Friday, March 17, 2023

Can Stress Cause Overactive Bladder

Ask A Doctor About Behavioral Therapy

What causes overactive bladder and what can be done about it?

Behavioral therapy can improve bladder control by providing a person with strategies to help manage their OAB symptoms. These strategies may include doing pelvic floor exercises and using a bladder diary to understand the triggers and patterns of OAB.

In a clinical trial involving more than 200 men with OAB symptoms, adding behavioral therapy to pharmaceutical treatment was associated with significant improvements in symptoms and quality of life compared with either behavioral therapy or medication alone.

Cognitive behavioral therapy focuses specifically on the psychological aspects of OAB. CBT often involves strategies such as reshaping thinking about OAB and learning to calm the mind and body.

In a involving 10 women with drug-resistant OAB, CBT improved urinary symptoms and led to significant improvements in both anxiety and depression.

Consider Alternative Treatment Options

In addition to the established treatment options for OAB, a variety of alternative treatments may help reduce symptom-related anxiety and stress.

The results of a 2020 randomized controlled trial involving 27 females revealed that laser acupuncture led to significant improvements in OAB symptoms and quality of life.

Researchers have also investigated electrical stimulation, which sends targeted electrical pulses to the muscles that control and support the bladder, for use in OAB treatment. A found that electrical stimulation, in combination with bladder training and biofeedback, significantly reduced the symptoms of OAB and improved quality of life.

Can Anxiety Cause Incontinence

Weve established that its not uncommon for anxiety and overactive bladder to occur together . But what about incontinence and OAB? Can anxiety cause you to lose control over your bladder? Yes but its rare. This would happen if you experience peak anxiety that puts you deep into fight-or-flight mode. At that point, your limbic system takes over. When the anxiety reaches its peak, your limbic system might decide its unable to support all your necessary functions and shut down the area that controls your bladder triggering temporary incontinence.

Incontinence triggered by extreme anxiety is more common in people with severe phobias. In rarer cases, it can happen to those suffering from panic disorder and PTSD.

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Intravesical Mediators And Phasic Contractions

The intravesical contents from the three baseline distensions were collected and frozen at 80 °C for later analysis of ATP and ACh content using commercially available assay kits and analysed according to manufacturer instructions.

During bladder distension and accommodation phasic intravesical pressure increases were observed and were associated with phasic increases in afferent nerve activity. The frequency and amplitude of spontaneous contractions during filling were measured during the 200 s preceding intravesical pressure reaching 20 mmHg and during accommodation were measured during the 200 s at the end of the stabilisation period. The increase in afferent activity associated with each contraction was also quantified and the mean represented as nerve impulses per second.

What Can You Do To Manage Urinary Frequency

can stress cause overactive bladder

First of all, it is extremely important to ensure there isnt 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, Parkinsons, 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 systems signals. Bladder training, for example, is a reliable technique that has been shown to improve symptoms,6,7 and involves bringing back your desire to pee into voluntary control. It is done in a stepwise fashion over time.

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.

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Keeping A Bladder Diary May Help Identify Triggers

Keeping a diary may sound time consuming, but it will help both you and your doctor identify any triggers for your overactive bladder and establish just how often you visit the bathroom each day.

How should you keep a diary for your overactive bladder?

  • Document exactly what kind of fluids you drink and their volume.
  • Write down the type and quantity of food you eat.
  • Record the number of trips to the bathroom and rate your trips as successful or not.
  • Indicate what you were doing when leakage or the urge to urinate occurred

What Is Overactive Bladder

Overactive Bladder, or OAB, is the frequent and urgent need to empty your bladder. Also sometimes called spastic bladder or irritable bladder, OAB affects an estimated 33 million people in the USA alone. And half of the people with Overactive Bladder are struggling with Urgency Urinary Incontinence , when leakage actually occurs.

Overactive bladder can be a nuisance at best, and debilitating at worst. Its frustrating to constantly be running to the bathroom, and can cause anxiety, shame and even depression when its is also accompanied by urinary incontinence.

Contrary to what many people think, overactive bladder is NOT a normal part of getting older, and isnt something you should think you have to live with. Its a real medical condition that deserves treatment.

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Normal Female Bladder Function

The adult bladder is a hollow organ with a muscular wall. Urine enters the bladder from two ureters which run from the kidney to the bladder. Urine is expelled from the bladder to the exterior via the urethra.

The detrusor muscle of the bladder wall is specifically designed to be able to store urine without increasing bladder pressure. The bladder acts as a reservoir relaxing to receive urine during the filling phase and only contracts to evacuate during the voiding phase.

The urethra acts reciprocally to contract during the filling phase to keep urine in the bladder and relaxing during voiding to allow for micturition. At rest the urethra is closed and the walls coapt against each other to form a seal that acts to keep urine in the bladder. Under situations of increased abdominal pressure contraction of the pelvic floor muscles and muscles around the urethra act to offer increased urethral resistance and maintain continence.

This video explains the pathophysiology of the overactive bladder. Bladder overactivity is a common problem affecting nearly 1 in 7 seven women. The aim of the video is to understand what is happening when the bladder is overactive. When you understand the cause you are more likely to be compliant with the treatments.

