanding balloon. This urine is kept in the bladder by your urethral sphincters, of which there are two. One of these muscles is controlled with your thoughts, but you have no control over the other one, it is part of autonomic nervous system control.

Eventually, your bladder fills up to the point where it starts sending signals to your brain that you need to go to the bathroom. At this point, you are still able to voluntarily control whether you empty your bladder or not. Once you make time to go to the bathroom, your brain signals both the urethral sphincter and pelvic floor muscles to relax, and prompts another muscle that makes up the bladder, the detrusor muscle, to contract, squeezing urine out of your bladder.

Urinary frequency

Urinary frequency is a condition defined as urinating more than eight times in a 24 hour period, or once or twice per hour during the day.1 There can be many causes for feeling as though you need to empty small amounts of urine very often throughout the day. These include urinary tract infections (UTIs), chronic constipation, pelvic organ prolapse, alcohol, tea, coffee, smoking, being overweight, medication side effects, and medical problems that affect your nervous system. If you have any condition that could be playing a part such as diabetes or multiple sclerosis, or your urinary frequency has any associated symptoms, it is important to see your doctor to see if there is a simple, correctable cause.

Can anxiety play a role in urinary frequency?

When you are anxious you may also feel the need to pee. Unfortunately, there aren’t that many clinical studies looking into anxiety and urinary frequency. However, the bladder’s ability to contract itself is controlled by the nervous system, emotions such as anxiety can be interpreted by the brain as the presence of a threat generating the body’s stress response, and the bladder is supplied with nerves from the same nervous system. Given all of the above, it stands to reason then you can have urinary symptoms associated with anxiety.

Studies have shown that a higher proportion of women with overactive bladder do suffer from anxiety, and those that do tend to have worse symptoms.

Why this occurs is poorly understood, although some treatable conditions or factors, such as diabetes, may contribute to its development, and it is really important to ensure that any medical causes that might need treatment are ruled out before deciding that your symptoms are related to anxiety.

How is anxiety related to bladder symptoms?

To understand how anxiety and bladder symptoms are related, it helps to understand how emotions work on the body. If, for example, you were suddenly faced with a stressor, such as being chased by a dog, your emotions would generate a stress response in your body, the fight or flight response. Among other things, you may notice your pulse pounding rapidly in your ears, that your mouth feels dry, you may feel a bit shaky and not hear much going on around you, and you may feel sweaty.

This is all the result of a cascade of hormones that the body releases to respond to an acutely stressful situation, preparing you to fight a danger or run away. These hormones also act on the bladder, causing the muscles to relax and the bladder to empty. This is why, in films or novels, you find that when a person gets scared they wet their pants.

When you suffer from anxiety, your fight or flight response tends to be activated when there is no clear danger present. On a neurobiological level, the need to urinate is controlled by three different nerve pathways. The first, the autonomic nervous system, manages involuntary control. Its two branches (the sympathetic and the parasympathetic nervous systems) supply the internal sphincter and detrusor muscle respectively with nerves.

This pathway is managed in the brain by a center called the pontine micturition center, but once we are toilet trained we can override this to a certain extent by voluntary thought. This voluntary control supplies the external sphincter muscle with nerves, but it can be overridden by the limbic system – the connection of neurons that transmit emotions (including anxiety) for processing by the brain.2

Studies have shown that a higher proportion of women with overactive bladder do suffer from anxiety, and those that do tend to have worse symptoms.3 Furthermore, a smaller study has suggested that anxiety is a risk factor for overactive bladder, although there is insufficient information about whether or not anxiety-reducing medication improves bladder symptoms.4

Another study found that “patients with anxiety report more severe bladder symptoms, worse quality of life, and more psychosocial difficulties compared to overactive bladder (OAB) patients without anxiety. There are positive correlations between the severity of anxiety symptoms, and OAB/incontinence symptoms”.5

Other symptoms you may notice if your urinary frequency is related in anxiety may be a stress response in other parts of your body — such as a dry mouth, racing heart, tunnel vision, or a ringing in your ears. Pay close attention to the situations or triggers that give rise to these feelings.

