How do I stop freaking out about urination?

December 9, 2008 7:27 AM

How do I deal with urine-related anxiety? It's intruding more and more in my life and I don't know what I can do to fix it.

Over the course of college, I had two incidents in which I wet myself. In one, alcohol was involved...in the other, a boy I had just met and had kind of a crush on was involved (not a witness, thank god, but I put off peeing because I was embarrassed to excuse myself...dorky I know). I also had a couple of close calls that required public urination...not easy when you're a girl. So, being anxious about my ability to control my urine is not unwarranted.

Since graduating (2 years ago) I have a huge amount of anxiety associated with whether I will be able to get to a bathroom. I work in an office and go to a large number of hour-long (or longer) meetings and find that in general by about 45 minutes in, I'm squirming with urgency. I never have to pee that much, but I just have a feeling that I'm not going to be able to make it to the restroom before I let loose. This just keeps getting worse, to the point where I've had to excuse myself by saying I wasn't feeling well. Needless to say this is unusual behavior and as one of a small number of women in my workplace I worry that my frequent trips to the restroom are attracting scrutiny. This is probably just paranoia, but it sucks anyway. Today I was watching a presentation by the CEO and had a minor panic attack about feeling like I had to pee, although I'd just gone half an hour before. We're talking racing heart rate, sweating, trouble breathing...basically all around unhealthy stuff. It was scary.

This is really getting in the way of my life. I know I need to talk to my doctor about it, but I think it's a mind over matter thing and I mostly need some coping strategies. Has anyone else experienced this and figured out a way to make it stop, or at least make it better? I'm not interested in taking anxiety medications - in general I'm not a person that needs them, I'm just freaky about the idea of peeing my pants and it gets the best of me sometimes.

posted by anonymous to health & fitness (26 comments total)

There are some physical issues that cause frequent urges to urinate, so your doctor may want to check you out for that first. As well he should (if it IS because you just have Smedley's Pee-Mor Syndrome, or whatever, then knowing it actually has a physical root CAUSE may be a mental relief). While you're taking care of that, you can discuss your suspicions that it may indeed be a mental thing, and your doctor can help you figure out what to do.

But do make sure it doesn't have a physical cause first. Smedley's Pee-Mor may be easily treatable, if that's all it is.
posted by EmpressCallipygos at 7:42 AM on December 9, 2008

Do you actually have to urinate that frequently or is it anxiety/panic attacks related to the idea of not being able to go if you need to?

I ask because there are medical conditions that lead to frequency of urination, and it may well be that because of an underlying medical condition that you have had some accidents and tense moments not being able to find a bathroom... which in turn spawned the anxiety attacks. Sort of how kids with ADHD can get really depressed, but the depression is a secondary symptom to the struggling in school and life with ADHD.

Go to a physician first. Make sure there isn't any medical reason. For all you know you're experiencing the start of diabetes and that's the cause of your increased urination. If you don't actually have a medical condition and/or you're not actually having to go to the bathroom as much as you think you are... then go talk to psychologist. I doubt you'll end up on anti-anxiety meds but a bit of therapy about your anxiety might help.

Or you could always get a job in the adult industry peeing on people! Problem solved! The world would be your bathroom then! ;-)
posted by JFitzpatrick at 7:42 AM on December 9, 2008

Cognitive-behavioral therapy may help. I myself have bathroom-related issues, mostly about not being relatively close to one at all times. i.e. I am more anxious in stores where a bathroom isn't available for public use.

Anxiety attacks are a tough issue to get through. The only thing I can think of that may help is comparing the times you DO make it to a bathroom than the times that you don't. You've had two real, embarrassing incidents- but compared to the times you can normally perform bathroom functions, that's very small.

Best of luck. I know explaining this hangup to a psychologist or therapist may be difficult, but ignoring it or shaming will just encourage the anxiety.
posted by rachaelfaith at 7:50 AM on December 9, 2008

I agree with the physician-needing, you could have a bladder issue that really is giving you the feeling of needing to go. It may be just subtle enough that you aren't sure if you are feeling it, therefore think you aren't, and consequently think its all in your head.
posted by aleahey at 7:52 AM on December 9, 2008 [1 favorite has favorites]

Follow-up from the OP

When I'm not worried about being able to find a bathroom, the urge to urinate isn't nearly as intense. For example, I rarely wake up in the middle of the night having to go, nor do I go every half-hour when I'm just sitting at my desk working. At home I'll go hours without feeling any urge at all. I think I pee more than the average person, but I only become a crazy urination/anxiety machine when I know it would be socially weird to get up right then, or if I'm in a place where there's no bathroom. I'm not denying that this could be a bladder issue, but if it is, it's a very subtle one.

