Mental health conditions, such as anxiety and depression, are common among people with overactive bladder (OAB). Frequent urination and the risk of bladder leaks can be stressful for some individuals.

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Research suggests that almost one-half of people with OAB experience symptoms of anxiety, with nearly one-quarter having moderate-to-severe anxiety. Those who experience anxiety as a result of OAB also have higher levels of stress and depression than those who do not.

It is important to note that OAB-associated stress is different than stress incontinence, which occurs as a result of an activity stressor, such as coughing or laughing.

Stress, anxiety, and depression may actually contribute to OAB and urinary incontinence. In a study involving more than 16,000 women in Norway, having anxiety or depression symptoms at baseline was associated with a 1.5- to two-fold increase in the risk of developing urinary incontinence.

Although researchers and medical professionals are not exactly sure why anxiety may cause frequent urination, there are two main theories.

The first is that stress creates the so-called fight-or-flight response that increases the sensitivity of the nervous system. Everyone experiences this in response to stress, but in people with OAB, basic reflexes such as bladder voiding can become stimulated more easily.

People with OAB may worry about having symptoms, especially in social situations, and this can set off their fight-or-flight response. This response can then lead to OAB symptoms, creating a cycle in which the more symptoms a person has, the more anxious they feel.

The second theory is that anxiety and stress can cause muscle tension, which can affect the muscles of the bladder and increase the urge to urinate.

Anxiety and depression are also associated with nocturia, which is the term for frequently waking during sleep to go to the bathroom. Some professionals believe that this is actually due to sleeping problems, which are common in people with anxiety and depression. They suggest that these individuals are going to the bathroom more often simply because they spend more time awake.

People can take steps to manage stress and anxiety that occur as a result of OAB. These include the following:

1. 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 2019 study 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.

2. Practice yoga

Yoga is a practice that aims to promote mindfulness and relaxation.

According to the results of a small pilot study published in 2021, women with urgency urinary incontinence who participated in yoga experienced significant improvements in their quality of life, including better sleep. Although the researchers observed no effect on anxiety or stress perception, the participants reported improvements in symptoms of depression.

3. Seek treatment for OAB symptoms

Many people believe that bladder leaks are a normal and inevitable part of aging. However, although urinary incontinence and OAB are common, people do not just have to deal with them. Various treatment options are available to help manage or prevent the symptoms of OAB, including:

  • lifestyle and dietary changes
  • pelvic floor exercises
  • medications and surgery

A 2019 study found that women who received medical treatment for OAB symptoms also experienced improvements in their anxiety and depression symptom scores.

4. 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 2020 clinical trial found that electrical stimulation, in combination with bladder training and biofeedback, significantly reduced the symptoms of OAB and improved quality of life.

5. Ask a doctor about behavioral therapy

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 (CBT) 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 pilot study involving 10 women with drug-resistant OAB, CBT improved urinary symptoms and led to significant improvements in both anxiety and depression.

6. Connect with others

Anecdotal evidence suggests that some people can find dealing with OAB embarrassing and isolating, but the condition is very common. People who feel this way may find it helpful to talk with others who are experiencing the same issues. These individuals can also provide additional advice for managing the symptoms.

A person can ask a healthcare professional about local or online support groups for OAB. Alternatively, the National Association for Continence provides resources to help connect people with specialized support groups.

Several health conditions may cause frequent and urgent urination. It is important to be aware of the other possible causes of urinary incontinence, which include:

  • urinary tract infections
  • vaginitis
  • interstitial cystitis
  • bladder stones
  • diabetes

People who experience a frequent, urgent need to urinate or have urine leakage should discuss treatment options with a doctor. The doctor can provide a diagnosis and put together a treatment plan.

If a person is finding it difficult to manage the stress and anxiety associated with OAB, the doctor can also direct them to a specialist to help manage these psychological symptoms.

Stress and anxiety are common among people with OAB, and they may also contribute to urinary incontinence. Managing the psychological symptoms of OAB may help improve both the urinary symptoms and the person’s quality of life.

A person should talk with a doctor if they are experiencing anxiety or depression due to OAB symptoms. Starting a conversation is the first step to identifying the medical and lifestyle options that can help improve the symptoms of OAB.