Project Summary
Urinary urgency incontinence (UUI) is a highly prevalent, morbid and costly (up to $83 billion/year) disorder
among older women, with up to 36% of those over 65 afflicted. One commonly experienced phenomenon among
those with UUI is conditioned bladder responses to external triggers, often labeled “situational incontinence.”
Situational incontinence is described by sufferers as urinary urgency and leakage when confronted with specific
contextual triggers or cues, such as approaching the front/garage door ‘latch-key incontinence’, and exposure to
running water such as doing dishes. Generally ascribed to 'bladder spasms' (detrusor overactivity), studies have
revealed that anywhere between 42% and 80% of women with UUI experience situationally provoked urgency,
with approximately 26% of those experiencing situationally triggered leakage. Our recent work has focused on
developing methods to recreate exposure to individuals’ situational urgency cues, testing the impact of “urgency”
and “safe” cues on self-report urgency and actual leakage, and finally assessing the role of bladder control
mechanisms in the brain in response to these personal situational cues. We found that women with situational
UUI experienced increased urgency and leakage when exposed to personal “urgency” versus “safe”
photographic cues from their daily lives. Further, brain areas related to attentional and visuospatial processing
were activated during exposure to urge, but not safe, cues. Past studies of urgency simulated by bladder filling,
show that prefrontal cortex, a seat of executive control, is activated to aid in controlling bladder activation.
However, our study found that the PFC was not recruited during exposure to visual cues among women with
situational urgency. Thus, we propose that interventions capable of enhancing PFC activation during exposure
to urgency situations should enable women to gain executive control over cues and result in less cue-provoked
urgency and leakage, as well as overall UUI symptomatology. Using our now well-tested methods to personalize
stimuli with photographs of urgency-provoking situational cues, our goal is to test the feasibility, acceptability,
and compliance of these promising methods to attenuate urgency-related reactivity and reduce UUI symptoms.
These novel methods include: (1) Brief mindfulness (MI) focused on body scan and acceptance language, (2)
Transcranial direct current stimulation (tDCS) applied to the dorsolateral PFC, and (3) a combination of MI +
tDCS. Sixty women with situational UUI will be randomized into a 7-session study, with a mail-in follow up 1-
week post-training. All participants will undergo 4 urgency-cue exposure training sessions during which they will
engage in one of the three interventions, based on group. Changes in urgency will be assessed via pre-post
training differences in: Cue-reactivity to personal urge and safe cues, reaction time to a urinary Stroop task, self-
report severity of bladder problems, and UUI episodes and urgency ratings on a daily bladder diary. Attenuating
reactivity to situational urgency cues will increase our ability to complement and enhance the efficacy of UUI
therapy and reduce symptom burden for its many sufferers.