Stress and Anxiety-Related Urinary Symptoms

Clinical Presentation and Treatment

• In children and adolescents, stress and anxiety at critical developmental periods can delay attainment of bladder control, leading to secondary enuresis, which frequently follows identifiable stressors including parental divorce, school trauma, sexual abuse, and hospitalization 1, 2, 3, 4
• The American Academy of Child and Adolescent Psychiatry suggests that stress and anxiety can cause frequent urination in patients with overactive bladder syndrome, characterized by urgency, frequency, and nocturia 1, 2
• Behavioral therapies, including fluid management, caffeine reduction, pelvic floor muscle exercises, and bladder training, should be offered first to all patients with urinary urgency, including those with stress/anxiety 5
• If behavioral therapies are insufficient, antimuscarinic agents or β3-agonists are first-line pharmacologic options, and combining behavioral therapy with pharmacotherapy may enhance efficacy 5
• The American Academy of Child and Adolescent Psychiatry recommends treating the underlying anxiety or depression to improve bladder symptoms, as psychological improvement has been noted after successful treatment of urinary symptoms 1, 2

Diagnosis and Assessment

• Obtaining a voiding diary is crucial to reliably measure frequency and incontinence episodes rather than relying solely on patient recall 6
• Comorbid conditions, including sleep apnea, cardiovascular disease, and neurologic disorders, should not be overlooked as they can cause nocturnal polyuria in stressed patients 6