Don’t: Stop Your Pelvic Muscle Exercises

Traveling and Overactive Bladder

More often than not, OAB is a chronic condition it can get better, but it may not ever go away completely. To start with, doctors often recommend exercises such as Kegels to strengthen pelvic floor muscles and give you more control over your urine flow. Many people go like gangbusters with their exercises at first, then, over time, taper off. When their symptoms return, they wonder why.

To truly control symptoms, you’ll need to keep doing pelvic-floor strengthening for the rest of your life. But that 5 minutes a day will make a big difference.

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Botox Injections In The Bladder

An option for women who have failed all other medications. Onabotulinum toxin A is injected into the bladder muscle and causes partial paralysis of the detrusor muscle. Each course last approximately 6-12 months and patients typically will require multiple top-ups for the botox to be effective . This is performed under sedation in hospital as a day case and the botox takes approximately 7-10 days before working.

The botox is injected into the bladder wall as shown in the image, thru a small cystoscope that is introduced via the urethra. Approximately 5% of women will have trouble emptying there bladder following botox and use of a temporary catheter would then be required. The botox is now funded on the PBS in Australia when administered by a Urogynaecologist.

Try Pelvic Floor Exercises

The muscles in the bottom of the abdomen that support the pelvis, bladder, and urethra are known as the pelvic floor muscles. These muscles can become stretched or weakened as a result of surgery, pregnancy, or childbirth, reducing their ability to control the pelvic organs effectively.

Pelvic floor exercises can help restrengthen these muscles and improve the symptoms of urinary incontinence and OAB. A physical therapist can work with an individual to come up with an exercise plan that works for them.

In a review of 31 clinical trials, researchers found an association between participation in pelvic floor muscle therapy and significant improvements in not only the symptoms of urinary incontinence but also in quality of life. The measures of quality of life included a score of anxiety and depression symptoms.

People of all sexes can benefit from pelvic floor exercises. A found that following prostatectomy, which is the removal of part or all of the prostate gland, participation in pelvic floor exercises led to significant improvements in urinary incontinence, anxiety, and depression.

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Hyperstimulation Can Cause Over Active Bladder

While not a disease, Over Active Bladder is the name of a group of symptoms that affect urinary function, such as the sudden urge to urinate that seems difficult to control, incontinence, and frequent urination. OAB affects approximately 30 40 percent of North Americans.

Research has found that emotional problems, such as anxiety disorder, can cause and aggravate over active bladder. For instance:

OAB patients reported higher anxiety symptoms compared to controls. OAB patients with anxiety reported more severe OAB/incontinence symptoms, worse quality of life, and more psychosocial difficulties compared to OAB patients without anxiety. There are positive correlations between the severity of anxiety symptoms and OAB/incontinence symptoms.

While the exact science isnt settled about the reasons why emotional problems can contribute to OAB, two theories suggest:

  • The heightened autonomic nervous system activity can override normal nervous system communication between the bladder and brain causing the brain to generate a sense of urgency to urinate when the bladder isnt full, as we mentioned previously.

Any of the above reasons can cause a wide range of bladder and urination problems, including frequent urination.

Frequent urination during sleep hours is also common. Contributing factors include:

  • Hyperstimulation can cause an increase in resting metabolism even when sleeping. An increase in resting metabolism will cause the body to produce more urine than normal.

How Do Stress And Anxiety Impact The Bladder

What is Incontinence?

Anxiety and an overactive bladder can occur simultaneously. Stress and anxiety affect the bladder in several ways. Both cause muscles in your body to tense up , and the bladder is essentially a muscular sac that also tightens with stress. Additionally, your pelvic floor is comprised of muscles that can tighten, compressing your bladder. Chances are that when your body tenses up, so does your pelvic floor and bladder. This triggers the need to urinate, and if youre anxious often, you might need to go too often.

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What Causes Overactive Bladder

An overactive bladder can be caused by several things, or even a combination of causes. Some possible causes can include:

  • Weak pelvic muscles: Pregnancy and childbirth can cause your pelvic muscles to stretch and weaken. This can cause the bladder to sag out of its normal position. All of these factors can cause leakage.
  • Nerve damage: Sometimes signals are sent to the brain and bladder to empty at the wrong time. Trauma and diseases can cause this to happen. These can include:
  • Pelvic or back surgery.
  • Stroke.
  • Medications, alcohol and caffeine: All of these products can dull the nerves, which affects the signal to the brain. This could result in bladder overflow. Diuretics and caffeine can cause your bladder to fill rapidly and possibly leak.
  • Infection: An infection, like a urinary tract infection , can irritate the bladder nerves and cause the bladder to squeeze without warning.
  • Excess weight: Being overweight places extra pressure on your bladder. This can lead to urge incontinence.
  • Estrogen deficiency after menopause: This hormonal change could contribute to a loss of urine due to urgency. Ask your doctor if vaginal-only estrogen therapy is right for you. This is different from systemic hormone therapy, which is absorbed throughout the body.
  • Often, there may be no specific explanation for why this is occurring.

