Now that we have an understanding of how stress effects the body on a short-term basis, let’s explore what happens to your urinary system with prolonged stress. If you missed our last blog post, you can check it out here.
First, we have to understand what prolonged stress is. It can come in various forms, such as work-related stress, emotional abuse in a relationship, mental health issues such as anxiety, experiencing persistent or chronic pain, or a combination of all the above. Remember that when we feel threatened our “fight or flight” response or sympathetic nervous system is activated. Chronic or hyper-activation of this system can lead to imbalanced activation of your autonomic nervous system affecting your whole body and its function. Research has shown us how chronic stress can hinder your cognitive function and reactivity. So, if you’re in an already fast-paced work environment, you may have more difficulty making those tough and quick decisions and further escalate your stress. Can you see how easy it can be for this vicious cycle to manifest?
How does this affect my bladder?
Have you ever had an intense urge to pee right before a major presentation or exam? Do you feel like you have a small bladder because of how often you pee? Ever not made it to the bathroom in time? These are signs of sympathetic hyperactivity that contributes to bladder hypersensitivity.
There are many bladder conditions that are a part of a spectrum of hypersensitivity, with the common symptoms being urgency and frequency. The sympathetic and parasympathetic nervous systems work together to control your bladder function. We still do not fully understand these changes, but studies have shown us there are neurogenic (nerves/reflexes) and myogenic (muscle) mechanisms that can contribute to hypersensitivity of the bladder.
Neurogenic changes refer to abnormal activation of the voiding reflex via dysfunctional nerve pathways which leads to premature contraction of the bladder. Typically when we get an urge to go and aren’t ready, our brain sends a signal to the bladder indicating we are not ready to void and the urge goes away. Prolonged stress causes this voiding reflex to be activated more readily and easily along with inhibiting your brain’s ability to stop this reflex. This is one of the many reasons you may experience of urgency, frequency, and potentially leakage.
Myogenic changes refer to malfunction of the detrusor muscle, also known as your bladder. When your bladder is filling, your detrusor muscle is in a relaxed state. When you need to void, your detrusor muscle will contract. Although the nervous system can control bladder function, the detrusor muscle is also autonomous and can decide when it wants to contract or void. It is important to note, in a healthy individual the first urge of bladder filling may be around 100 ml, but the sense of a full bladder is between 400-600 ml. This means our first urge should be treated more like a warning signal. So, how does stress change this? Similar to the neurogenic changes, the detrusor muscle is more sensitive and contracts more easily and prematurely. Again, leading to the same symptoms of urgency, frequency, and/or leakage.
Can this be fixed?
It is not something that needs to be “fixed”, but rather re-trained. Many people that experience urgency or frequency engage in poor bathroom habits that further solidify these neurogenic and myogenic changes. For example, going to the washroom before you leave the house… just in case. We also know that more people who experience anxiety are more likely to have symptoms of overactive bladder or urge incontinence since their nervous system is already in a hypersensitive state. One of the many things pelvic health physiotherapists do is bladder re-training. We have specialized training to address dysfunctional bladder patterns and nervous system hypersensitivity. We work together to engage in new behaviours that will you help restore your bladder function. I will be releasing a video during Incontinence Week (June 17-23) that discusses bladder re-training, so stay tuned for more details!
Hopefully that gives you some insight into why you may be experiencing some of those bladder symptoms during intense periods of stress. Remember that urgency or frequency are not permanent issues and you have the ability to regain control your bladder with the help of your local pelvic health physiotherapist!
Next I’ll be talking about how prolonged stress affects your cardiovascular system!
Grecia Alaniz PT, MScPT