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What is incontinence anxiety?

Bladder and bowel incontinence anxiety (also known as bladder and bowel obsession, bowel movement phobia, urinary obsession, bowel obsession, and bladder/bowel control anxieties) refers to psychological conditions that involve overwhelming fear of incontinence in public situations.Incontinence anxiety is commonly associated with individuals living with a bladder and/or bowel condition. Incontinence affects around 1 in 5 adults. In Australia, over 6 million identify with having a bladder and/or bowel control concern.

Incontinence anxiety symptoms

Individuals with incontinence anxiety are likely to experience anxious thoughts about losing control of their bladder and/or bowel in public, being humiliated and embarrassed for doing so, and receiving judgement and criticism from others. These symptoms typically occur while in public and are generally worse in non-private settings (e.g., public shopping centres, restaurants) and may be exacerbated by an underlying bladder and/or bowel condition.

Individuals with incontinence anxiety tend to experience an increase in symptoms when they are in public places where there are many people present and in closeproximity (e.g., a busy shopping centre, music festival, restaurant).

Symptoms of incontinence anxietycan vary in severity and can include:

  • An overwhelming fear of urinary and/or faecal incontinence in public.
  • Physical symptoms consistent with anxiety such as a rapid or racing heartbeat, trembling, muscle tension, excessive sweating, nausea, and blushing.
  • Avoidance behaviours such as avoiding using restrooms in public, limiting and/or avoiding public transport.
  • Safety behaviours such as reducing food and fluid intake anticipating anxiety regarding incontinence.
  • Planning life so that there is always a bathroom in close vicinity, to the point where it interferes with social and occupational activities.
  • Forcing oneself to use the restroom prior to leaving home.
  • Spending an inordinate amount of time in the restroom making sure the bladder and/or bowel is completely empty.
  • Constantly feeling like the bladder and/or bowel is not completely empty.
  • Avoiding holidays and/or social activities such as parties, dating, sporting events, and other occasions where access to a restroom may not be easy.

Incontinence anxietyis associated with feelings of shame, embarrassment and problems across multiple domains of life, including relationships, social activities, and employment. Anxiety around incontinence can influence the type of work environment that an individual is comfortable in, andmay affect whether they are willing to travel. While incontinence anxiety can have a significant adverse impact on psychosocial functioning and associated quality of life, the majority of individuals living with this condition do not seek treatment.

Age of onset

The age of onset for incontinence anxiety is currently unknown;however it may range from adolescence to older age. Due to the increased rate of incontinence associated with bladder and bowel conditions, it is expected that incontinence anxiety may be higher in older age groups.

Prevalence of incontinence anxiety

The prevalence of incontinence anxiety is currently unknown due to the lack of research on this condition, however initial research suggests that around 1 in 4 adults report concerns relating incontinence anxiety.

Diagnosis of incontinence anxiety

At this time there is no validated diagnostic criteria published for incontinence anxiety. Diagnosis of incontinence anxiety is based upon establishing that there is the presence of anxiety symptoms associated with incontinence (or fear of incontinence) causing significant interference with an individual’s life.

Causes of incontinence anxiety

There has been very little research into thecauses ofincontinence anxiety. Of the research available, the previous experience of incontinence has been noted to be a major feature in individuals afflicted with incontinence anxiety.

Comorbid physical conditions

It is likely that the majority of individuals living with incontinence anxiety have an underlying physical condition. Causes of urinary incontinence include advancing age, diabetes, lower urinary tract symptoms (LUTS) and infections (UTI), pregnancy and vaginal delivery, hysterectomy, prostatectomy, and neurological disorders and cognitive dysfunction (e.g., Dementia, Multiple Sclerosis, Parkinson’s disease, traumatic spinal and/or brain injuries/accidents).Causes of faecal incontinence include diarrhoea and rapid colonic transit, and sphincter damage.

Past experience or trauma

Some individuals report that the onset of their incontinence anxiety was associated with previous a traumatic experience surrounding incontinence, such as losing control of one’s bladder and/or bowel in public (e.g., in a classroom or busy shopping centre). A study in 2013 by Pajak and colleagues identified that some individuals believed their incontinence anxiety was directly linked to a previous experience of incontinence, a “near miss”, or both.

Psychological difficulties

Incontinence anxiety is likely to be associated with a number of other psychological conditions, including social anxiety disorder, obsessive compulsive disorder,and depression.Anxiety, regardless of its cause, can be associated with worries relating to incontinence. Through a series of physiological processes, feelings of anxiety and fear can impact upon the function of the bladder and bowel, which can increase the risk of incontinence. In addition, concerns about having incontinence in the future, may further increase anxiety.Click HERE for further details.

Family history

Paruresis may be learnt in childhood from the behaviour of close family members. For example, if a father experiences incontinence anxiety, the child may interpret that going out is not safe and take on their father’s fears.

Treating incontinence
History of incontinence anxiety