The Connection between Stress/Anxiety and Urinary Urgency
Leeanna Maher PT, MPT. H.BSc
What is Urinary Urgency
Urinary urgency, the sudden and overwhelming sensation of a need to urinate immediately without an ability to defer, is a highly distressing experience. This sensation may feel like intense pressure or spasming of the bladder or lower abdominal region. This occurs when the detrusor muscle (the muscle surrounding the bladder) contracts more forcefully than normal, thus signaling the brain to perceive an urgent need to empty the bladder. Over time, the fear associated with experiencing urinary leakage in public may lead to an increased sense of embarrassment and social isolation. While it's often associated with physical factors such as bladder health and hydration, research has demonstrated a connection between urinary urgency and stress or anxiety.
The Role of the Nervous System
The connection between urinary urgency and stress lies in the intricate interplay between the nervous system and the urinary system. The autonomic nervous system governs involuntary bodily functions, including bladder control. Within the autonomic nervous system, two branches are of particular importance: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).
o Sympathetic Nervous System (SNS): This branch of the nervous system is responsible for the "fight or flight" response during stressful situations. When activated, the SNS diverts energy away from non-essential functions, such as digestion and bladder control, and redirects it to vital organs and muscles to prepare the body for immediate action..
o Parasympathetic Nervous System (PNS): In contrast to the SNS, the PNS induces the "rest and digest" response, promoting relaxation and maintaining regular bodily functions, including bladder control.
The Stress Response and Urinary Urgency
When stress or anxiety triggers the "fight or flight" response, the sympathetic nervous system (SNS) becomes dominant, leading to a cascade of physiological changes in the body. As a result, the detrusor muscle contracts more forcefully, causing urinary urgency. Additionally, stress-induced muscle tension in the pelvic floor can further exacerbate the sensation of urgency.
Moreover, chronic stress can also lead to hormonal imbalances, such as elevated levels of cortisol (the primary stress hormone). These hormonal fluctuations may impact bladder function and contribute to an increased sense of urgency and urinary frequency over time.
Anxiety and Overactive Bladder (OAB)
Overactive bladder (OAB) includes symptoms associated with urinary urgency with or without incontinence, urinary frequency, and nocturia (multiple night wakings to empty the bladder). Research studies have described positive correlations between the severity of anxiety and OAB symptoms. It is still not clear if anxiety is a causal factor for OAB or if the anxiety results from having the bladder symptoms. One such hypothesis for the link between anxiety and OAB suggests that they share similar biologic pathways including the serotonergic pathway. Persistent anxiety reduces serotonin levels in the central nervous system and reduced serotonin has been connected with increased urinary frequency and bladder contractions. It is fair to say the connection between OAB and anxiety is complex and multifactorial.
Breaking the Cycle: Managing Urinary Urgency through Stress Reduction
Recognizing the link between stress, anxiety, and urinary urgency opens doors to more holistic approaches to managing these symptoms. Here are some strategies that may help break the cycle:
o Stress Reduction Techniques: Incorporate stress-reduction techniques into your daily routine, such as mindfulness meditation, deep breathing exercises, yoga, or regular physical exercise. These practices can help activate the parasympathetic nervous system and promote relaxation.
o Cognitive Behavioral Therapy (CBT): CBT is an evidence-based therapeutic approach that can be beneficial for individuals experiencing both urinary urgency and anxiety. It can help identify and modify thought patterns and behaviors that contribute to stress and anxiety. There are mental health counselors that are experienced and trained in this technique.
o Healthy Lifestyle Habits: Stay hydrated and avoid excessive consumption of caffeine or alcohol, as these factors can exacerbate urinary urgency.
Where Does Pelvic Physiotherapy Fit In?
Pelvic physiotherapy, also known as pelvic floor physical therapy, is a specialized form of physical therapy that focuses on the muscles, ligaments, and connective tissues of the pelvic region. Pelvic Physiotherapists take a whole body approach to treatment. Here are some ways pelvic physiotherapy can help:
o Pelvic Floor Muscle Training: The pelvic floor muscles play a crucial role in supporting the bladder and controlling urinary function through the voluntary contraction and relaxation of the external urethral sphincter. Pelvic physiotherapy involves exercises that strengthen and train these muscles. Optimizing the mobility and strengthening the pelvic floor can improve bladder control and reduce urgency and urge incontinence.
o Education and Behavioral Techniques: Pelvic floor physical therapists educate you on optimal bladder habits, hydration/fluid goals, and bladder irritants. Proper toileting techniques are taught to optimize the muscular mechanics of bladder and bowel emptying. Pelvic physiotherapists guide you on strategies such as "urge suppression techniques" to help you gain control over your bladder urges and reduce the frequency of urinary leaks.
o Biofeedback: At Proactive Pelvic Health Centre, biofeedback training is a tool that may be very useful for some people who have difficulty connecting to the proper coordination of their pelvic floor muscles. During this process, sensors are used to monitor and provide visual and/or auditory feedback on your pelvic floor muscle activity. This helps you become more aware of your muscles and learn how to contract or relax them more effectively.
o Relaxation Techniques: For some individuals, pelvic floor muscles can be overly tense, contributing to urgency. Pelvic physiotherapy can teach relaxation techniques that help reduce tension in the pelvic region and alleviate urgency symptoms. Pelvic physiotherapists also attempt to help identify what behaviors and activities may be driving the pelvic muscles to become tense in the first place.
o Bladder Retraining: Bladder retraining is a behavioral therapy technique that aims to improve bladder control by gradually increasing the time between bathroom visits.
o Manual Therapy: Pelvic physiotherapists use hands-on techniques to properly assess and treat the presence of tension in the pelvic muscles and surrounding structures. This can help improve blood flow, reduce pain, and improve overall pelvic function.
o Lifestyle and Dietary Recommendations: The physiotherapist can provide advice on lifestyle modifications and dietary changes that may positively impact bladder health, reducing urgency symptoms.
The connection between urinary urgency and stress or anxiety highlights the intricate relationship between our mental and physical well-being. Acknowledging this link empowers individuals to take a more comprehensive approach to managing urinary urgency by addressing the underlying stress and anxiety factors. By promoting relaxation, healthy lifestyle habits, seeking professional support resources such as mental health counselors, doctors, and pelvic health physiotherapists, individuals can achieve better control over their urinary health and overall well-being.
Resources:
https://www.frontiersin.org/articles/10.3389/fphys.2022.818993/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988874/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116264/