In the midst of studying for anatomy quizzes and this first round of exams, I found myself wondering why one of the responses to fear is a quick opening of our floodgates. Maybe this is a question that doesn't need to be answered, but personally, I was curious. We know that our sympathetic nervous system is responsible for the “fight or flight” response. So let's break it down. You find yourself being chased by Ghostface (I'm a fan of the scream movies), your survival instincts are activated which quickly hands over control to the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis (Dhabhar, 2018). Your brain hits the panic button, adrenaline floods your system, heart rate and blood pressure shoot up, and blood is diverted to your skeletal muscles. You’re now ready to sprint hoping you have the same luck as THE scream queen Sidney Prescott.
But what about your bladder? Stress doesn’t just rev up your heart, but it can also influence the neural “pee circuits” that coordinate bladder control. Research in animals shows that different types of stress have different effects. “Water-avoidance stress,” which mimics being placed in an uncomfortable situation, tends to cause urgency and frequency, making bathroom breaks more likely (Shimizu et al., 2021). Think of exam day nerves or stage fright. On the other hand, “social defeat stress,” would include experiences like embarrassment or bullying, pushing the bladder in the opposite direction, leading to retention instead of release (Shimizu et al., 2021). Beyond those examples, animal models also show early-life stress, chronic unpredictable stress, or repeated restraint stress can each alter urinary function in different ways (Gao & Rodríguez, 2022). In humans, long-term psychological stress has been linked to symptoms of urgency, frequency, incontinence, and even bladder pain, suggesting that stress can actually reshape how the urinary system works over time (Chess-Williams et al., 2021).
Neuroscientists break this down into pro-micturition and anti-micturition pathways. Pro-micturition signals increase excitatory neurotransmitters we know and love like glutamate or reduce inhibitory GABA signals, encouraging urination. While anti-micturition signals strengthen the GABA “brakes,” holding urine in (Shimizu et al., 2021).
In a Ghostface moment, your body releases a combo of fast-acting neurotransmitters plus the slower-burning hormone cortisol. This mix boosts survival performance and fires up nearly every system, sometimes indirectly inducing the bladder reflex (Dhabhar, 2018). Meaning your muscles are ready to run, but your bladder might insist on making an appearance first. Other times, stress can suppress urination altogether (Shimizu et al., 2021). All this to say, whether you pee or not under pressure depends on the type of stress you're experiencing.
So if you ever find yourself running from a man in a cheap Halloween mask, your bladder might betray you or lock down entirely. Either way, in that situation, needing a change of clothes is probably the least of your worries...
Chess-Williams, R., McDermott, C., Sellers, D. J., West, E. G., & Mills, K. A. (2021). Chronic psychological stress and lower urinary tract symptoms. Lower urinary tract symptoms, 13(4), 414–424. https://doi.org/10.1111/luts.12395
Dhabhar F. S. (2018). The short-term stress response - Mother nature's mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Frontiers in neuroendocrinology, 49, 175–192. https://doi.org/10.1016/j.yfrne.2018.03.004
Gao, Y., & Rodríguez, L. V. (2022). The Effect of Chronic Psychological Stress on Lower Urinary Tract Function: An Animal Model Perspective. Frontiers in physiology, 13, 818993. https://doi.org/10.3389/fphys.2022.818993
Shimizu, T., Shimizu, S., Higashi, Y., & Saito, M. (2021). Psychological/mental stress-induced effects on urinary function: Possible brain molecules related to psychological/mental stress-induced effects on urinary function. International journal of urology : official journal of the Japanese Urological Association, 28(11), 1093–1104. https://doi.org/10.1111/iju.14663
yes.
ReplyDeleteI love this post Maggie! It makes me wonder, if people with chronic stress suffer more with urinary incontinence and frequency, are medical providers especially at risk? Through years and years of schooling, and then going out into the real world as a clinician, we are bound to face a unorthodox amount of stress (Rink, 2023). So, are we, as medical professionals, destined to face some kind urinary incontinence in the future?