posted by jessamyn at 8:15 AM on December 9, 2008

Take a cup of water with you and then if you do pee yourself spill it on yourself to cover your tracks. Sounds like an anxiety thing to me.
posted by zeoslap at 8:31 AM on December 9, 2008

A very good friend of mine had this exact similar issue. He had every test done, but it ended up being purely psychological -- a physical symptom triggered by unrelated anxiety, causing more anxiety about having to pee every half hour, causing the symptoms to get worse -- it's a horrible circle. If he wasn't thinking about it, he was pretty much fine. But the minute he wasn't entirely comfortable with the facilities situation, the problem became magnified. The solution? A simple little pill, taken once a day.

You really need to talk to a doc. I know you know this, but it's not just about mind over matter or finding coping strategies. Your coping strategy is to get the help you need. Talk to a doc, get everything tested to make sure it's not something physical (this will ease some of the anxiety), and if it is purely psychological, there are many magic pills out there that will help you get over this. Some, yes, are anti-anxiety. Others control the symptoms, which when controlled breaks the anxiety cycle and things just sort of take care of itself from there. But you need to work with a doc to figure out which is appropriate for you. Please. Seriously, this supposedly little thing has a serious affect on your quality of life, and chances are it can be fixed without too much difficulty -- you just need to take the first step and see a (competent) doc.
posted by cgg at 8:34 AM on December 9, 2008

sigh... "exact similar issue" started off reading "a similar issue" which I then tried to change to "the exact same issue"
posted by cgg at 8:38 AM on December 9, 2008

Nthing everyone else. See your regular doctor. Do not be embarrassed. We've heard it all, and much "worse" things than this. Rule out a medical cause. Then go see a therapist.
posted by gramcracker at 8:53 AM on December 9, 2008

It doesn't sound like you have had more accidents than other people--you've really had only two, and those would have been avoided if you had just gone to look for a bathroom. It also doesn't sound like your degree of urgency--even if it's worse when you're feeling anxious--is so weird that anyone would care or notice.

I believe your doc (after checking you for any physical issues) will reassure you that your urination frequency is really pretty normal. I hope that allows your "weirdness" feelings to go quietly away.

What gramcracker said. Good luck.
posted by JimN2TAW at 9:26 AM on December 9, 2008

A urologist told me that some food dyes irritate the bladder, as do spicy foods. And anything caffeinated, and beer, increase urination. So, avoid dyes, and plan any spicy food, caffeine and beer. Develop the habit of going to the bathroom on a schedule, and going before you have to pee. Pee before meetings, whether you feel the need, or not. Urgency may be caused or exacerbated by urinary tract infection. Cranberry juice and vitamin C are good for Urinary tract health. Do see a doctor, and make sure there's no infection.
posted by theora55 at 9:48 AM on December 9, 2008

I'd just chime in that briefly leaving a meeting to use the restroom, even if the CEO is speaking, would not be considered unprofessional in any workplace I've ever been in. Hell, I've briefly stepped out of meetings just for a breathe of fresh air if the room got stuffy. Unless it is a very small group, nothing need be said, just quietly excuse yourself.

When nature calls, listen.
posted by McGuillicuddy at 10:02 AM on December 9, 2008

follow-up from someone who would prefer to remain anonymous

My wife and I have both suffered from this problem (me as a teenager, her as an adult). For me, the problem gradually went away by itself when I left school and no longer faced the embarrassment of asking to leave the class several times a week. I still pee more often than most people, don't like to be away from a bathroom and there are a few activities I would avoid but I'm able to live normally. What I don't have any more is the panic reaction - I've learned to trust myself to hold it. Strangely, for me I think getting into drinking beer helped as well, the fact that it causes the bladder to fill more quickly plus also makes the drinker more relaxed meant that I learned that I could hold a lot more than I thought.

When my wife's problem got bad enough that it was really interfering with her life she had CBT for it, I think it was about 8 sessions altogether. It did help a lot, she doesn't worry too much now about anything less than an hour now when previously a 15-minute cab ride was enough to make her anxious. Part of the training was basically me and her going on increasingly longer drives together but her and the therapist also did a lot of work together on trying to identify and break down the thought patterns and "safety behaviors" that she was using to avoid the problem (like not getting in a car with anyone apart from me). Every time she managed to stop herself from carrying out a safety behavior was a little victory that gave her more confidence.

I also suggest that you learn how to do diaphragmatic breathing (breathing into the belly instead of the chest), it is a natural anti-anxiety technique that is discreet enough that you could do it in the middle of a meeting without anyone knowing. And of course anything that you can do to reduce the amount of stress in your life will probably help as well.

