Incontinence anxiety – also known as bowel and/or bladder control anxiety (BBCA) – is a term that describes an overwhelming fear of experiencing urinary or bowel incontinence (or both) in a public setting.
People with incontinence anxiety won’t necessarily have a bladder and/or bowel condition – though many do. However, the stress caused by worrying about incontinence can negatively impact a person’s health and wellbeing.
With this in mind, it’s important to seek support if you’re struggling. To help, we’ll explore some common symptoms and causes of incontinence anxiety – and offer suggestions for ways to manage it.
What are the symptoms of incontinence anxiety?
Doctors Sunjeev Kamboj and Lan Rachel Brown from University College London (UCL) tell us that incontinence anxiety “is an understudied and largely unrecognised area in anxiety disorder research” – despite many people living with it. However, experts have been able to identify some common symptoms.
As we’ve already mentioned, the main symptom of incontinence anxiety is an overwhelming fear of losing bladder and/or bowel control in public. However, this can lead to other symptoms, such as…
1. Physical symptoms of anxiety
These include sweating, lightheadedness, shaking, muscle tension, a rapid heart rate, and a churning feeling in your stomach.
Research suggests that people with incontinence anxiety often experience some of these sensations intensely in their gut or bladder, which can reinforce their belief that an accident will occur.
To read more about the symptoms of anxiety and ways to relieve it, take a look at our article on the subject.
2. Social isolation
People living with incontinence anxiety might limit social interactions through fear of embarrassment, which can negatively impact personal and professional relationships – and health and wellbeing.
Research shows that social isolation can have a similar effect on our health as smoking 15 cigarettes a day or having an alcohol disorder – and can be twice as harmful as obesity.
3. Other avoidance behaviours
People with incontinence anxiety might also exhibit other avoidance behaviours. For example, you might find yourself staying away from new places or locations where toilets aren’t easily accessible (such as public transport), which can limit your quality of life.
4. Limiting food and drink
In their research, doctors Kamoj and Brown describe one woman who’d restrict her fluid intake for days at a time to try and reduce her chances of having an accident. People with incontinence anxiety may also restrict their food intake or avoid certain foods they believe might increase their risk of an accident – for example, spicy foods.
Limiting food and drink can lead to health concerns like dehydration and malnutrition. NHS advice is to always speak to your doctor before making drastic changes to your diet.
5. Hypervigilance
If you experience incontinence anxiety, you also may be hypervigilant about both your internal and external environment.
For example, as well as constantly monitoring your bodily sensations for signs that you need to go to the toilet, you may also be preoccupied with where exits and toilets are – which can distract you from things like work and socialising.
You can read more about hypervigilance in this article from Healthline.
6. Feeling like your bladder and/or bowel isn’t empty
People with incontinence anxiety also report constantly feeling like their bladder and/or bowel isn’t completely empty. This can lead to frequent and disruptive trips to the restroom, especially before leaving the house.
7. Feelings of shame and embarrassment
If you have incontinence anxiety, you might feel ashamed or embarrassed at the prospect of having an accident in public, which can lead to low self-esteem.
While feeling this way is understandable, incontinence is nothing to be ashamed of. Unfortunately, there’s still a taboo around the subject, which can make it seem like we’re alone in experiencing incontinence issues. However, incontinence is much more common than you might think, which we’ll discuss in the next section.
How common is incontinence anxiety?
Because of the lack of research surrounding incontinence anxiety (and incontinence in general), it’s tricky to say how many people experience it. However, there are some figures that can give us an idea.
The NHS estimates that over 14 million people in the UK suffer from some degree of urinary incontinence, and over half a million adults have bowel incontinence – with many also experiencing anxiety as a result.
In fact, this study of women with urge incontinence found that 56.6% reported symptoms of anxiety – so incontinence anxiety is certainly not uncommon. However, these figures don’t take into consideration how many people experience incontinence anxiety without physical incontinence, which accounts for many more.
So, if you’re experiencing feelings of shame or embarrassment, try to be gentle with yourself. It can be helpful to remember that anxiety surrounding incontinence isn’t unusual, and people are generally much more understanding about it than we might think.
What are the causes of incontinence anxiety?
While there isn’t much research surrounding incontinence anxiety, experts have proposed some possible causes…
- Previous experience with incontinence – one of the first detailed studies of incontinence anxiety in 2013 found that 50% of the 140-person sample group had experienced at least one episode of incontinence in the past.
- Physical and neurological health conditions – these are thought to contribute to the development of incontinence anxiety, especially those that list incontinence as a symptom.
There are lots of health conditions that can cause incontinence. You can learn more about these on the NHS’s bowel and urinary incontinence pages. - Age – experts suggest that age can play a role in the development of incontinence anxiety. This is because both urinary and bowel incontinence become more common with age.
- Family history – it’s also thought that a fear of urinating in public can be learned from close family members. For example, if one of your parents experienced incontinence anxiety when you were a child, you might have unintentionally inherited their fears.
- Mental health problems – Many experts link incontinence anxiety with other mental health issues, such as depression, social anxiety disorder, and obsessive-compulsive disorder (OCD). The UCL research mentioned earlier also found that 78% of those suffering from incontinence anxiety also reported having panic attacks.
