There is believed to be a neuropsychological association between mental disorders such as anxiety and lower urinary tract symptoms (LUTS). This association has been noticed in different cultures and societies since ancient times (1, 2). Recent scientific findings have confirmed that anxiety and depression disorders increase the norepinephrine level in the body, which affects bladder function and urinary incontinence (3). Urologists who work in functional urology encounter many patients complaining of LUTS while having no obvious urinary pathology yet concurrently suffering from mental disorders. Nowadays, it has been proven that certain mental conditions, including anxiety disorders like obsessivecompulsive disorder (OCD), have a direct effect on the incidence and severity of some lower urinary tract disorders such as an overactive bladder (OAB) and urinary incontinence (UI)
(3). However, the patient history is not reliable in these cases and physicians need to have objective data to achieve better management of such patients.Psychological disorders are sometimes accompanied by chronic lower urinary tract symptoms (LUTS) for which no obvious pathology in the urinary tract is found. In this study, we investigated the “obsessive bladder” as a type of psychogenic urinary dysfunction.

This cross-sectional study included women aged 18-80 years presenting to our female urology clinic with chronic LUTS from 2012 to 2018 but lacking any apparent urinary pathology in the primary investigations. The patients were divided into two groups, one with a history of obsessive-compulsive disorder (OCD) and the other without any history of psychiatric disorders (control). Data on the clinical phenotypes and urodynamic findings were obtained and analyzed.

The OCD group featured a lower mean age, longer symptom duration, and greater prevalence of voiding phase problems than the control group. The predominant type of urinary incontinence was urge urinary incontinence in the OCD group and stress urinary incontinence in the control group. Key urodynamic findings included bladder outlet obstruction (45% OCD vs. 17% control) and type 2 detrusor overactivity (18.8% OCD vs. 12.5% control), with only 6.2% having a normal urodynamic study in the OCD group
compared with 20.3% in the control group. Urination disorders had resulted in chronic kidney disease in two patients (3.12%).

An essential finding while evaluating the voiding diary and questionnaires of the patients was the fact that sensory urgency and UUI were accompanied by urinary frequency in the control group, as per the definition of OAB syndrome. At the same time, there was no urinary frequency in the OCD group, with many of them having infrequent voiding and complaints of urgency (sensory urgency or urge incontinence). Nevertheless, in the Jiwanmall et al. study conducted in 2016, the OCD patients presented with urinary frequency and pollakiuria (17). The present study showed that OCD patients postponed their micturition for a long period of time, probably to avoid dealing with their compulsions. However, after voiding, the female OCD patients would frequently return to the toilet and check themselves for ‘wetting’ and ‘contamination’ or due to fear of incomplete emptying, so the correct definition of urinary frequency may not apply in such cases. Despite complaints of urgency, the OCD group patients tried to postpone their urination as long as possible due to the fear of a prolonged washing process for the complete resolution of both contamination and religiously defined impurity (Nejasat in Islam). Such infrequent voiding and urgency were generally common among the OCD patients, representing potentially
valuable symptoms in diagnosing the voiding phenotype of OCD patients. The other annoying symptoms of OCD patients were prolonged (>5 min) washing and purifying (Taharat in Islam).

Voiding dysfunction had a profound impact on the quality of life of women with OCD and resulted in severe impairments in their bladder dynamics. These psychosomatic disorders should be recognized and treated appropriately.

Barczak P, Kane N, Andrews S, Congdon AM, Clay JC, Betts T. Patterns of psychiatric morbidity in a genito-urinary clinic. A validation of the Hospital Anxiety Depression scale (HAD). The British journal of psychiatry : the journal of mental science. 1988;152:698-700.
Norton KR, Bhat AV, Stanton SL. Psychiatric aspects of urinary incontinence in women attending an outpatient urodynamic clinic. BMJ. 1990;301(6746):271-2.
Felde G, Bjelland I, Hunskaar S. Anxiety and depression associated with incontinence in middleaged women: a large Norwegian cross-sectional study. International urogynecology journal. 2012;23(3):299-306.