Need to pee when you're nervous or scared?

Ever wonder why you need to pee more than usual before an exam or job interview? You might also have heard of someone peeing their pants when they're very scared. I often talk about how emotions affect pelvic pain, but here’s an example of how emotions also greatly influence urgency and leaking issues. So how does this happen?

Doctors and scientists do not fully understand the urge to pee when we are scared or anxious, but it is primarily controlled by nerves in our spinal cord, brain, and emotions. Three areas of the brain regulate the sensation to pee.

First, there is an area called the pontine micturition center (PMC). When the bladder becomes full or stretches beyond a certain point, sensors in the bladder wall send this information to the PMC. In response, the PMC relaxes the external sphincter—a pelvic floor muscle that controls the urethra—allowing urine to flow out.

If that were all there was to it, we would pee automatically whenever our bladder fills, which wouldn't be ideal. Our ability to control this process voluntarily comes from a second brain region called the prefrontal cortex. The prefrontal cortex sends signals to the bladder to delay emptying.

Thanks to this control, we can tell our bladder to wait while we make our way to the restroom. However, when we are extremely nervous or scared—like when being chased by a lion—our body activates a “fight-flight-freeze” response, involving a third brain region called the limbic system. The limbic system, which is vital for our survival, sends out powerful signals that override the signals from the prefrontal cortex, resulting in an accidental leak.

This fight-or-flight-freeze response may also increase kidney urine production and enhance bladder contractions, prompting us to feel the urge to urinate. During stress, our nervous system can become more sensitive, making it more likely to trigger the voiding reflex.

One effective way to manage nervous or fear-based urination is by practicing distraction techniques or calming breathing exercises to lessen the urge. However, if your nervous system tends to remain in the fight-or-flight or freeze state due to adverse childhood experiences or intense work and life stress, you might need to explore techniques that shift your nervous system into a rest-and-relax mode or seek emotional therapy support.

Mia Dang, PT, is a pelvic physiotherapist with extensive supplementary training in pelvic floor physiotherapy and perinatal care