Your question: Why do I feel anxious about peeing myself?

My reply:

Hi, I hope this message finds you well. My name is Cesar Guedez, a psychologist trained in cognitive behavioral therapy. One topic that can be quite embarrassing for adults is urinary incontinence. This is because growing up we logically understand that it is a skill that we must master to perfection as a synonym of reaching maturity. However, it is quite common to have the sensation of peeing ourselves in certain circumstances, such is the case of anxiety.

According to the NHS, an estimated 3 to 6 million people in the UK experience some form of urinary incontinence, with anxiety and depression commonly associated with this condition (1). The relationship between anxiety and incontinence lies in the fact that anxiety is a state of dysregulation of our body, both psychologically and physically. Therefore, the physical sensations experienced during episodes of anxiety are largely common, including the sensation of urinating or urinary incontinence itself.

The sensation of peeing yourself is in your mind?

Not entirely, incontinence anxiety is both a physical and psychological process, like any other manifestation of anxiety. What happens is that during the anxious episode we feel the urgent need to urinate, even though our bladder is not full. Other physical symptoms during anxiety such as increased heart rate and sweating play against, and increase the feeling that we must go to the bathroom.

Therefore, it is necessary to check with your family doctor, as it could be an organic problem in the urinary tract and not a psychological condition per se.

Why is this happening to you?

Urinary incontinence and anxiety disorders are common conditions with important social and psychological consequences. Prevalence estimates of urinary incontinence among community-dwelling adults range from 24 to 34% for men and 41 to 55% for women (2).

The origin is ambiguous and varies from person to person. Some of the most common causes are related traumatic experiences in childhood, during the period when we learn to control our sphincters at will. Another common cause may be a family history of urinary tract problems.

However, in many cases incontinence anxiety can be addressed from a psychological perspective by treating the emotional conditions associated with the patient’s anxiety.

How do you stop this feeling?

First, it is necessary to work on the underlying anxiety and the cause of it. This involves an exercise of self-observation, which allows you to indicate where the stress and anxiety in your life comes from. It may be work, academic, family, romantic or past events that haunt you. Whatever the cause, an effective tool is to keep a journal.

Let’s call it a “panic diary” (2), in which you will record the events in your daily life that generate anxiety, with a detailed description of how, when, where and who. In addition, you will indicate how often you experience the sensation of incontinence, or incontinence itself, during these anxious episodes.

In addition to this, there are pelvic floor exercises (4) that you can do at home to train the muscles, and avoid episodes and sensations of incontinence in the future.

Also, it is very important that you work on progressive relaxation before and during episodes of anxiety. Inhale and exhale gently, and repeat in your mind that only you have control over your body. This mental exercise will help you understand that the feeling of incontinence during anxiety episodes is not a guarantee that you will pee yourself. Once you learn to know your mind and body better and communicate effectively with them, these unpleasant sensations will be less frequent.

In my experience…

The feeling that you are going to urinate when you have anxiety is common, has a logical cause and therefore, has a solution. While it can be desperate and embarrassing, it is a natural process of your body that you must learn to manage with patience and attention to what your mind has to tell you.

Remember that we all have the ability to improve our psychological state, even if during moments of anxiety or depression we feel that we are hopeless. We can always make small changes that will pay off in the long run. The fact that you are contacting me to seek professional attention is already a step, and I recognize and applaud you for that. Apply the techniques at your own pace and I am confident that you will gradually improve. It was a pleasure to write to you

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