    Talk With Others Who Understand

    Dealing with OAB can make you feel isolated. Those around you probably dont really understand what youre going through.

    Local support groups and online forums can provide assistance that will help you deal with feelings of loneliness. Ask your doctor for information on groups that meet near you, or find online communities at MD Junction and the National Association for Continence.

    It may feel uncomfortable at first, but once you hear other peoples stories, youll realize youre not alone.

    • fatigue
    • crying spells

    Depression symptoms usually last for weeks at a time. Talk to your doctor if you notice these symptoms. Getting treatment for depression can help you refocus your efforts on finding solutions to OAB.

    You may have to get up to go to the bathroom a couple times a night if you have OAB. A lack of sleep can increase risk of stress, anxiety, and depression.

    To increase your odds of getting a good nights sleep, try these steps:

    • Go to bed and get up at the same time every day, even on weekends.
    • Avoid drinking a lot of fluids before bedtime.
    • Keep the television, cell phone, computer, and other gadgets out of the bedroom.
    • Indulge in a relaxing presleep activity, such as reading with a dim light, taking a warm bath, and doing a few easy yoga poses.

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    How To Recover From A Loss Of Bladder Control

    This type of response tends to only occur in those that are faced with extreme fear. It’s unfortunately not something you can control if you still experience that level of fear. You cannot tell your limbic system to control your bladder because it’s reacting to what it perceives as a dangerous threat, and if you ever were in danger you would want your limbic system to act the same way.

    There are two important factors for overcoming the loss of bladder control:

    • Preventing yourself from experiencing any shame or embarrassment.
    • Controlling anxiety from becoming that severe.

    Your anxiety is going to make it very hard for you to not care about something like a loss of bladder control. You are going to need to do whatever it takes to remind yourself that no one is judging you – no one cares that you lost control of your bladder from fear, and no one would care if it happened again in the future. Fear of losing control of your bladder contributes to further fears and anxiety. You have to make sure that you do whatever it takes to prevent it from affecting you further.

    You’ll also need to learn to control your anxiety so that it is not severe enough to cause that level of fear. Those with phobias should strongly consider desensitization therapy. It’s an effective and widely used to way to reduce overall phobias.

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    Overactive Bladder Vs Stress Urinary Incontinence

    Dr. Yaser Bassel Discusses Hyperactive Bladder and Stress Incontinence – BayCare Health System

    This information was made available with an “unrestricted educational grant from Pfizer Canada.”

    Overactive bladder occurs when a muscle in the bladder known as the detrusor contracts more often than normal. This causes a person to feel a sudden and sometimes overwhelming urge to urinate even when the bladder isnt full.

    The symptoms of overactive bladder include:

    • Frequency having to urinate more than 8 times over 24 hours, often including 2 or more times a night.
    • Urgency frequent, sudden, strong urges to urinate with little or no chance to postpone urination.
    • Wetting accidents : involuntary loss of or leaking urine following a sudden, strong desire to urinate.
    • It is estimated that most people with overactive bladder experience only the symptoms of urgency and frequency . The remaining 37% have wetting accidents in addition to urgency and, often, frequency.

    If you have these symptoms, dont forget one important fact overactive bladder can be treated regardless of the cause!

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    Losing Weight May Help To Improve Your Bladder Control

    Excess weight puts extra stress on your pelvic floor muscles and contributes to an overactive bladder and loss of bladder control. If you can lose even a small amount of weight, it will help with bladder control.

    The best weight loss plans are always those that set realistic goals combined with healthy eating habits and physical activity. Fad diets, although often successful short-term, rarely achieve sustainable weight loss, because once you tire of the diet, you often revert to ingrained unhealthy eating habits.

    Check out our Obesity and Weight Loss guide for more information.

    Medications That Can Cause Urinary Incontinence

    Urinary , or the loss of bladder control, can be caused by various health conditions and physical changes, such as childbirth, changes in diet, infection, prostate issues, menopause, and neurological disorders. But there are also a number of medications can cause urinary incontinence in both men and women in a variety of different ways.


    Diuretics such as hydrochlorothiazide , furosemide , bumetanide , triamterene with hydrochlorothiazide

    Increase urine production by the kidney

    Frequent urination, overactive bladder, stress incontinence

    Muscle relaxants and sedatives such as diazepam , chlordiazepoxide , lorazepam

    Cause sedation or drowsiness relax the urethra

    Frequent urination, stress incontinence, lack of concern or desire to use the toilet

    Narcotics such as oxycodone , meperidine , morphine

    Cause sedation or drowsiness relax the bladder, causing it to retain urine

    Lack of concern or desire to use the toilet, difficulty in starting urinary stream, straining to void, voiding with a weak stream, leaking between urinations, frequency incontinence

    Antihistamines such as diphenhydramine and chlorpheniramine

    Relax the bladder, causing it to retain urine

    Overflow incontinence

    Alpha-adrenergic antagonists such as terazosin , doxazosin

    Relax the muscle at the outlet of the bladder

    Leaking when coughing, sneezing, laughing, exercising, etc.

    From , Harvard Health Publishing

    Image: Thinkstock

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