Home›Psychiatry› Stress, PTSD, and Anxiety Linked to Worse Urinary Incontinence
Stress, PTSD, and Anxiety Linked to Worse Urinary IncontinenceStress and trauma are linked to worse urinary incontinence
American journal of obstetrics and gynecologyPublished August 9, 2026Study authors: Scharp Danielle, Goldstein Karen M, Kelly Ursula A, Burgio Kathryn L, Vaughan Camille P, Intrator Or…PubMed ↗DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
AI-generated summary of the cited source, checked by automated accuracy review.
How we work
Share
Key Takeaway
Psychological and trauma factors are associated with worse incontinence and lower treatment response, suggesting integrated care.
A secondary analysis of a randomized controlled trial examined psychological and trauma-related factors in 200 women veterans receiving behavioral treatment for urinary incontinence across three Veterans Healthcare Administration systems. The study assessed how perceived stress, anxiety, post-traumatic stress disorder (PTSD), and military sexual trauma related to incontinence severity and treatment response.
Results showed that higher perceived stress was associated with greater incontinence severity (beta coefficient = 0.18; 95% CI [0.08, 0.27]; P <.001). Similarly, diagnosed anxiety (beta = 3.35; 95% CI [1.73, 4.97]; P <.001), PTSD (beta = 1.96; 95% CI [0.40, 3.51]; P =.02), and reported military sexual trauma (beta = 1.80; 95% CI [0.18, 3.41]; P =.03) were each linked to more severe symptoms.
Regarding treatment outcomes, 55% (109/200) of participants were classified as responders to behavioral treatment. Higher perceived stress was associated with lower odds of response (adjusted odds ratio = 0.98; 95% CI [0.97, 0.99]; P =.01).
These findings highlight the importance of addressing psychological and trauma-related factors in urinary incontinence care. The authors suggest that trauma-informed, interdisciplinary approaches may improve outcomes for women veterans. However, as a secondary analysis, the study cannot establish causality, and the associations observed warrant further investigation.
How this fits prior evidence
How this fits prior evidence: This finding addresses a gap by identifying specific psychological and trauma-related factors associated with urinary incontinence severity in a veteran population. While previous coverage has established that intolerance of uncertainty and worry show robust associations with multiple anxiety disorders, the current study specifically links these types of distress to physical symptoms like urinary incontinence.
Living with urinary incontinence can be a heavy burden, but new research suggests the problem might be tied to deeper emotional struggles. A study involving 200 women veterans looked at how mental health factors like stress and trauma impact their physical symptoms.
The results showed that higher levels of perceived stress were linked to more severe cases of urinary incontinence. Additionally, women who were diagnosed with anxiety or post-traumatic stress disorder (PTSD) reported worse symptoms. The study also found a link between military sexual trauma and increased severity of the condition.
While these findings show a clear connection between mental health and physical symptoms, it is important to remember this was a secondary analysis of an existing trial. This means the data shows how these issues happen together rather than proving one causes the other. The study highlights why doctors should take a whole-person approach when treating urinary incontinence.
What this means for you:
Women with higher stress, anxiety, and PTSD often experience more severe urinary incontinence symptoms.
Common questions
Does stress make urinary incontinence worse?
Yes, the study found a positive association between perceived stress and the severity of urinary incontinence. Specifically, higher levels of stress were linked to more severe symptoms in the group of 200 women veterans studied.
How do anxiety and PTSD affect these symptoms?
Both diagnosed anxiety and post-traumatic stress disorder (PTSD) were associated with greater severity of urinary incontinence. The data showed that these mental health conditions are linked to more difficult physical symptoms.
Does stress affect how well treatments work?
The study found that higher levels of perceived stress were associated with lower odds of responding to behavioral urinary incontinence treatment. While 55% of the women were considered responders, those with high stress had a harder time seeing results.
BACKGROUND: Psychological and trauma-related factors (ie, stress, anxiety, post-traumatic stress disorder, and military sexual trauma) may induce physiological responses that contribute to urinary incontinence. Women veterans are disproportionately affected by psychological and trauma-related factors, which may influence urinary incontinence severity and response to behavioral urinary incontinence treatment.
OBJECTIVE: We aimed to examine associations between psychological and trauma-related factors and both urinary incontinence severity and response to behavioral urinary incontinence treatment among women veterans.
STUDY DESIGN: We conducted a secondary analysis of data from a randomized controlled trial that evaluated the effectiveness of 2 remote urinary incontinence behavioral treatment modalities in 3 southeastern Veterans Healthcare Administration systems from April 2020 to September 2023. Urinary incontinence severity was measured with International Consultation on Incontinence-Urinary Incontinence Short Form scores to reflect urinary incontinence frequency and amount leaked. Treatment response was defined as a 2.52-point reduction in International Consultation on Incontinence-Urinary Incontinence Short Form scores and modeled as a binary outcome. Stress was assessed with the Perceived Stress Scale-10. Military sexual trauma was determined based on 2 validated Veterans Health Administration screening items. Post-traumatic stress disorder and anxiety were assessed with self-reported items indicating whether participants were ever diagnosed with these conditions. We performed bivariate analyses to examine differences in sample characteristics by treatment response status. We used linear regression models to examine associations between each psychological and trauma-related factor and urinary incontinence severity at baseline and reported β coefficients. We used logistic regression models to estimate the odds of treatment response by each psychological and trauma-related factor.
RESULTS: Among 200 women veterans (mean age=54 years, standard deviation=11), the most commonly reported psychological and trauma-related factors were anxiety (138/200, 69%), military sexual trauma (120/200, 60%), and post-traumatic stress disorder (101/200, 51%), and their mean perceived stress score was 17.9 (standard deviation=8.6) indicating moderate stress. Higher levels of perceived stress (β=0.18, 95% confidence interval [0.08, 0.27], P<.001), diagnosed anxiety (β=3.35, 95% confidence interval [1.73, 4.97], P<.001), post-traumatic stress disorder (β=1.96, 95% confidence interval [0.40, 3.51], P=.02), and reported military sexual trauma (β=1.80, 95% confidence interval [0.18, 3.41], P=.03) were significantly associated with greater urinary incontinence severity after adjusting for age, race, ethnicity, education level, body mass index, vaginal parity, menopausal status, medication for urinary incontinence, hysterectomy status, and randomization group. In total, 55% (109/200) of women veterans were classified as treatment responders. Higher levels of perceived stress were associated with lower odds of response to behavioral urinary incontinence treatment in the adjusted model (adjusted odds ratio=0.98, 95% confidence interval [0.97, 0.99], P=.01).
CONCLUSION: Findings highlight the importance of understanding what psychological and trauma-related factors are associated with urinary incontinence among women and underscore the need for trauma-informed, interdisciplinary approaches to urinary incontinence care to improve health outcomes.