ReplyDeleteReference
Rink LC, Oyesanya TO, Adair KC, Humphreys JC, Silva SG, Sexton JB. Stressors among healthcare workers: A summative content analysis. Global Qualitative Nursing Research 10, 2023.
You and JoJo both bring up a very interesting point. It’s true that healthcare providers often work long hours without even having time for a bathroom break. This made me wonder what this means specifically for female healthcare workers, who are already more susceptible to lower urinary tract symptoms and infections due to anatomical and hormonal factors, as well as possible pelvic floor changes after childbirth.
DeleteThis suppression of urination among healthcare workers appears to be less of a stress response and more of a behavioral adaptation developed to get through demanding workdays. To answer your question, I found a study that examined the correlation between maladaptive toileting behaviors and lower urinary tract symptoms (LUTS) among females in the medical field. Out of 146 participants, 83% reported at least one LUTS symptom, with the most common being incontinence (Perlow, 2023). While this is primarily the result of individual urinary voiding behaviors, stress still plays a role here. In the same cross-sectional study, 30% of women reported some form of incontinence, with stress-induced incontinence being more common than urgency-induced (Perlow 2023).
So, what I can deduce is that holding in your urine and working in a stressful environment is a recipe for some undesired waterworks, especially for female professionals. This calls into question the pressure we put on our healthcare providers, as well as the lack of freedom they have to relieve themselves in a timely manner. While this sacrifice, to some degree, is an inherent part of the job, our healthcare systems could definitely work with providers to find ways to alleviate this issue so that healthcare workers aren’t always sacrificing their own health to restore others.
Perlow, A., Joyce, C. J., Bennis, S., Mueller, E. R., & Fitzgerald, C. M. (2023). Toileting Behaviors and Lower Urinary Tract Symptoms Among Female Physicians and Medical Students. Urogynecology (Philadelphia, Pa.), 29(8), 678–686. https://doi.org/10.1097/SPV.0000000000001333
This is a great post Maggie! While reading your post, it brought me back to the time I was shadowing doctors in Europe and how, during my rotations, they would sit from 9am to 4pm seeing patients back to back, without a bathroom break. Under universal healthcare, doctors are seeing double the number of patients with various conditions. As you mention how stress can suppress urination, I wonder how much stress/what sort of stress must they have been under to not even think about their own health? In addition, I wonder if the fact that they are so used to it, they have built up chronic stress that has been unaddressed? This raises the concerns for how we need to better assist doctors in their practices, as the literature has pointed out that the consequence of chronic stress leads to high burnout rates among practitioners (Kumar, 2016; Soler et al.,2008).
ReplyDeleteKumar, S. (2016). Burnout and Doctors: Prevalence, Prevention and Intervention. Healthcare, 4(3), 37. https://doi.org/10.3390/healthcare4030037
Soler, J. K., Yaman, H., Esteva, M., Dobbs, F., Asenova, R. S., Katić, M., ... & (European General Practice Research Network Burnout Study Group). (2008). Burnout in European family doctors: the EGPRN study. Family practice, 25(4), 245-265.
I would actually be more scared of peeing my pants than being chased by a man in a cheap halloween mask haha
ReplyDeleteMaggie! I am also a HUGE fan of the Scream movies (I have a little Ghostface tattoo on my wrist and decor around my house from that series & other horror movies). But I think I could maybe hold in my pee for a little. I do well in a haunted house, but the levels of fear are different when someone is out for blood rather than screams. I will say Izzy's point of chronic stress potentially suffer from more urinary incontinence. I wonder if the same could be said of those suffering from anxiety, where your brain itself is "scaring" you to a degree? Could this increased sense of urgency also mean that those affected are also more likely to have or be at higher risk for UTIs?
ReplyDeleteI LOVE the way you wrote this post! You get the information across in such an easily digestible way, which I think is so important! It's so interesting that our brain processes the feeling of fear in this way. I would love to know if this also happens with people with severe anxiety.
ReplyDelete