CBT for Urge Incontinence

Feeling anxious about incontinence only makes it worse. Cognitive behavioural therapy can help rewrite this frustrating cycle.

While a physiotherapist is a go-to resource for pelvic floor health, cognitive behavioural therapy (CBT) can also help in treating issues like urge incontinence. There’s a relationship between your thoughts, behaviours and emotions, explains Tobey Mandel, a Montreal psychologist.

Let’s say you’re worried that you’re going to pee yourself if you don’t get home by 2 p.m. The closer you get to your door, the more urgent the need to pee will be. “The rush of anxiety and those emotions will impact your body’s registration of urgency,” she says. “You’re having a behavioural reaction along with the psychological response.” If you make it home by 1:55, you’ll think that you wouldn’t have made it if you were later—confirming, as Mandel puts it, “that the alarm system in your body is accurate.”

The idea behind CBT is to help understand and manage emotions. The first step is to look for a cycle. “What are my thoughts in the moment? What behaviours am I engaging in and what are the feelings I’m having?” Mandel says. She would then help track that cycle to see when a rise in panic is first detected and collect the data surrounding it: “What happens next? How do I respond? What happens after the behavioural response?” Then she begins to adjust the dials

of thoughts and behaviours to regulate emotional response.

The idea is to take it slowly. Push by oneminute increments the time you “need” to pee by. This will help reeducate your brain that thoughts are not facts; just because you think you can’t hold it doesn’t mean you can’t. This might look like walking to your door at a leisurely pace instead of rushing or circling the block once before parking. It’s all about baby steps—working slowly and consistently to build tolerance. “You’re going to do the opposite of what the panic signal is telling you so that your brain starts to reinterpret that signal as benign,” says Mandel. “When it’s better able to recognize that the signal is like a broken alarm instead of a true threat, the alarm doesn’t ring as loudly or as frequently.”

She stresses that there’s no one-size-fits-all solution—treatment is individual. If you’ve had problems with leakage, there might be shame involved, which must be broken down and reinterpreted. (This involves normalizing the leakage and realizing that you’re not alone.) The key is to understand that we can change what’s in our control—our thoughts and behaviours—and work from there.

“You’re going to do the opposite of what the panic signal is telling you.”