Fight, Flight or Freeze: How the bladder responds to fear and stress

We often think about the feeling of anxiety or panic that comes with the flight, fight or freeze response (FFF), how it affects our heart rate and breathing. In fact, FFF affects so much more of our body, from our brain to our bladder.

We all have seen the funny shaky-kneed, cross legged peeing out of fear in cartoons, or the wet patch as a result of terror in horror films. You might also be aware of 'Latchkey Incontinence' - the urge to pee the minute that you get home and put your key in the lock of your front door and feel that need-to-go urgency suddenly descend. Many people, male and female experience the sudden urge to urinate during stressful situations, which prompts the question, why does this happen? Let's take a look:

What controls the fight, flight or freeze response?

The fight-or-flight response is primarily controlled by the autonomic nervous system, which is a complex network of nerves that regulate involuntary bodily functions. Specifically, the sympathetic branch of the autonomic nervous system is responsible for initiating the fight-or-flight response in response to perceived threats or stressors.

This branch of the autonomic nervous system activates various physiological changes aimed at preparing the body for action, including increased heart rate, dilation of the airways, and redirection of blood flow to vital organs such as the heart and muscles.

Does the fight, flight or freeze response affect the need to pee?

Yes! During moments of stress or fear, the body activates the sympathetic nervous system, which leads to the release of stress hormones such as adrenaline and noradrenaline. These hormones stimulate various physiological changes aimed at preparing the body for action, including increased heart rate, elevated blood pressure, and decreased urine production.

The reduction in urine output is a result of decreased blood flow to the kidneys, which reduces the filtration rate and subsequently leads to a decrease in urine formation. This mechanism helps conserve fluid and redirect resources to essential functions required for survival during stressful situations.

Is this because the bladder relaxes during fight, flight or freeze response?

Contrary to the idea that we just lose strength and control with the panic during FFF, the bladder doesn't actually 'relax'. Instead, FFF can lead to involuntary contractions of the bladder muscles. Activation of the sympathetic nervous system during the response stimulates the release of neurotransmitters that cause the detrusor muscles of the bladder to contract. These contractions can result in the sudden urge to urinate, even if the bladder is not completely full.

Additionally, the internal sphincter, which normally helps maintain continence by preventing urine leakage, may relax involuntarily under the influence of stress hormones, further exacerbating the urge to urinate.

Can the fight, flight or freeze response cause you to NOT be able to pee?

While the fight or flight response is associated with increased bladder activity and the urge to urinate, it can also lead to urinary retention in certain circumstances. In situations where the sympathetic nervous system is overly activated or in individuals with pre-existing bladder dysfunction, the detrusor muscles may become overactive, leading to incomplete bladder emptying.

Stress-induced constriction of blood vessels can also impair blood flow to the bladder and pelvic organs, further exacerbating urinary retention. In severe cases, this can result in discomfort, pain, and an increased risk of urinary tract infections.

Can stress mess with our bladder?

Yes - in fact, chronic stress has been linked to various bladder dysfunctions, including overactive bladder (OAB), urinary urgency, frequency, and incontinence. Prolonged exposure to stress hormones such as cortisol can disrupt the normal functioning of the bladder and pelvic floor muscles, leading to increased bladder sensitivity and involuntary contractions.

Stress can also contribute to pelvic floor dysfunction, which further exacerbates bladder symptoms as a result of the impact of cortisol on this area of the body. That's why stress is more than just a feeling of overwhelm - we need to manage it for our whole body health, too.

Is it true that our pelvic floor 'holds emotion'?

Yes - while this is still an area that requires further research, there is thought that the pelvic floor stores emotions such as stress, especially, just like other muscles in the body. When we experience stress, anxiety, or tension, our muscles often respond by contracting or becoming tense.

The pelvic floor muscles play a crucial role in supporting the pelvic organs, including the bladder, and maintaining continence. When these muscles become tense due to stress or other factors, it can lead to symptoms such as pelvic pain, urinary urgency or frequency, constipation, or discomfort during sexual activity.

Chronic stress and tension can contribute to ongoing pelvic floor dysfunction, such as pelvic floor muscle hypertonicity (excessive tension) or pelvic floor muscle weakness. Both of these conditions can cause discomfort and affect a person's quality of life and of course, can contribute to bladder weakness during FFF response.

3 Tips for Controlling Your Bladder During a Fight, Freeze, or Flight Response:

Practice Relaxation Techniques

Incorporate relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation into your daily routine. These techniques can help reduce stress and anxiety levels, thereby minimising the impact of the fight-or-flight response on bladder function.

Consider making changes to your lifestyle

Adopting a healthy lifestyle can support bladder health and resilience during stressful situations. Stay hydrated by drinking plenty of water throughout the day, but be mindful of caffeine and alcohol intake, as these substances can irritate the bladder and exacerbate urgency. Additionally, aim to maintain a balanced diet rich in fibre to prevent constipation, which can worsen bladder symptoms, and if you are experiencing leaks, try Jude's Bladder Strength Supplement to help aid better bladder control naturally.

Do your pelvic floor exercises

Strengthening your pelvic floor will give you better control over your bladder and leaks. Aim to do at least 10 squeezes, three times a day for optimum pelvic floor health; consistency is key! If you are unsure whether you are doing them correctly, check out our guide here.

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