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History of incontinence anxiety

Bladder and bowel incontinence anxiety has been known by several names including bladder and bowel obsession, bowel movement phobia, urinary obsession, bowel obsession, and bladder/bowel control anxieties. Bladder incontinence anxiety was first studied by Epstein and Jenike in 1990 where they detailed the treatment of a 25-year-old male and a 37-year-old male. Epstein and Jenike reported that psychological therapy in conjunction with medication was effective in attenuating bladder incontinence anxiety symptoms.

Regarding bowel incontinence anxiety, Jenike and colleagues (1987) were the first to document four individuals afflicted with this condition. Jenike and colleagues explored the use of cognitivebehavioural therapy in treatment of bowel incontinence anxiety. Jenike and colleagues used techniques such as cognitive restructuring (to address unhelpful thinking patterns), relaxation, and exposureactivities (engaging in a planned activity that elicits anxiety with the goal to engage in strategies to become more comfortable with and/or reduce unwanted feelings). Treatment was noted to be successful as individuals were free of symptoms after treatment, and at 15-24 months follow-up.

Expanding on the aforementioned case studies, Pajak, Langhoff, Watson,and Kamboj (2013) were the first to investigate the role of intrusive imagery (imagining oneself experiencing incontinence)in both bladder and bowel incontinence anxiety. Through a series of semi-structured interviews, Pajak and colleagues reported that the majority of incontinence anxiety sufferers believed their fear of incontinence was directly due to a previous experience of incontinence, a “near miss” or both.

Following on from the research by Pajak and colleagues, Kamboj and colleagues (2015) explored the prevalence of psychological conditions in a community sample of adults with bladder and bowel incontinence anxiety. Kamboj and colleagues reported that individuals with incontinence anxiety tend to experience panic attacks and intrusive mental imagery, with panic and intrusive imagery symptoms being particularly prominent for those with bowel incontinence anxiety. Kamboj and colleagues also noted that incontinence anxiety sufferers displayed avoidance and safety behaviours along with high levels of distress and impairment.Incontinence anxiety was also found to overlapwith other psychological conditions such as social anxiety disorder.

Recently in 2019, Kuoch, Austin, Meyer, and Knowles developed the first validated symptom severity scale for bladder and bowel incontinence anxiety, known as the bladder and bowel incontinence phobia severity scale (BBIPSS). Development of this severity scale enabled the assessment of incontinence anxiety symptom severity. Following on from the development of the BBIPSS, Kuoch and colleagues conducted two further studies on incontinence anxiety.

The first study by Kuoch and colleagues investigated whether the extended bivalent fear of evaluation model of social anxiety(click HERE for more information) could be used to explainincontinence anxietysymptoms (see incontinence anxiety and social anxiety disorder section for further details). Kuoch and colleagues found that the psychosocial processes involved in social anxiety could also be used to explain incontinence anxiety symptoms.


The second study by Kuoch and colleagues explored the similarities and differences between incontinence anxiety, paruresis (difficulty or inability to urinate in restrooms due to overwhelming fear of perceived scrutiny), and parcopresis (difficulty or inability to defecate in restrooms due to overwhelming fear of perceived scrutiny). The researchers found that there were no differences in terms of psychosocial processes (e.g., fear of negative evaluation; distress in response to unfavourable evaluation of oneself by others), between incontinence anxiety, paruresis, and parcopresis. These findings suggest that bladder and bowel anxieties are underpinned by similar psychosocial processes consistent with social anxiety disorder.

What is incontinence anxiety?
Theories of incontinence anxiety