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Urinary Incontinence and Depression
Photo by Anthony Tran on Unsplash

A recent study connects anxiety, urinary incontinence and depression in women

What is urinary incontinence?

Urinary incontinence refers to the loss of urine, out of your control. There is actually more than one kind of urinary incontinence: the two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB).

  • Stress Incontinence: urine leaking with physical activity - sneezing, coughing, laughing, lifting, pushing/pulling, jumping.
  • Urge Incontinence: urine leakage that is coupled with urgency to go- leaking while you’re in line for the toilet, leaking/urgency when you’re parking your car in the driveway, putting the key in the door, fumbling with your pants, etc.
  • Mixed UI: a combination of stress and urge symptoms

Urinary incontinence and depression… What’s the connection?

Previous studies by showed an association between depression/anxiety to all three main types of urinary incontinence: stress incontinence, urge incontinence, and mixed incontinence. However, the strongest connection was between urge incontinence and mixed urinary incontinence (Felde, 2012; Melville, 2009; Concepcion, 2018).

A 2009 study conducted by Melville, Fan, et al. tracked 5,820 women with the mean age of 59.3 for 6 years to study the possible relationship between between depression and urinary incontinence (UI). The researchers found that major depression increased the odds of women to develop urinary incontinence. 21% of respondents with depression developed urinary incontinence whereas 11% of those without major depression developed urinary incontinence. Conversely, Melville et al. did not find that having urinary incontinence at baseline led to a greater incidence of developing depression.

Researchers believe there could be an underlying biologic reason why depression/anxiety may lead to greater risk of developing urinary incontinence. There are shared neurologic and biochemical pathways in both urinary incontinence and depression/anxiety. Depression and anxiety increase the activity the hypothalamic-pituitary axis, which is an interactive relationship between the hypothalamus, the pituitary gland, and the adrenal glands. The hypothalamic-pituitary axis plays in important role in the body’s response to stress and is also involved in both bladder control and in the way depression/anxiety affects our brain chemistry.

What you can do if you have urinary incontinence and depression

Bring up all health concerns with your doctor

It is important to bring up both mental health and physical health concerns with your doctor. Treatment for depression and anxiety can differ for many people and may or may not include the use of medicines, talk therapy, and other tools. For all patients, we recommend having a robust healthcare team that includes support from a doctor, pelvic floor therapist, mental health therapist, and any other specialists that may help you heal.

Pelvic floor therapy may help with urinary incontinence and depression.

The therapists at Femina can help determine what musculoskeletal dysfunctions are contributing to your urinary incontinence: pelvic floor muscle weakness, poor muscle control of the pelvic floor, or other orthopedic issues. Therapy may include:

  • Bladder and bowel habits including lifestyle modifications like optimal fluid intake and constipation management
  • Therapeutic exercise to strengthen the pelvic floor
  • Biofeedback training with intravaginal sensors
  • Electrical stimulation using the InTone device
  • Manual therapy to treat connective tissue dysfunction and myofascial trigger points
  • Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to reduce intra-abdominal pressure, improve motility, and organ function
  • Internal pelvic manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can contribute to urgency, frequency, and leakage
  • Training in self treatment techniques including correct form for pelvic floor strengthening and abdominal lymphatic massage
  • Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including reducing bladder spasms

Pelvic floor therapists are trained to fully assess what is going on in your body in order to fully understand what is contributing to any urinary incontinence and depression. Check out our post on what to expect on your first visit for more info.


Melville, J. L., Fan, M.-Y., Rau, H., Nygaard, I. E., & Katon, W. J. (2009). Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample. American Journal of Obstetrics and Gynecology, 201(5), 490.e1–490.e7. doi:10.1016/j.ajog.2009.05.047

Nygaard I, Turvey C, Burns TL, Crischilles E, Wallace R. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol. 2003;101:149–56.

Felde, G., Engeland, A., & Hunskaar, S. (2020). Urinary incontinence associated with anxiety and depression: the impact of psychotropic drugs in a cross-sectional study from the Norwegian HUNT study. BMC Psychiatry, 20(1). doi:10.1186/s12888-020-02922-4

Felde G, Bjelland I, Hunskaar S. Anxiety and depression associated with incontinence in middle-aged women: a large Norwegian cross-sectional study. Int Urogynecol J. 2012;23:299–306. 4.

Concepcion K, Cheng Y, Mcgeechan K, et al. Prevalence and associated factors of urinary leakage among women participating in the 45 and up study. Neurourol Urodyn. 2018;37:2782–91.

What Our Patients Have to Say


Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

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