Overcoming panic attacks involving urinary urgency?
May 16, 2012 6:58 PM   Subscribe

How to control panic attacks/panic disorder when the primary symptom is sudden urinary urgency?

This is sort of an embarrassing question, but it is an issue that is causing me a lot of distress and is impacting my life more and more for the worse every day. Basically, my problem is that the MORE inconvenient it is for me to go to the bathroom in a given situation, the MORE I have the urge to go. Some troublesome situations include:

*Bumper-to-bumper traffic with no indication of when things will start moving again.
*Getting stuck at a long/slow train.
*Being the passenger with a very slow driver at the wheel.
*Going somewhere new where the length of the trip will be long, and/or the availability of bathrooms along the way will be scarce.
*Going somewhere new where the length of the trip, and/or the availability of bathrooms along the way, is uncertain.
*Going for a walk somewhere where bathrooms are scarce/absent (cities with little public restroom access, large public gardens or nature walks where things are too done up and public to just "go behind a tree").
*Places where I have to stay put (concerts, plays, even funeral processions).

When I am in these kinds of situations, I will have a sudden onset urge to go, and to go BADLY, with all the symptoms thereof (fluttery sensation, full bladder with pressure to release, some hyper-ventilation, panicked/urgent thoughts). Basically though it is like a panic attack with an emphasis on urinary symptoms. There are a few likely reasons I suffer from this. For one, panic disorder runs in my family and I have always been a bit on the anxiety-prone side. Additionally, I have always suffered from somewhat of a small bladder, or at least a tendency to have to go a bit more often than other people. Medically speaking, I have not been diagnosed with anything specifically related to this (other than possibly IBS), although my doctor did try me on some overactive bladder medication just for kicks, though this did nothing.

Ultimately things really started to go downhill for me when I got my first UTI (didn't know it at the time) and the urge to go hit me while I was on the train on my way to school. I had to get off at a weird stop to find a bathroom in an unfamiliar part of town, but in the end there was not enough liquid to warrant the stop. I had several more urgent episodes like this on my way to school, on the campus, and on the way back home. The next day I was driving to the train station and got so worried that it would happen again that I turned around and went home instead. That was the only day I avoided the situation, and eventually I got my diagnosis and was treated. Insidiously, this urgency problem got worse and worse over the years for mostly psychological reasons rather than purely physiological reasons. So now situations like those above will trigger the instant urge to go. It does not matter much if I went shortly beforehand. I also do not need to actively fret over the issue. Just being in those situations trigger it automatically. Sometimes controlled breathing helps but I have to keep at it for a long time (like most of a car ride), and sometimes it doesn't matter. Sometimes when I stop to urinate there isn't much fluid, or at least not enough to warrant the extreme sensations. Other times, there IS a whole lot of fluid... but it is hard to know if my panic influenced the volume amount or not.

Present company matters too. If it is me by myself the panic is relatively low. If it is me and my husband it is a little higher, but not too bad (he'll let me dodge behind a tree or drop me off wherever I need to). If it is with my family it is worse because it is more inconvenient for everyone to stop, and if it is with friends/peers it is worst of all because they will be merciless.

It is often impossible for me to discern whether or not there exists a sincere need to go, or if it is just panic. Most of the time the feelings are exactly the same. And I think therein lies the biggest problem. If you can ignore an urge ALL of the time, or heed it ALL of the time, it is easier to manage. But when it is sometimes legitimate and sometimes not, it makes it very hard to manage. I continue to put myself in these uncomfortable situations ("exposure therapy," if you will) but things just keep getting worse. I also practice with holding it as long as possible, and reminding myself about how long I have been able to hold it, but to no avail. I am hoping to get some kind of professional help for this problem, but money and scheduling issues are delaying it. I also just got back from a VERY long road trip, where obviously this was very inconvenient so it is weighing heavily on my mind. I am wondering if anyone has any sage advice for me, or if anyone has experienced this and gotten through it. I would really appreciate it a lot. Sorry for being so long-winded, but I thought the details might be helpful.
posted by anonymous to Health & Fitness (10 answers total) 5 users marked this as a favorite
 
