I’m always afraid of wetting my pants. What’s going on?

Do you feel anxious when you leave the house because you worry that you might wet your pants? Is this thought constantly in the back of your mind? Maybe you even take steps to try to make sure it doesn’t happen, like going to the bathroom before you go anywhere, wearing adult diapers just in case, or keeping a change of clothes in your car. 

This fear might bring a slew of uncomfortable emotions with it, like embarrassment, shame, or anxiety. You may feel like you’re the only person on the planet who feels this way, but you’re not. And you can work through it, says April Kilduff, LPCC, LCPC, LMHC, a therapist and clinical trainer at NOCD.

Why am I afraid of wetting my pants?

If this anxiety takes up a significant amount of your time and energy, and brings you the kind of distress that impairs your ability to live your life the way you want, that’s a sign that what you’re experiencing warrants help. And that acknowledgement is a good thing! In fact, it’s an act of courage to say, I want to make my life better.

OCD

One mental health condition that can be tied to this fear is obsessive-compulsive disorder (OCD), which consists of repetitive, unwanted intrusive thoughts, images, urges, sensations, and/or feelings (obsessions). They are ego-dystonic, meaning that they don’t align with your true intentions, wants, or values—and this can be extremely upsetting. 

Your intrusive thoughts could sound like:

• What if I pee my pants and can’t handle the embarrassment?
• What if I don’t realize I have to go to the bathroom, so I leave the house and then I wet my pants?
• What if I ruin all my underwear?
• What if I wet my pants during an important meeting?
• What if I get so embarrassed over peeing my pants that I have to quit my job or leave my social circle?
• What if I can never stop thinking about this?

“With OCD, the fear of wetting your pants has moved to the point where specific behaviors are involved to try to prevent the worst from happening,” explains Kilduff. 

In the hopes of ridding yourself of these worries and the feelings they bring, or to eliminate the possibility of wetting your pants, you may engage in compulsions. These can be mental compulsions or physical ones that include:

• Checking. You might scan your body to check for the sensation of having to urinate. Or you may check to make sure the bathroom hand towel is damp before leaving the house, signaling to you that you went to the bathroom recently.
• Rituals. These can take many forms, but are any process you feel like you must do in order to “feel OK.” Perhaps every time you use the bathroom, you have to do each part of the act in a very specific order. Maybe you have to use the exact right number of toilet paper squares or hand soap pumps. 
• Reassurance-seeking. You may seek reassurance from others or from yourself that your intrusive thoughts aren’t true. You might ask yourself, Did I use the bathroom before I left? Or you may repeat to yourself, Of course I used the bathroom before I left. I always do. Of course I won’t wet my pants. 
• Avoidance. This happens when you steer clear of any situation, activity, media, person, place, or other stimuli that triggers your intrusive thoughts. You may even start to avoid leaving home for long periods of time, or even avoid drinking fluids for a full day ahead of an event.
• Distraction is the process of trying to drown out your thoughts or worries. You may use substances, television, social media, other people, or anything else that can take you out of your brain. 

The relief that compulsions provide is short-lived. OCD wants 100% certainty, so no amount of compulsions can ever be enough. The condition needs to know that something isn’t only improbable, but that it’s impossible—and in most cases, you simply can’t say that. We can’t perfectly control everything our bodies do! As a result, you’ll feel the need to keep doing more and more compulsions, which keeps you stuck in the obsessive-compulsive cycle.

Social Anxiety

Another condition to know about is social anxiety disorder. It hinges on the fear of being negatively judged, criticized, humiliated, or rejected by others, says Kilduff. You could worry extensively about meeting new people, being in social situations, or giving presentations.

Both OCD and anxiety disorders commonly come with physical symptoms of stress, such as a racing heart, sweating, shakiness, muscle tension, dizziness, and gastrointestinal issues.

Agoraphobia

Another type of anxiety disorder that can trigger a constant fear of wetting your pants is agoraphobia. “This disorder shares some similarities with social anxiety disorder, but is specifically related to how far away you feel you can get from a ‘safe zone’ like home,” says Kilduff. It’s often tied to the fear of having a panic attack in public and either doing something embarrassing or not being able to get help. “Over time, there are fewer and fewer places that you feel you can leave your home to go to,” she adds.  

If you think you may have OCD or an anxiety disorder, talk with a licensed mental health professional who can help you assess the best treatment option for you. 

How can I stop worrying about wetting my pants?

The go-to, evidence-based treatment for OCD and anxiety disorders like social anxiety or agoraphobia is exposure and response prevention (ERP) therapy. You may have heard the term “exposure therapy” before, but the response-prevention piece is key in breaking the obsessive-compulsive or fear-response cycle.

The process consists of gradually exposing yourself to your fears—and rather than engaging in compulsions to push away or “fix” your anxiety, your therapist will give you tools to help you sit with the discomfort. 

And that’s a key part of the ERP process. Experiencing discomfort in a safe space helps you learn that your fears aren’t founded or dangerous, and that you can move past them.

With ERP, you’ll never be forced into anything. Your therapist will know how to tow the line between guiding you out of your comfort zone without going too far, too fast.

Over time, as you get more and more comfortable sitting with anxiety and uncertainty, you’ll become desensitized to those feelings. So each time you resist a compulsion or safety behavior, you’ll realize that they were never keeping you safe, anyway—and in fact, they were keeping you stuck. Your brain learns that it doesn’t need to sound the alarm in the face of intrusive thoughts, worries, or “what if?” questions. 

Even if you feel like you can’t be helped, that’s your condition lying to you. You are capable—and worthy—of getting better. There is a life not ruled by the constant fear of wetting your pants waiting for you.