Understanding Bowel and Bladder Anxiety/Incontinence Anxiety : How Exposure Therapy Can Help
Bowel and Bladder Anxiety (BBA) or Incontinence Anxiety is a little-known but deeply distressing condition that affects many individuals, often in silence. It is characterized by an overwhelming fear of losing control over one's bowel or bladder in public or in situations where a bathroom may not be easily accessible. While not officially listed as a separate disorder in major diagnostic manuals, BBA is increasingly recognized by clinicians as a specific manifestation or variant of agoraphobia—a condition rooted in the fear of being trapped or unable to escape in embarrassing or dangerous situations. Other research indicates it can also be a theme of OCD. Luckily, regardless of exact diagnosis the treatment is the same and both OCD and agoraphobia have a good prognosis with the appropriate treatment.
What Is Bowel and Bladder Anxiety?
At its core, Bowel and Bladder Anxiety stems from catastrophic thinking: the person fears that they will urgently need to use the restroom in a setting where they cannot reach one in time, leading to public humiliation. Common triggers include:
Long car rides
Public transportation
Standing in long lines
Public spaces without close bathrooms
Being in meetings or classrooms
Social events where leaving abruptly may be awkward
Certain foods that cause potential stomach upset
As a result, many sufferers begin to avoid these situations, significantly reducing their social and occupational functioning. Over time, the avoidance behaviors may expand, creating a restricted lifestyle that closely mirrors agoraphobia.
Is It Just a Fear or a Medical Condition?
Importantly, BBA is not usually caused by a gastrointestinal or urological disorder—though it may be more common in individuals with a history of Irritable Bowel Syndrome (IBS), overactive bladder, or prior traumatic episodes involving loss of control. For many, medical evaluations yield normal results. The issue lies not in the actual risk of an accident but in the perception of danger and the anxiety that ensues.
The Role of Exposure Therapy
One of the most evidence-based treatments for BBA is Cognitive Behavioral Therapy (CBT), particularly exposure therapy. Exposure therapy involves gradually and systematically confronting the feared situations—starting with less anxiety-provoking scenarios and working up to more challenging ones. The goal is to reduce avoidance, challenge catastrophic thoughts, and ultimately retrain the brain to no longer perceive these situations as threatening.
How Exposure Therapy Works for BBA
Here is an example of what an exposure hierarchy might look like for someone with bowel or bladder anxiety:
Visualizing being in a meeting and feeling the urge to go to the restroom without being able to leave
Taking a 15-minute walk away from home without using the restroom first
Sitting in a short, non-stop public transit ride (e.g., one subway stop)
Higher-intensity
Attending a 1 hour meeting or class without a planned restroom break
Going on a longer car ride or flight without frequent restroom access
Each stage is repeated until the person's anxiety decreases significantly, and they gain confidence in their ability to manage discomfort or uncertainty.
Working with an expert in exposure therapy is important, as traditional talk therapy may actually exacerbate symptoms. Meghan Cromie LPC is well versed in treating Bladder and bowel anxiety and an exposure therapy specialist.
Breaking the Silence Around BBA
Because BBA is not widely discussed—even among mental health professionals—those suffering from it often feel isolated, ashamed, or dismissed. This lack of awareness can delay diagnosis and effective treatment. However, with proper recognition and a tailored treatment plan that includes graded exposure, individuals can regain freedom and confidence in their daily lives.
When to Seek Help
If you find yourself avoiding places or situations for fear of needing a restroom, or if this fear is interfering with your work, relationships, or social life, it may be time to consult a mental health professional. Trained exposure therapists can guide you through the process of exposure therapy and help you reclaim your sense of autonomy. Meghan Cromie LPC is well versed in treating Bladder and bowel anxiety and an exposure therapy specialist.