The bladder and the brain are intimately connected. Not only do experts think that incontinence can contribute to anxiety, but that anxiety can also contribute to incontinence – which can lead to further anxiety.
5 ways to manage incontinence anxiety
1. Speak to your doctor
As with all non-urgent health issues, one of the best things you can do if you’re experiencing incontinence anxiety is to speak to your GP.
Currently, there doesn’t seem to be a standard criteria for diagnosing incontinence anxiety – as further research is needed on this. However, your doctor may diagnose you with incontinence anxiety if your fear of having an accident in public is having a significant impact on your day-to-day life – for example, if you’re isolating yourself due to worries about being embarrassed.
There also doesn’t seem to be a standard treatment for incontinence anxiety. If you suffer from a condition that’s causing incontinence, your doctor may recommend treatment for this – which can include lifestyle changes, medication, or surgery. You can learn more about bowel and urinary incontinence treatments on the NHS website.
As well as treating any causes of incontinence, experts have suggested that incontinence anxiety itself could be treated similarly to other anxiety disorders – for example, with things like medication and cognitive behavioural therapy (CBT). However, more research is needed to confirm the effectiveness of these.
2. Wear protection
To help ease your anxiety when out and about, you could also try wearing specially designed incontinence products like pads and pull-up pants. These are typically made from super-absorbent materials that soak up leaks and neutralise odours – hopefully leaving you feeling dry and fresh.
That said, we know it’s not always possible to be prepared. Though, sometimes, thinking about what we can do if caught off-guard can give us peace of mind. For advice on this, why not check out our article; How to cope with a bladder leak in public?
3. Strengthen your pelvic floor
Your bladder and bowel (along with your uterus, if you have one) are supported by a system of muscles called your pelvic floor. These can be weakened by things like surgery, pregnancy, or childbirth, which may lead to incontinence. As a result, health professionals often recommend pelvic floor strengthening exercises for people suffering from urinary and bowel incontinence.
Even if you haven’t experienced any incontinence symptoms, but you’re worrying about the possibility, doing some pelvic floor exercises could help to ease your anxiety.
For example, this review of 31 clinical trials found that women who engaged in pelvic floor muscle treatment (PFMT) were more likely to report a better quality of life, as well as improved urinary incontinence. In the trial, quality of life took into account anxiety levels. Other studies (such as this one) have indicated a similar result with men.
Pelvic floor exercises can have other benefits too. For example, they can lead to more powerful orgasms and increased sensitivity during sex – and can help to combat symptoms of erectile dysfunction. For more information on the benefits of pelvic floor muscles and how to get started, check out our article here.
4. Practice mindful activities
Because of the lack of information surrounding incontinence anxiety, there aren’t many treatments directly linked with easing its symptoms. However, research indicates that mindfulness can be a useful tool for combating symptoms of both anxiety and incontinence.
Take this 2012 pilot study of women with urinary urge incontinence, for example. Five of the seven women who participated in a mindfulness-based stress reduction program (MBSR) reported improved symptoms.
Yoga is also commonly recommended as a way of easing the symptoms of anxiety around incontinence, perhaps because certain types of yoga are mindful and strengthen the pelvic floor. However, this study suggests that an MBSR program is actually more effective – but more research is needed on this topic to say for certain.
Because these findings don’t have a direct link to incontinence anxiety, it’s worth taking them with a pinch of salt. However, practising mindfulness can be helpful for our wellbeing in many ways. So even if it doesn’t ease symptoms of incontinence anxiety specifically, you might find some unexpected benefits.
To learn more, take a look at our introduction to mindfulness.
5. Maintain connections with others
As we’ve already mentioned, if you’re experiencing incontinence anxiety, you might be tempted to shut yourself away from your friends, family, and social events. But it’s important to try to maintain connections with others.
We understand that this is easier said than done if you’re feeling anxious about an accident, but try not to underestimate how helpful a shoulder to lean on can be.
With this in mind, if you feel comfortable, you could confide in a loved one about your fears. Just knowing that someone understands what you’re going through can be reassuring and help you feel less alone. And, who knows, your bravery might prompt them to open up about their own incontinence issues.
However, if you don’t feel comfortable telling a loved one, you could consider reaching out to a continence service like Bladder & Bowel UK. They offer a national helpline that provides confidential advice on incontinence issues.
Alternatively, you might find a continence support group helpful. You can find out more about these on the Coloplast Charter website.
Final thoughts…
Unfortunately, there hasn’t been much research on incontinence anxiety, and there’s still lots we don’t know about it. But we hope this article has given you a good idea of what it is and things you can do to help if you’re experiencing it.
Above all, it’s important to recognise that incontinence issues are quite common. Although the prospect of having an accident in public might seem like the end of the world, try to remember that it isn’t – and that people are generally much more understanding than we might think.
For more help on living with incontinence, take a look at our articles; Living confidently – a guide to managing incontinence in daily life, How to cope with a bladder leak in public, and Urinary incontinence in men – how common is it and what can you do about it?
Have you experienced incontinence anxiety? If so, do you have any extra tips for managing it? We’d be interested to hear from you in the comments below.