I don't have any great suggestions for right now, but when you get to see a healthcare professional, I recommend trying to get in with a urogynecologist, they specialize in women's bladder issues. Ask whether biofeedback therapy might help you.
posted by treehorn+bunny at 7:07 PM on May 16, 2012 [1 favorite]


I had the same symptoms. Things that have helped me is to cut out coffee (even decaf is a diuretic) and cut down on alcohol. I'm also on a low dose of zoloft for anxiety, which has helped immensely.

Needing to pee is a phyiscal manifestation of anxiety--treating the anxiety will help relieve your symptoms.

If medication is just not an option right now, try meditation once or twice a day to help reset your mind, and do kegel exercises to build up your bladder endurance. It's not just about holding it as long as you can, but controlling the sphincter that lets it out. When you pee, try to stop the pee 10 times before you finish. The first few times will be very uncomfortable and feel very unnatural (like trying to stop a sneeze) but stick with it. I don't know if this will be as good as getting some more thorough professional help, but it will probably help. (Anyway, the kegels are great for your lower back and pelvis strength, too, so win-win.)
posted by elizeh at 7:08 PM on May 16, 2012 [1 favorite]


Best answer: Some years ago, while my mother was caring for a dying parent, she understandably started to suffer very badly from anxiety and general crappy health, one manifestation of which was a spastic bladder that was getting her out of bed over and over all night.

Her GP gave her Klonopin wafers - they melt in your mouth like breath strips - both for the anxiety and specifically to quiet her bladder. It worked a treat, she only took it when she needed it, it didn't make her foggy (really important, as she often had to get up in the night to help her father). My husband has taken it for anxiety as well, and found it to be just enough to take the edge off.

A lot of people do have pee responses to adrenaline, like when badly frightened. It doesn't necessarily mean there's anything wrong with your bladder, and there are ways to get some help.
posted by Lyn Never at 7:40 PM on May 16, 2012


With the caveat that none of us are your doctor, I'd suggest:

See a specialist. As mentioned above, there are doctors and nurse-practitioners who specialize in this issue; this is important because you need to eliminate physical causes, test medications, and (probably) work with biofeedback or behavioral options.

Treat the anxiety. You're in a vicious cycle, where the bladder issues make you anxious, and the anxiety makes your bladder act up. So while you are seeing the urologist about your bladder, make sure you talk with someone about the anxiety. There are medications for both situational anxiety and for pervasive issues; one or both might be of use to you, as might be a variety of calming techniques like meditation.

See an acupuncturist. Ignore this if you are someone who refuses to go near anything with even a hint of "alternative" medicine, but this is the kind of issue that acupuncture often works well for.

Pay attention to other people. It's easy to be all "OMG, what if I am the person who makes us stop the car so I can pee?!?!" -- but in reality, someone is always stopping the car to pee, and no one thinks it's odd or a problem. Making a big deal out of it in your mind is a symptom of the anxiety, not a reflection of reality.
posted by Forktine at 7:46 PM on May 16, 2012


When you are in a position to seek professional help, I have two suggestions: physical therapy (bladder retraining), and cognitive behavioral therapy (for managing the anxiety and the positive feedback loop between the nervousness and the urgency).

