How to manage frequent urination caused by anxiety?

From the Guidelines

To manage frequent urination caused by anxiety, clinicians should offer behavioral therapies as first-line therapy, which includes bladder training, bladder control strategies, pelvic floor muscle training, and fluid management, as they are as effective as anti-muscarinic medications in reducing symptom levels 1. When addressing frequent urination caused by anxiety, it's crucial to tackle both the psychological and physiological aspects.

• Practice stress-reducing techniques such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation to decrease anxiety levels.
• Limit the intake of substances that can exacerbate both anxiety and urinary frequency, such as caffeine and alcohol.
• Implement a timed voiding schedule to gradually increase the time between bathroom visits, thereby retraining the bladder.
• Maintain adequate hydration but avoid excessive fluid intake, particularly before bedtime.
• Engage in pelvic floor exercises (Kegels) to strengthen the muscles controlling urination, aiming for 10-15 contractions, three times daily. For persistent anxiety, considering cognitive behavioral therapy (CBT) can be beneficial as it effectively addresses anxiety disorders. In some instances, healthcare providers might recommend anti-anxiety medications, but these should be used judiciously, especially short-term benzodiazepines, due to their dependency risks. The approach of combining bladder training with anxiety management techniques is supported by the principle that it helps reset the disrupted brain-bladder connection caused by anxiety, while also reducing stress hormones that can trigger frequent urination 1.

From the FDA Drug Label

Oxybutynin chloride relaxes bladder smooth muscle In patients with conditions characterized by involuntary bladder contractions, cystometric studies have demonstrated that oxybutynin chloride increases bladder (vesical) capacity, diminishes the frequency of uninhibited contractions of the detrusor muscle, and delays the initial desire to void Oxybutynin chloride thus decreases urgency and the frequency of both incontinent episodes and voluntary urination.

To manage frequent urination caused by anxiety, oxybutynin may be used as it decreases urgency and the frequency of both incontinent episodes and voluntary urination by relaxing the bladder smooth muscle.

• Key benefits of oxybutynin include:
  • Increases bladder capacity
  • Diminishes the frequency of uninhibited contractions of the detrusor muscle
  • Delays the initial desire to void 2

From the Research

Managing Frequent Urination Caused by Anxiety

To manage frequent urination caused by anxiety, it is essential to understand the relationship between anxiety and lower urinary tract symptoms (LUTS). Research has shown that chronic psychological stress can result in the development of symptoms such as urinary frequency, urgency, incontinence, and pelvic pain 3.

Mechanisms Involved

The mechanisms involved in stress-induced LUTS include inflammatory responses induced by chronic stress, which can cause bladder dysfunction and pain via actions in the central nervous system and locally in the bladder 3.

Treatment Options

While there is little information on which treatments may have the most benefit for stressed/anxious patients with LUTS, animal studies suggest that traditional drugs for overactive bladder (solifenacin, mirabegron) are more effective on LUTS than anxiolytic drugs (fluoxetine, imipramine) 3.

Relationship Between Anxiety and LUTS

Studies have shown that anxiety is a common comorbidity with LUTS, particularly overactive bladder (OAB) 4, 5. Anxiety symptoms have been found to be more severe in patients with OAB, and these patients report more significant bother and impact on quality of life compared to those without anxiety 5.

Key Findings

• Anxiety disorders can predict the onset of urinary incontinence among community-dwelling adults 6.
• Anxiety, urge incontinence, and frequency appear to interact and exacerbate each other 7.
• A significant proportion of women with urge incontinence report symptoms of anxiety (56.6%) and depression (37.6%) 7.

Management Strategies

Based on the available evidence, management strategies for frequent urination caused by anxiety may include:

• Addressing underlying anxiety disorders through psychological interventions or medication.
• Using traditional drugs for overactive bladder (solifenacin, mirabegron) to manage LUTS symptoms.
• Developing a more integrated psychological model of urge incontinence that takes into account the interaction between anxiety, urge incontinence, and frequency.