Need to pee when you feel nervous or scared?

Ever wonder why you feel the need to pee more than ever before an exam or an interview? You may have also heard about someone peeing their pants when they are super scared?  I have often mentioned the impact of emotions on pelvic pain but here is an example of how emotions also have a powerful impact on urge and leaking issues. So how does this happen?

The need to pee when we are scared or anxious is not entirely understood by doctors and scientists but it is mainly controlled by the nerves in our spinal cord, our brain and our emotions. The urge to pee is an event that is controlled by 3 areas of the brain.

First, there is an area called the pontine micturition center (PMC).  When the bladder is full or expands past a certain point, there are sensors in the bladder’s wall that relay this information to the PMC. Thus the PMC relaxes the external sphincter (a pelvic floor muscle that controls the opening of the urethra) and voila, pee flows out.

Now, if that’s all there is to it, we would pee automatically whenever the bladder is full, which is not a good thing. What allows us to have voluntary control is a second area in the brain called the prefrontal cortex. The prefrontal cortex sends signals to the bladder to stop it from voiding.

Great, with this control, we have the power to tell the bladder to stop peeing while we make our way to the washroom. However, when we are super nervous or super scared (like when we are being chased by a lion), our body goes into a “fight-flight-freeze” response and a third part of our brain, called the limbic system, kicks in. The limbic system, which is critical for our survival, sends out signals so powerful that they overrule the signals from the prefrontal cortex and consequently, we have an accidental leak.

This fight-flight-freeze response may also increase the kidney’s production of urine as well as increase the contraction of the bladder muscle that makes us want to pee. When we are under stress, our nervous system may also become more sensitive which makes it more likely to activate the voiding reflex.

One of the techniques that help with nervous or fear-based urination is to practice distraction techniques or calming breaths to reduce this urge.  However, if our nervous system is prone to be in the fight-flight-freeze state due to adverse childhood experiences or severe work/life stress, we may need to consider techniques that shift our nervous system into the rest-relax state or get emotional therapeutic support.

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