The Emotional Effects of OAB

The physical effects of overactive bladder are obvious. But the emotional impact isn’t talked about as much. You might avoid going on road trips with friends, playing sports, or visiting your grandchildren because you’re self-conscious about leaking or having to stop a lot to use the restroom. 

“People start to live their lives around management of their bladder,” says Aqsa Khan, MD, a urologist at the Mayo Clinic in Phoenix, AZ.

Even at home, OAB can make the simplest social interactions stressful. Khan says one of her patients, a 50-year-old woman, described having a nice chat with her neighbor in the yard when she suddenly started to pee in the middle of her conversation. To cover it up, she turned the garden hose onto herself.

The loss of control, Khan says, can be devastating. “It’s losing something that really defines you as a social being,” she says. “It makes you feel infantilized, in a way. It takes you back to wearing diapers.”

OAB can also impact intimacy. You might avoid sexual activity because you’re worried about leaking. This can lead to bigger relationship issues. If your partner doesn’t know what’s wrong, they may think it has something to do with them. Try your best to open up and trust your partner to be supportive.

Intimacy challenges are tough enough for couples who have been together for decades. They can be even more overwhelming when you’re in the dating game. “[OAB] can be a huge elephant in the room when starting up those more intimate relationships,” says A. Lenore Ackerman, MD, PhD. She’s the research director for UCLA Health’s Division of Female Pelvic Medicine and Reconstructive Surgery.

You might wake up four times a night but go right back to sleep each time. Others may only get up twice a night. But they have so much trouble getting back to sleep each time that it has a huge effect on their quality of life. “It’s torture,” Khan says.

That’s because when you don’t get enough rest, your body doesn’t get the chance to recuperate. This could lead to other issues, including problems with brain function. There is a strong link between OAB and depression, Ackerman says, and poor sleep is a key factor. “Sleep is really centrally important to all of it,” she says.

The anxiety surrounding OAB can also make your physical symptoms worse. Just as you might clench your jaw without realizing it, people with OAB often clench their pelvic floor muscles, says Veronica Asence, DPT. She’s a physical therapist at Lahey Hospital & Medical Center in Burlington, MA, who specializes in pelvic health.

“Your pelvic floor is always active: supporting your pelvis, holding up your organs,” she says. “If we’re clenching our pelvic floor muscles in relation to the urge [to pee] and the anxiety surrounding that urge, it’s like we’re constantly tucking our tail.”

This nonstop squeezing can wear them out. So much so they lose control when you need them the most. You could see a big change in your symptoms just by working on ways to ease your anxiety and the pelvic floor tension that comes with it.

If you’re older, you might think urinary issues are a normal part of aging. (They’re not.) But if you’re young, OAB can carry an additional level of shame and self-blame. You might wonder how this could be happening or what’s “wrong” with you.

Shame can be a major block in asking for help, but OAB is more common than you think. “Talk to your friends,” Ackerman says. “Odds are some of them have it, too.” In fact, Ackerman says the first thing she does when meeting a new patient is tell them about her own urinary problems.

By talking about it more, others with OAB will likely feel more comfortable looking for long-term treatments instead of just managing symptoms with pads, backup underwear, catheters, and other items. They can be a great way to take back control. For instance, new products are often designed with light, flattering fabrics that secretly hold lots of fluids. But they sometimes stop people from getting professional help, Ackerman says.

“You don’t have to deal with this alone,” Ackerman says. “This happens to a lot of us, and there’s treatment, and we want to get you treatment.”

“Physicians get into this line of work because they want to help patients,” says Sevann Helo, MD, a Mayo Clinic urologist in Rochester, MN. “We can’t improve something we don’t know is a problem.”

If your doctor doesn’t know how to treat OAB, they should refer you to someone who can. With help, you can take control. “It doesn’t matter if you’re 28 years old or 88 years old,” Asence says. “Your bladder can be retrained at any point in your lifetime.” The key, she adds, is to be persistent and take care of your whole self. “The bladder’s personality is a lot like a toddler: it does best with structure, discipline, and a healthy environment.”