The “IC’s Related Conditions” series takes a look at conditions that can go hand-in-hand with IC. Not all patients have all of these conditions, but IC patients are more prone to be diagnosed with these conditions than the general population. (As always, this is not intended as medical advice and is for informational purposes only. Any and all medical questions should be addressed with your doctor.)

There is no doubt that anxiety and stress can intensify the symptoms of IC. But did you know that your brain will actually intensify pain if it accompanied by anxiety but pain accompanied by laughter is minimized by the brain. And, after the year we’ve had, there’s no doubt that many IC patients are struggling with symptoms that have been exacerbated by stress.

“Every day I work with patients who have chronic anxiety disorder, often triggered by a traumatic event or PTSD early in their life. Some are so anxious that they are literally spinning in place, unable to take any step forward in their medical care,” offered national IC support group leader Jill Osborne. “What they don’t see is that their anxiety is not only worsening their pain, it’s causing the nervous system to become more sensitive. Every catastrophic thought triggers a fight or flight response that, over months or years, can take a terrible toll on our nervous system.” Unchecked anxiety disorder and catastrophizing are common.

Research studies have proven that IC patients are 4.37 times more likely than the general population to have been diagnosed with general anxiety disorder previous to their IC diagnosis. And if they weren’t, patients are still 2.4 times more likely to be diagnosed with anxiety after the onset of their urinary symptoms.(1) Studies have shown the two issues often overlap one another. Yet, as anxiety is treated, urinary symptoms often reduce dramatically.

Symptoms

There are several types of anxiety disorders, including: generalized anxiety disorder, social anxiety disorder, separation anxiety disorder and specific phobias.

One common symptom is feeling nervous, restless or tense.(2) These feelings are intense enough to interfere with regular activities and can be difficult to control. They are often out of proportion to actual danger and can last a long time. In fact, patients may avoid places or situations.

Patients with anxiety can have a hard time truly relaxing. They may feel a sense of impending danger, panic or doom.2 It can feel like a pit in your stomach as your heart rate and breathing increase. You may even start sweating. Feeling weak, tired or fatigued is common and sometimes the result of insomnia and muscle tension.(3)

With so many anxious thoughts racing through the mind, maintain- ing focus at work can be challenging, as well as increased irritability, panic attacks and avoiding social situations. Anxiety can also trigger a pounding heart, shortness of breath, tremors, headaches, upset stomach, as well as IC and IBS flares.(4)

Risk Factors

There are many medical conditions that can also exacerbate anxiety, including: heart disease, diabetes, thyroid problems, menopause, respiratory disorders and chronic pain. Some medications can also cause anxious thoughts.

There are situational risk factors for developing an anxiety disorder as well. Going through a traumatic event at any age can put you at higher risk for developing anxiety. Stress buildup – meaning either a big stressful event or multiple smaller ones – can trigger anxiety. While situational anxiety can be temporary, it can also trigger an anxiety disorder.

Having other mental health disorders, such as depression, or having blood relatives with an anxiety disorder can increase your risk as well.

Certain personality types are also at greater risk. If you were shy or had behavioral inhibitions as a child, you are more likely to be diagnosed with an anxiety disorder.(5)

Diagnosis

Your doctor will evaluate you with a physical examination, an interview and some lab tests. Once any physical reason is ruled out, your doctor may refer you to a mental health professional for further evaluation. Mental health professionals can then help you identify your specific anxiety disorder type and come up with a treatment plan.

Treatment

Treatments vary from patient to patient and even throughout the anxiety journey. Anxiety symptoms can wax and wane to require more or less treatment at different times in the same person. Generally speaking, many patients with anxiety disorders utilize a combination of treatments: psychotherapy, medication and self-help.