Good luck with this, it is an embarrassing and annoying problem to have but I hope these stories demonstrate that it is possible to improve the situation.

posted by jessamyn at 10:09 AM on December 9, 2008

I have a teeny bladder and pee often under the best of circumstances. When I'm a little more stressed than usual I can get that "omg out of range of bathroom, what to do?!" feeling. Depending no how bad this is for you, you may be able to psyche yourself out of this, or you may need to talk to a professional.

For what it's worth, it's a very very common version of anxiety disorders, to have concerns about when/where you will find a bathroom. It's sort of a social anxiety, worrying what people will think of you when you walk out of a room to go to the bathroom, worrying about how to ask for a bathroom, etc. For some people this gets exacerbated by having had weird jerkish parents (my dad was famous on long road trips for trying to get us to wait til we got home or til we passed a rest stop instead of pulling over at the first available bathroom) who gave us bad ideas about how "normal" it was to want/need to use the bathroom.

So, first step is making sure you don't give yourself a hard time about this. Within the range of anxiety disorders, this is normal.

Second step, going to pee is more normal than having some sort of an accident. So, no matter what the situation is -- have to climb over people in a movie theater, in church, need to use the bathroom in a grocery store -- make it your FIRST goal to give yourself permission/access to a bathroom. It's okay, it's normal and anyone who gives you a hard time for it is a jerk.

Then, try to make it easier to do this for yourself. This has two parts 1) making it easier to get to a bathroom (sit on aisles at movies/airplanes, sit near doors at meetings, get used to what sorts of places have public restrooms) 2) making you less likely to have to pee (less caffeine/alcohol, more salty snacks, less liquids, go pee befre you leave any place that has a decent bathroom) and possibly also 3) get more brazen about asking to use the bathroom even if there's no public bathroom. You can claim it's period-related if you feel weird about the peeing thing. Women generally get a little more leeway for bathroom trips since there's a real possibility you're bleeindg on to your clothes which any sane person would want to help you avoid.

And last, be logical with yourself. ANY amount of grief from some boorish person is preferable to peeing on yourself. If you haven't had anything more to drink in a long time, the excess bladder pressure you feel is likely partly anxiety-driven. This helps for me on long car trips where I'm like "Oh shit, I just passed an exit and the next one is in 20 miles!" but realistically I haven't been drinking much so if I feel like I HAVE to pee, I'm mostly just being nervous, not in a situation where I'm in trouble.

So for your specific situation at work, go to the bathroom beforehand, keep your drinking beforehand to a minimum, and if you have to use the bathroom JUST GO. The more you do this, the more normal it becomes and the less likely it is to be an issue. Best of luck.
posted by jessamyn at 10:30 AM on December 9, 2008

As I'm sure others have said, doublecheck with a doctor to make sure there's nothing physically wrong.

After that, I'd recommend working up a certain defiance about this. I'm always the person who gets up in the middle of the meeting to pee, or when I was in classes would have to get up to pee, and generally every single time I was in class.

This thought helped me enormously, because I'm as self-conscious about it as anyone: I'M A GROWN WOMAN AND WHEN I HAVE TO PEE, I'M GOING TO GO PEE. I'm not going to sit there and feel bad about it.
posted by A Terrible Llama at 10:37 AM on December 9, 2008 [1 favorite has favorites]

The symptoms, once a physical cause is ruled out, are consistent with classic panic disorder, with which I am unfortunately intimately familiar. I highly recommend the Anxiety and Phobia Workbook, and therapy. The anon poster above also has some really good advice.
posted by desjardins at 10:42 AM on December 9, 2008 [1 favorite has favorites]

Oh, and realize that most people do not care at all about other people's bathroom habits.
posted by desjardins at 10:44 AM on December 9, 2008

Another possible medical reason: do you have back/lower back problems? The nerves in your lower back could be screwed up, and one of the things that those nerves affect is how you pee.
posted by phunniemee at 11:15 AM on December 9, 2008

I'm a huge fan of walking out of meetings to use the bathroom. It is rather empowering. The speaker would rather have you feeling relaxed than trapped (unless he is a monster).

I've also enjoyed walking out of movies, sermons and job interviews. I have not had a reason to walk out of a dental appointment or haircut, but I would.