A study found that “patients with anxiety report more severe bladder symptoms, worse quality of life, and more psychosocial difficulties compared to overactive bladder (OAB) patients without anxiety. There are positive correlations between the severity of anxiety symptoms, and OAB/incontinence symptoms”.

Keeping a diary of when you go to the bathroom, how much urine you pass when you get there, what medications you are on, what you’ve had to drink during the day, and any other pertinent surrounding situational factors can help your doctor zero in on the cause of your symptoms.

What can you do to manage urinary frequency?

First of all, it is extremely important to ensure there isn’t a medical problem causing it, and your doctor will discuss any other symptoms with you and look at your medical history. Examples of conditions that can cause urinary frequency include diabetes, MS, Parkinson’s, dementia, stroke, bladder tumours and bladder stones.

If your urinary frequency is determined to be secondary to your experience of anxiety, it can help to visit a licensed counsellor to look at both the underlying cause of your anxiety as well as getting cognitive behaviour tips for the management of secondary symptoms.

Other simple lifestyle changes can reduce your need to visit the bathroom so frequently, such as removing bladder irritants like caffeine and alcohol, reducing your weight if you are overweight, and stopping smoking.

Finally, since humans are able to learn new behaviours and responses, it is possible to train your bladder to not respond to your emotional nervous system’s signals. Bladder training, for example, is a reliable technique that improves symptoms, and involves bringing back your desire to pee into voluntary control, and is done in a stepwise fashion over time.6

If you are finding you need to pee all the time, and believe it could be related to anxiety, then it is important to visit your GP, as there are plenty of solutions that can help. Incontinence is a very common condition, and there is no need to just put up with it.

Disclaimer: This content is designed to provide general information and is not a substitute for medical advice. Medical opinion, practice and routine may vary from country to country and may change from time to time. The author is not liable for the results of misuse or inappropriate application of the information. If you are an individual who chooses to access this information, you should not rely on the information as professional medical advice or use it to replace any relationship with your doctor or other qualified healthcare or social care professional. For medical concerns, including decisions about medications and other treatments, individuals should always consult their doctor or, in serious cases, seek immediate assistance from emergency personnel. Individuals with any type of medical condition are specifically cautioned to seek professional medical advice before beginning any sort of health treatment. Individuals with specific queries or concerns should seek appropriately qualified medical advice. Clinicians must use their own judgement when interpreting this information and deciding how best to apply it to the treatment of patients.

Featured image shows a woman leaning forward resting her head on her arm, which covers her eyes. The image is cropped so you can only see her arm and her lips and nose in profile.

References

  1. Publications & Communications Committee, ‘Fact Sheets – A Background to Urinary and Faecal Incontinence’, International Continence Society, (available online), 2015, https://www.ics.org/public/factsheets, (accessed 2 July 2018).
  2. C. J. Fowler et al., ‘The neural control of micturition’, Nat Rev Neurosci., Vol. 9, No. 6, 2008, pp. 453-466.
  3. H. H. Lai et al., ‘The relationship between anxiety and overactive bladder / urinary incontinence symptoms in the clinical population’, Urology, Vol.98, 2016, pp. 50-57.  
  4. R. Sakakibara, ‘Depression, anxiety and the bladder’, Lower Urinary Tract Symptoms, Vol. 5, Iss. 3, 2013, pp. 109 – 120.
  5. H. H. Lai et al., The relationship between anxiety and overactive bladder / urinary incontinence symptoms in the clinical population’, 2016, pp. 50 – 57.
  6. Oxford University Hospitals, ‘The overactive bladder and bladder retraining – Information for patients’, [available online], 2016, https://www.ouh.nhs.uk/patient-guide/leaflets/files/14187Poveractivebladder.pdf, (accessed 2 July 2018).

Dr. Natasha Abdul Aziz

Natasha is senior clinical fellow in Obstetrics & Gynaecology with the Chelsea & Westminster NHS foundation trust. She was previously a clinical research fellow at the University of Oxford and national women’s health lead for the Muslim Doctors Association of the UK. Her special interests include the use of digital healthcare solutions to help vulnerable populations of women, volunteer work with refugees, and chasing that last sliver of sun on her balcony after work.

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