The sudden, overwhelming need to pass urine. Rushing to the toilet and not always making it. Planning every outing around where the toilets are. An overactive bladder is common, particularly in women and with increasing age, and many people put up with it in silence.
It is usually treated with bladder training, pelvic floor exercises and medication. An American research team has tested something less expected: hypnotherapy.
Why the brain is involved
Bladder control is not just plumbing. The bladder sends signals to the brain as it fills, and the brain decides when it is appropriate to go. Most of the time it suppresses the urge without our noticing.
In overactive bladder, that conversation is disturbed. The urge arrives too early and too forcefully, and the brain’s ability to hold it back is reduced. Brain imaging of people with urgency incontinence shows differences in regions involved in attention and in control of the bladder.
Urgency is also strongly shaped by learning and attention. The sound of running water, arriving at the front door, or simply thinking about the toilet can set it off. Anxiety makes it worse, and the fear of an accident creates a state of constant watchfulness.
That is why behavioural treatments work, and why researchers thought hypnosis might too.
The trial
In a study published in 2020, a team at the University of New Mexico recruited 152 women with urgency urinary incontinence that was not caused by a neurological condition.
They were randomly assigned to one of two treatments.
- Hypnotherapy: weekly sessions for two months, followed by continued self-hypnosis at home
- Medication: a standard bladder drug with weekly counselling for two months, then medication alone
The people assessing the results did not know which treatment each woman had received. The main measure was the change in episodes of urgency incontinence recorded in a bladder diary at two months, with further checks at six and twelve months.
It was designed as a non-inferiority trial: its purpose was to test whether hypnotherapy was at least nearly as good as the drug.
What it found
Both groups improved substantially. The authors concluded that hypnotherapy is a promising alternative treatment for women with urgency incontinence.
On the strict statistical test at two months, hypnotherapy fell just short of being confirmed as non-inferior to medication. At six and twelve months, the reported results indicated that it was non-inferior: women who continued self-hypnosis were doing about as well as those who continued taking the drug.
A companion study using brain imaging reported changes in attention-related networks in the women treated with hypnotherapy.
How to read this
Strengths: a reasonably large randomised trial, a real comparison with standard medication, blinded assessment, and a year of follow-up.
Limitations: one centre, women only, and a single trial that needs repeating.
It matters because bladder medications have well-known drawbacks. Many people stop them because of dry mouth, constipation or cost, and some of the older drugs have been linked with memory problems in older people. An option with no side effects is worth having.
What the hypnotherapy involved
The sessions combined education about the bladder with hypnotic suggestions, including:
- Relaxation, to reduce the tension and anxiety that feed urgency
- Imagery of bladder control: a calm, comfortable bladder that fills slowly and holds easily
- Suggestions that the urge is a signal, not a command, and that it will pass
- Rehearsal of trigger situations, such as arriving home, while remaining calm and in control
- Confidence in the body’s ability to wait
- Self-hypnosis for daily practice
Where it fits
Hypnotherapy is not yet part of standard guidelines for overactive bladder. The usual approach is stepwise.
- Lifestyle: cutting down caffeine and fizzy drinks, managing fluid intake sensibly, treating constipation, losing weight if needed
- Bladder training: gradually lengthening the time between visits to the toilet
- Pelvic floor muscle training, ideally taught by a specialist physiotherapist
- Medication
- Further treatments, such as nerve stimulation or bladder injections, for those who need them
Hypnosis sits naturally alongside the second and third, since it works on the urge and the anxiety around it.
A self-help routine
Use this together with bladder training, not instead of medical advice.
Daily practice, ten minutes:
- Sit or lie comfortably and breathe slowly.
- Relax your body, including your belly and pelvic floor.
- Imagine your bladder as a soft, flexible balloon, filling slowly and comfortably, with plenty of room.
- Picture a calm, steady connection between bladder and brain: the brain receives the signal and decides, unhurried, when to go.
- Tell yourself: “My bladder is calm and holds comfortably. I decide when to go.”
- Rehearse a trigger, such as putting the key in the door, while staying relaxed.
When an urge strikes:
- Stop and stand still, or sit down. Do not rush.
- Tighten your pelvic floor muscles quickly several times.
- Breathe slowly and tell yourself: “This is a wave. It will pass.”
- Distract yourself: count backward, or name things you can see.
- When the urge fades, walk calmly to the toilet, or wait if you can.
See a doctor
Bladder symptoms should always be assessed. See your doctor promptly if you have:
- Blood in your urine
- Pain or burning when passing urine
- Difficulty passing urine, or a poor stream
- Recurrent infections
- New symptoms with back pain, weakness or numbness in the legs
- Symptoms that started suddenly
Ask about referral to a continence service or a pelvic health physiotherapist.
The bottom line
A well-conducted trial found hypnotherapy performed about as well as medication over a year for urgency incontinence, with no side effects. It is one study, but a credible one. Combined with bladder training, self-hypnosis is a reasonable thing to add.
Next in the series: Hypnosis for Hay Fever: Can You Think Your Way to Fewer Sneezes?
This article is for general information and is not medical advice.