Anxiety induced urinary urge

July 26, 2007 5:07 PM

When there is no bathroom available, my wife panics and gets a really strong urge to urinate. This is seriously impairing her ability to take part in a lot of activities. So far our doctor has not been able to help, so I'm asking for suggestions here.

So far the GP has tried her on some kind of muscle relaxant (I think Detrol but I'm not sure) which had no effect, and a kind of hypnotherapy which was supposed to cure the problem by improving her general confidence, but this has also not really made much difference. We are going back to the doctor again but since this seems to be mainly a psychological problem I thought Metafilter users might have some helpful advice.

posted by anonymous to health & fitness (11 comments total)

I think this is a job for a psychotherapist.
posted by Steven C. Den Beste at 5:16 PM on July 26, 2007

Question: does she also suffer of paruresis?
posted by kepano at 5:23 PM on July 26, 2007

If you google "nervous bladder" and "overactive bladder," you will find a wide array of resources and possible approaches, if indeed that is what she has. She should also try to get an appointment with a specialist (OB/GYN and/ or urologist), to rule out physical possibilities.
posted by Forktine at 5:32 PM on July 26, 2007

What sort of activities? Outdoors stuff? Maybe she should get comfortable with the idea of hiking a little into the woods, squatting and peeing. Then everywhere private becomes a bathroom if necessary - problem solved! (I'm not totally joking.)
posted by Dasein at 5:37 PM on July 26, 2007

My first thought when reading this is that it might be a manifestation of agoraphobia:

agoraphobia primarily consists of the fear of experiencing a difficult or embarrassing situation from which there is no ready escape to (psychological) safety.

Does your wife have any history of panic attacks? Agoraphobia is usually (although not always) comorbid with panic disorder. I think it would be worth seeing a mental health professional if the two of you think this might be a possibility, as both conditions respond well to treatment.
posted by granted at 7:01 PM on July 26, 2007

I have very little information to go on here, but it sounds like in addition to seeking treatment for a possible psychogenic disorder, she needs a workup by a qualified urologist, preferably a urodynamics specialist. Depending on the exact balance between the abnormal sensation of having to urinate and the physically demonstrable hyperactivity of her bladder muscle, this could be interstitial cystitis, overactive bladder, or urge incontinence. In addition to a Google search, here are some links to fairly easy-to-understand review articles by experts on overactive bladder.
posted by wireless at 7:24 PM on July 26, 2007

If it is psychiatric, this seems like the kind of unfortunate association that cognitive-behavioral therapy was designed to break. Of course your medical team is the one to ask. If your GP hasn't been helpful, just ask him for a referral to an independent psychiatrist in addition to the psychologists doing hypnosis.

Psychiatrists can be very different in their approaches. If you think that one is engaging in an ineffective therapy, feel free to go to another. If your GP isn't giving helpful referrals, go to another that a friend in your area recommends.

Note: despite the popular association, psychiatrists work on all kinds of psychological problems and discomforts, not just "crazy" people in hospitals.
posted by a robot made out of meat at 8:02 PM on July 26, 2007

Ask your GP to refer your wife directly to a local urogynaecologist. There is a significant psychological component, but the investigation and treatment need to include the bladder itself.

(Disclaimer: I am a UK urogynaecologist, and I'm doing my PhD on overactive bladder. I guess I've been waiting for this question ever since I signed up to Metafilter.)
posted by roofus at 5:15 AM on July 27, 2007

If she's middleaged, this isn't just all in her head.


I had the same problem, and working on it from the physical angle is what helped. Medication for my bladder plus drinking MORE fluids and training myself to hold it just a little longer helped.

But I still like being near a potty.
posted by konolia at 5:38 AM on July 27, 2007

If this is strictly anxiety related to not having facilities available (and I agree with getting checked out a little more to make sure thats all it is) she could always learn to pee standing up. I know it sounds snarky, but I know a couple of women who can do this and it makes outdoor activities a lot easier for them.
posted by TedW at 6:42 AM on July 27, 2007

Sounds like agoraphobia to me. I take klonopin for it. It definitely helps with the panic attacks.

Also, she could use the underwear pads that people with bladder control problems wear. The right clothing can hide their presence. My guess is that it's not that she actually has to urinate, she's just afraid she will. If it doesn't matter one way or the other (i.e., if she urinates with the pad on, no one else will know), then the anxiety is reduced and her fear is far less likely to come true.
posted by desjardins at 12:07 PM on July 27, 2007