Check-Up: Anxiety and overactive bladder

December 02, 2019

Twenty-five-year-old Hilary emails Check-Up asking for advice on a problem for which she has already seen a doctor but that remains a concern.

Hilary noticed some months ago that she had started passing urine very frequently. It didn’t burn a lot, but she just had to pee often.


She tried increasing her fluids and taking cranberry supplements, but that didn’t help, so she visited her doctor, who, after checking her for sugar (diabetes), which she didn’t have, sent some urine off to be tested for germs and put her on antibiotics.

The test came back negative, and the antibiotic didn’t work. She also did some ultrasound and X-ray tests, which showed normal results.

Her doctor also gave her mist potassium citrate (a urinary antiseptic) to drink, with no good results.

The doctor found out that Hilary had just broken up with her boyfriend of six years and has suggested that her nerves are causing her to have an overactive bladder because of the stress of the break-up.

Doc gave her some nerve tablets to take and has suggested counselling, but Hilary hasn’t done anything yet.

Hilary’s doctor has made a plausible diagnosis and has suggested management. If Hilary remains doubtful and is now also worrying about this diagnosis, she could return to her doctor and discuss with them why they have made this diagnosis and chosen the treatment prescribed.

She could also ask for a referral for further evaluation by a urologist (urinary tract specialist) of her urinary symptoms before proceeding to take treatment for her nerves, if needed.

An overactive bladder can definitely occur with chronic stress, alongside other symptoms of anxiety such as headaches, agitation, palpitations, irritability, poor appetite, etc. The commonly reported symptoms include:

- Frequency of urination.

- Urgency to urinate.

- Needing to urinate even though you’ve just urinated.

- Getting up often during the night to urinate.

These urinary symptoms, which are very similar to those indicating a urinary tract infection, can occur during stressful times and might be difficult to resolve unless the pattern of anxious behaviour, and not just the event that caused it to become manifest, is resolved.

Anxiety tends to result in increased muscle tension. This is what causes the tension headaches that are associated with anxiety states (these often feel like bands are tightening around the head), neck muscle tightness, more frequent bowel movements, and increased muscle tension in the bladder walls, which results in the affected person feeling the need to urinate often.

Increased urination caused by anxiety will most often require treatment. It usually doesn’t go away by itself. Avoiding coffee and alcohol can help a bit, and, of course, taking medications like diuretics for high blood pressure or heart failure will increase urination, which is expected.

Muscle-relaxation techniques can be taught, but the best way to reduce anxiety-related urine frequency is to learn to manage your anxiety. Deal with the issues and resolve them, accept them. Learn to cope!

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