Wow, maybe I'm a controlling bastard!
posted by cockeyed at 11:33 AM on December 9, 2008

Pre-excuse yourself by letting it be known to a smattering of people that "jeez, it's such a pain but I've got to frequently leave meetings / stick close to a washroom because I have such a small bladder". It's a perfectly valid excuse (not that you need one) that will enable you to slip out to a washroom whenever you need to go (or not), and therefore possibly alleviate your anxiety.
posted by lunaazul at 11:58 AM on December 9, 2008

It's anxiety. Other people have the same fears about barfing, or pooping, and probably various other processes as well. If you have an excess of anxiety, it'll latch onto any normal process to give itself an 'excuse' to get you panicked. I ended up going on meds to control anxiety, and am much better off now. This is the sort of thing that can eventually develop into agoraphobia, ya know? CBT and a sympathetic ear can do you a lot of good.

And - everybody pees. It's ok to go pee whenever you feel the urge. People aren't paying attention, honest. If you had an eyelash in your eye, a contact that needed adjustment, a leaking tampon, a nosebleed, a wedgie, a piece of spinach stuck in your teeth - you need to go deal with it. It's normal, expected, and ignored, even in a meeting. No one is speculating on your restroom activities. Keep it low key, don't be compelled to overexplain, a murmured "would you excuse me for a moment? thanks." is all you need, without urgency, without emarrassment, in the same fashion you'd say "would you excuse me while I take this phonecall." Do you notice when other people absent themselves to the bathroom? Do you think judgmental thoughts about them? Probably not, right?

And - having a pee accident isn't that weird. Some people leak when they sneeze, cough, laugh, slip on the sidewalk. Pregnant ladies have a hair-trigger bladder. No one ever really talks about it, is all. You might start doing kegels, to give yourself some bladder control strength and confidence.
posted by Lou Stuells at 1:10 PM on December 9, 2008

i used to have horrible, horrible, uncontrollable ibs. eating anything, and drinking almost anything, would set me off. i HAD to be somewhere with a bathroom or else i just could not go out because i would be at a 99.99999% chance of pooping my pants. and i'm pretty sure we can all agree that pooping your pants is worse than peeing your pants! this lasted for about six miserable years.

at any rate, i adopted many of the strategies that jessamyn outlined: sitting in the aisle, going beforehand, etc. i also stopped caring if i just had to get up in the middle of class and leave. i once walked out on a final exam because it was poop my pants and finish the exam or fail the exam and make it to the bathroom.

just giving yourself permission to go if you have to will go a long way towards alleviating your anxiety. i promise.

and i would like to point out that i don't really have ibs anymore and that pants-pooping isn't a concern anymore, so please don't look at me like i'm that girl. also, almost all of us have pee'd ourselves--at least a little--while drunk. don't feel bad about that one.
posted by misanthropicsarah at 1:28 PM on December 9, 2008

I seem to remember that doing pelvic floor muscle/Kegels exercises helps with urinary frequency. Even if it doesn't help medically, it might have a good placebo effect and make you feel more empowered about the situation in general. Plus they're good for you! All women should do them.
posted by genmonster at 1:45 PM on December 9, 2008

Not sure if this will help in the slightest, but I find that if I restrict liquids, I have the feeling to pee more often (and less completely) than I do when I'm hydrated. Just wondering if you are restricting fluids out of anxiety?
posted by sully75 at 2:29 PM on December 9, 2008

When I was 15, I had this irrational, obsessive fear that I would tear a giant fart in the middle of Algebra II. It was so distracting, I couldn't think of anything else, and my breathing would go all shallow and my heart rate would increase and I'd get sweaty just thinking about it.

It wasn't a physical issue, and I was in no actual danger of farting. Most of the time, I didn't even feel remotely gassy. It was something I was obsessing over because I was anxious (I really hated math, and there was an incredibly cute nerdy guy in my class who I was in love with who made me nervous, plus generalized crazy.)

When I told my husband this story a couple days ago, he -- well, first, he had a good long, laugh at my expense, and then he suggested I read the Anxiety and Phobia Workbook, as desjardins mentions above.
posted by peggynature at 6:47 PM on December 9, 2008

Control of the bladder is voluntary*, my friend!!!

If you don't believe me, drink a bunch of water, and time yourself. How long before you get an urge to go? How long can you hold it? How long before you are pretty sure you can't hold it any longer? This will give you an idea of how your particular system works.

If you find that you lack basic control then, definitely, definitely you should go to the doc.

Otherwise, you have nothing whatsoever to worry about. You won't ever just randomly pee. Of the two times it's happened to you before, only the sober one counts.

You can manage yourself by knowing that
-being nervous will limit how long you can hold it (but won't make you just randomly pee)
-alcohol may affect your voluntary control

Otherwise, if you want to be proactive, Kegel exercises will give you more precise control.

(*Unless you are sleeping, intoxicated, startled, or have incontinence).
posted by OlivesAndTurkishCoffee at 8:43 PM on December 9, 2008