Laura, a 32-year-old from New York, had spent months planning and preparing for her first major trade show as a fashion designer. This was where she’d launch her collection to an arena full of potential buyers and boutique owners — and she wanted every last detail to be perfect. But when the day finally arrived and it came time for Laura to present her line, she was overcome with nerves.
“It was my first time at a trade show, I didn’t know what to expect and felt so exposed in this big space and on the spot,” said Laura, who wished to withhold her last name in order to discuss her mental health. “When I get nervous or anxious, I get an extreme urge to pee, so that whole day I was just freaking myself out that I was going to pee.”
Anecdotally speaking, having to go to the bathroom — or at least feeling like you have to — is actually a pretty common symptom of anxiety. Although there isn’t a ton of research to explain exactly why our bladders let loose when anxiety strikes, health experts have tossed around a couple theories. Here’s what some had to say about why so many of us feel the urge to go and what to do about it:
Our fight-or-flight response is probably making us pee more.
When you’re calm and relaxed, your bladder gradually fills up with urine from the kidneys. Throughout the day, your body sends signals to your brain that either say, “Hey, it’s time to go to the bathroom!” or “We’re all good, you can hold it a bit longer.”
When you start to feel anxious, however, things don’t run as smoothly. This is largely due to the fact that our bladders are closely connected to our body’s fear system — aka our “fight-or-flight” response. When that response activates, our brain tends to override all those lovely signals telling us whether or not it’s actually time to pee. At the same time, our bladder muscles contract, which puts more pressure on the bladder and sends us running for the bathroom.
“So when you feel anxious, your body’s fear response can be triggered, overwhelming your bladder’s mechanisms for retaining urine, causing you to want to urinate,” Ashwini Nadkarni, an associate psychiatrist with Brigham and Women’s Hospital and an instructor of psychiatry at Harvard Medical School, told HuffPost.
On top of all that, some experts suspect that the fight-or-flight response could also put our kidneys into overdrive, causing them to produce more urine than usual, according to LiveScience.
We’re more in tune with our body when we’re anxious.
When we feel anxiety, we also tend to become hyper-aware of our own body and how we feel in our own skin, health experts suspect. For example, every heartbeat may feel like your chest is pounding, you may zero in on your breathing or you could have an overwhelming urge to urinate.
“[People will] apply a ‘selective filter’ and focus on the feeling that they’re going to pee, when in fact, objectively, they might not actually pee or pee as much as they think,” Nadkarni said.
In other words, yes, you may have to pee — but it’s probably not as much of an emergency as you think it is. Your brain is just tricking you in the moment.
The good news: There are ways to manage it.
Needless to say, the last thing you want to be worried about when you’re well, worried, is trying to find a toilet. Anxiety is disruptive and distracting enough without having to think about your bladder, too.
“If it happens once in a while, for example before a job interview or going on a blind date, the level of disruption can be minimal. If it is happening more frequently, it may be worth thinking through your overall stress levels,” said Jessy Warner-Cohen, a health psychologist at the Long Island Jewish Medical Center in New Hyde Park, New York.
The good news is that there are some strategies you can take up to try to tame your bladder. Many mental health professionals recommend practicing cognitive behavioral therapy, or CBT, to help manage anxiety ― and thus, your bladder ― on a more regular basis. CBT can also help people understand that frequent urination is simply a byproduct of their anxiety and also that they probably don’t have to pee as much as they think they do, Nadkarni explained.
According to Warner-Cohen, practicing mindfulness techniques can also help. “Recognize that the sensations you are feeling are typical and you are actually safe,” Warner-Cohen said. “Engage in ‘belly breathing,’ slow breaths in and out, and focus on your breathing instead of whatever else is happening.”
Additionally, pelvic muscle exercises may help with bladder training, which can control how much you urinate, according to Fara Bellows, a urologist at The Ohio State Wexner Medical Center. Bellows also recommended limiting fluid intake — especially caffeinated beverages like coffee or tea — before doing anything that may make you feel anxious.
If you try these things and still struggle with holding it in, you may actually have a condition like “overactive bladder,” in which case you truly cannot control what’s going on with your bladder. If you suspect you may have a more serious issue, a urologist or your doctor can help determine why your bladder doesn’t want to cooperate and insists on calling all the shots.
“Living With” is a guide to navigating conditions that affect your mind and body. Each month, HuffPost Life will tackle very real issues people live with by offering different stories, advice and ways to connect with others who understand what it’s like. In May, we’re covering anxiety in honor of Mental Health Awareness Month. Got an experience you’d like to share? Email firstname.lastname@example.org.