In the interim, you might try some solo bladder retraining. Scheduling urination might help, can't hurt (though I also bet it'll be pretty challenging at first).
posted by gingerest at 8:00 PM on May 16, 2012


Best answer: I definitely have had similar issues from anxiety and have learned that my issues are caused by constantly tensing the muscle that are used to hold in pee. Relaxation has helped a great deal, as well as recognizing when I'm tensing and stopping that behavior. I definitely recommend seeing a specialist just in case you have a more serious issue that is causing this anxiety. Good luck!
posted by two lights above the sea at 8:04 PM on May 16, 2012


Best answer: I know *exactly* what you're talking about, and all the situations sound totally familiar to me. I've had it on and off for over 20 years, and I know for me it's stress-related. Mine developed right before I defended my dissertation, which was also when I had my first anxiety attack. I've had to leave theater performances, teaching was frequently a nightmare, as was traveling. Cutting down on caffeine did help, but I still get it on and off. I was offered anxiety meds, but was always too afraid to take them.

I have a sort of chant now that helps, like "You've never lost control, this is just the way you feel, nothing has ever really happened" etc. I also really try to work on controlling the stresses of my life. For me there's also a peak anxiety phase, about an hour, and if can get past that, I feel better. Maybe it's good to at least know there are other people who know what you're feeling.
posted by feste at 8:06 PM on May 16, 2012


I'm going to chime in and say I also have this problem and have also had it for 5-7 years.

Just like you, it started with one incident. Mine was train delays and having to be somewhere remote and scary and not being able to get off. It really just either damaged my nerves physically or mentally or both, since after that I had to go in 20 minute intervals (nightmare) and then finally got it up to 1.5hrs, where it's been holding steady despite...therapy, specialists (urologist, obgyn specialist in urinary issues, regular GP, 'physiotherapist for women's issues', medication (both for OAB and anti-anxiety/klonopin), and acupuncture (three series of attempts, latest for 9 months))!

I feel that it must be extremely psychologically based (except for beer- beer is a big problem, and maybe coffee but I was EXTREMELY depressed when I gave it up to try to follow the IC diet- another nightmare).

I'm not sure what the solution is. I teach all day, so I can never really properly try to "wait it out" and do bladder retraining...but if I had a 'regular' job, I would definitely try this.

It's sad but it has definitely interfered with my socializing, and the idea of long car rides or public transport (ie overland buses etc) definitely gives me the willies.

I do a bit of what Feste above says, try to talk myself out of it. But like you say, it's hard to tell what's 'real' from what's not. That's why I haven't got past 1.5hrs, before that I can tell myself it's not real, after that, I'm not sure.

Good luck and please report back here. It's completely a drag but eventually we should be able to put this psychological manifestation of anxiety behind us, right??? (please god, let it be so).
posted by bquarters at 8:38 PM on May 16, 2012


Please talk to a psychiatrist about this if you haven't already. This is a situation where a low dose anti-anxiety med, SSRI, or the quick acting meds above could have a HUGE impact on your quality of life.

I'd look carefully at this thread for some related advice about the interrelated nature of physical symptoms and stress anxiety. You can have real physical symptoms that are resolved by treating the anxiety.

Good luck!
posted by mercredi at 8:39 PM on May 16, 2012


Huh, I thought this was an issue nearly unique to me. A few things that have helped:
- I go a lot. Anytime I am near a clean bathroom I try. If I know I'm about to get in a car I try. Like a five-year-old girl *siiigh*
- I never drink anything in the car, or within a few hours of a long drive.
- When I know I'll be in an otherwise nervous situation, I wear a menstrual pad. Since I know my bladder will be pretty empty, I know that if I lose control, there won't be much liquid.

I think the last bullet is the key, and since I discovered this trick it's been a lot better. Because I have been in so many situations where I've prepared with a pad, I have built my confidence that I'm in control, which means if I end up in a situation where I haven't prepared and I'm not near a restroom, I can believe more comfortably that I can keep it together.

But yes - I've ended up in situations where I had to walk miles because I got off the bus, or went to the bathroom several times in a few minutes before a long trip, or went to the bathroom at home and then 5 minutes later at the movie theater, or whatever. You're not alone!!
posted by town of cats at 10:46 PM on May 16, 2012


« Older A head full of snot at altitude   |   Gluten Free Carribean Newer »
This thread is closed to new comments.