Anxiety symptoms are common in overactive bladder (OAB) and negatively impact OAB symptoms [1]. Many individuals with anxiety engage in “worry behaviors,” which are avoidance-based strategies (e.g., avoiding anxiety-inducing situations or people) that are meant to mitigate symptoms but ultimately foster increased sensitivity to anxiety triggers [2].  In the context of OAB, urinary cues (e.g., running water) may function as anxiety triggers, and repeated engagement in worry behaviors may increase sensitivity to urinary cues, indirectly worsening OAB symptoms. This study aimed to investigate whether worry behaviors predict increased lower urinary tract symptoms (LUTS) in patients with OAB, and whether variance in this relationship is explained by increased sensitivity to urinary cues.

226 adults with OAB from an ongoing prospective cohort study completed validated measures of LUTS, worry behaviors, and urinary cues. A series of linear regressions assessed relationships between these variables and whether urinary cue sensitivity accounted for a significant portion of the relationship between worry behaviors and LUTS. Nonparametric bootstrapping with 5,000 resamples was used to generate 95% confidence intervals for the indirect effect.

Worry behaviors significantly predicted LUTS (b = .31, β = .22, p < .0001) and urinary cue sensitivity (b = 1.37, β = .46, p < .0001). When both urinary cues and worry behaviors were included in the model, urinary cues significantly predicted LUTS (b = .21, β = .45, p < .0001), but worry behaviors no longer significantly predicted LUTS (b = .02, β = .01, p = .85). Worry behaviors demonstrated a significant indirect effect on LUTS via urinary cue sensitivity (b = .29, Bootstrapped 95% CI [0.19, 0.41]).

Results demonstrate an indirect relationship between worry behaviors and LUTS through urinary cue sensitivity. Thus, the relationship between avoiding anxiety-inducing situations and urinary urgency may be driven by increased sensitivity to urinary cues.

These findings suggest that individuals with OAB may experience heightened sensitivity to bodily cues driven by worry behaviors, highlighting potential mechanistic pathways for intervention. Worry behaviors may serve as a practical clinical intervention target, and future longitudinal research should explore causal pathways to directly inform interventions.

Lai HH, Rawal A, Shen B, Vetter J. The Relationship Between Anxiety and Overactive Bladder or Urinary Incontinence Symptoms in the Clinical Population. Urology. 2016;98:50-57. doi:10.1016/j.urology.2016.07.013
Mahoney AEJ, Hobbs MJ, Newby JM, Williams AD, Sunderland M, Andrews G. The Worry Behaviors Inventory: Assessing the behavioral avoidance associated with generalized anxiety disorder. Journal of Affective Disorders. 2016;203:256-264. doi:10.1016/j.jad.2016.06.020