Psychological Stress and Incontinence: Is there a Link?

As we’d expect, incontinence can cause psychological stress and embarrassment. However, could stress and other mental health issues be a possible cause of urinary incontinence?

Incontinence is often caused by physical injuries, illnesses and infection. However, recent research has shown that maintaining good mental health can actually be vital for staying continent. Experts assert that problems such as anxiety, confusion, depression, nervousness or stress can actually aggravate already existing incontinence and bladder problems. As researcher Hillary R Bogner asserts, “causes of urinary incontinence are incompletely understood and include psychological and physiological factors outside the lower urinary tract”.

In 2015, researchers Henry Lai and Vivien Gardener published an article titled “correlation between psychological stress levels and the severity of overactive bladder symptoms”. The study examined the relationship between psychological stress levels and the severity of incontinence symptoms. Patients diagnosed with overactive bladder participated in a case control study that inquired about their psychological stress levels using the perceived stress scale. In a similar 2006 study, researchers set out to investigate the relationship between anxiety, depression and urge incontinence in women. A sample of 12,568 women aged 40 years or more were mailed a postal questionnaire. This featured questions on general health, urinary symptoms and the hospital anxiety and depression scale. A significant proportion of women with urge incontinence reported symptoms of anxiety (56.6%) and depression (37.6%) before they experienced incontinence. This demonstrated the relevance of emotional factors in the development and maintenance of urge incontinence. As researchers Perry S and Grandmother CW assert, “assessment and treatment protocols for urge incontinence often concentrate only on the physical aspects. A more integrated psychological model of incontinence is proposed”.

Understanding the Link                                   

We know that the body produces chemical neurotransmitters that communicate with each other on the cellular level. The key chemicals that deal with stress are called serotonin and norepinephrine. When your body is under a great amount of stress, these neurotransmitters inform all the other cells to get ready to either stand up to the stress or run away from it. Serotonin and norepinephrine stimulate our cells to respond in unexpected physical ways. Data over the years shows that these responses evoke three physiological processes: tendency to succumb to depression, your response to pain and unexpected bladder leakage.

It is often assumed that individuals with anxiety and high stress levels may also be more sensitive to certain physical symptoms. This may influence the experience of urinary incontinence. Anxiety disorders and extreme stress can also often be a marker of vulnerability, making the development of urinary incontinence much more likely.

Preventing Incontinence Caused by Psychological Stress

Improving our ability to identify older individuals at risk for chronic conditions such as urinary incontinence is something that is of urgent need. To stay continent, it is important to stay in a healthy state of mind. If you are to stay continent, messages between your nervous system, your urinary tract muscles and your brain must coordinate properly. Simone Vigod, MD, a psychiatrist, clinician and researcher in Toronto, asserts, “both incontinence and mental health problems have an exponential impact on quality of life. They both need to be taken seriously”. It is therefore important to visit a Doctor or professional if you are struggling with constant anxiety or stress. Your Doctor should also recommend the most ideal incontinence treatment method for you. In the meantime, you can read our living with incontinence advice section for tips and guidance.

Using exercise disciplines that help both depression and incontinence can be helpful. A physical therapist trained in urology can screen for back or hip problems that could be causing or exacerbating the incontinence problem. Methods such as pelvic floor exercises can help prevent leakage, whereas frequent meditation can help calm your mind and body. You can read about exercises for incontinence here.

Avoiding caffeine, which is known to make both incontinence and stress levels worse, can be equally important. For Alison Lundberg, cutting caffeine out of her diet entirely was the key to calming anxiety after a family tragedy. She explains, “I was looking for alternatives to prescription medicine. I wanted to look at ways to cut stimulants, and anything I might be consuming that triggered anxiety”. Lundberg’s daily routine to starting the day consisted of diet coke and coffee, and she decided to replace the drinks with sparkling water and herbal tea. She explains the benefits of the changes, “the natural energy I’ve found is much more satisfying than anything chemical. I noticed my anxiety lessened, and I was able to have a stronger grasp on controlling my emotions”. A known bladder irritant, caffeine can increase bladder activity and result in higher urgency and frequency of urination. By reducing or eliminating caffeine intake, you should see a rapid decrease in symptoms.