Psychotherapy

Psychotherapy is also known as “talk therapy.” Mental health providers can tailor psychotherapy to your needs. Cognitive Behavioral Therapy (CBT) is one type of psychotherapy often helpful to patients with anxiety disorders. CBT helps people learn different ways of think- ing, behaving and reacting to anxiety and its triggers.5

Exposure therapy is often helpful alone or in conjunction with CBT. It focuses on fears underlying the anxiety disorder to help patients get back into activities they’ve been avoiding. Relaxation exercises and imagery are often used with exposure therapy as well.

Medication

Medications can help manage symptoms and require a prescription. from your primary care physician or psychiatrist. Three main types of medication treat anxiety disorders: anti-anxiety drugs, antidepressants and beta-blockers.

  1. Anti-anxiety drugs: The most common are benzodiazepines, which can help reduce anxiety, panic attacks and extreme fear or worry. However, if they are used long-term, patients can develop a tolerance to them. For this reason, doctors usually prescribe them for a short time or to use as needed. Buspirone is another option.
  2. Antidepressants: Medications used to treat depression can also treat anxiety disorders by improving how your brain uses certain chemicals that control stress and mood. Finding the right antidepressant can take time and patience.
  3. Beta-blockers: Medications used to treat depression can also treat anxiety disorders by improving how your brain uses certain chemicals that control stress and mood. Finding the right antidepressant can take time and patience.

Self-help treatment

Regular exercise, a healthy diet and good sleep are great places to start. Reducing or eliminating alcohol is important as both can worsen anxiety symptoms.

If stress is out of control, we encourage patients to try some new stress management techniques. Guided relaxation, meditation, repeating a mantra, visualization WILL help to calm and retrain more sensitive nerves and is considered a foundation of success.6 The ICN offers several free guided relaxations that you can do every single day.

Mindfulness is a core foundation of most chronic pain management programs because it acts to “wind down” an overactive nervous system, thereby calming pain responses. It also gives patients a much stronger sense of control rather than the powerlessness that many feel.

Something as simple as positive thinking and affirmations can be remarkably comforting and soothing. It’s time to stop judging yourself harshly. If you’re constantly thinking “I’m not worthy. I can’t do this. No treatments will work or I will always be in pain,” you are triggering more adrenaline into your bloodstream via the fight or flight response, which is winding up your nervous system. Turn the negative thoughts into positive ones by repeating affirmations, like “I am worthy. I can do this. I will find the right treatment. I will conquer this pain.”

Pay attention to what triggers your anxiety and what helps. Consider writing down your feelings and experiences in a journal to help both you and your medical provider sort them and determine the best treatment plan.(6) But, don’t forget to give yourself some grace as you are working through your anxiety journey. Some days will be harder than others.

Look for a support group (either in person, online or both). Reach out to friends and family instead of isolating yourself. Find a trusted person who can help you through your difficult days and cheer you on during your good days.

There is no shame in having anxiety. It happens to everyone. But we must each take a moment and ask if our anxiety is interfering with our lives. Has it gotten so bad that you are “ruminating” and/or dwelling on events that haven’t even happened yet? Are you catastrophizing about the future, assuming that you will not get better? You weren’t born with the skills to handle life with IC and/or, honestly, life during a pandemic. We have to learn them.

Jill Osborne talks frequently about the Phobease class she took years ago that changed her life. She said “I suffered with intense anxiety and catastrophizing for years. In just a few weeks, I learned how to control the anxiety and haven’t had a single panic attack since.”

Watch her video here! 

References

  1. McKernan LC, et. al. Psychosocial Co-Morbidities in Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS): A Systematic Review. Neurourol Urodyn. March 2018 Volume 37, No. 3.
  2. Mayo Clinic Staff. Anxiety Disorders. MayoClinic.org. May 4, 2018.
  3. Julson E. 11 Signs and Symptoms of Anxiety Disorders. Healthline. April 10, 2018.
  4. National Alliance on Mental Illness. Anxiety Disorders. Dec. 2017.
  5. National Institute of Mental Health. Anxiety Disorders. July 2018.
  6. Cirino E. Everything You Need to Know About Anxiety. Healthline. Sept. 16, 2018.

Updated: 12/27/20 – JHO