Mind over bladder: Mindfulness, zap therapy help with situational urge incontinence

Noninvasive approaches such as mindfulness training and transcranial direct current stimulation (tDCS) hold therapeutic potential in women with situational urgency urinary incontinence (UUI), as shown in a study.

In a cohort of women reporting regular situationally triggered UUI, mindfulness, tDCS, and their combination led to reduced reactivity to personal triggers for bladder urgency. Participants who underwent mindfulness plus tDCS also became less preoccupied or less hyper-focused on thoughts and words related to toileting. [Continence 2025;doi:10.1016/j.cont.2025.101765]

Accordingly, the mean number of leaks dropped significantly from baseline, by 0.81 episodes per day with mindfulness (p=0.010), by 0.90 episodes per day with tDCS (p=0.006), and by 0.95 episodes per day with mindfulness plus tDCS (p=0.002). Furthermore, the number of ‘triggered’ episodes recorded per day decreased by 1.63 (p=0.000), 1.56 (p=0.001), and 1.55 (p=0.001), respectively.

Finally, the interventions produced symptom improvement through the postintervention 1-week follow-up, as evidenced by reductions in ICIQ-FLUTS scores of 3.5 in the mindfulness group, 4.1 in the tDCS group, and 3.0 in the mindfulness plus tDCS group (p<0.05 for all).

Feasibility was high, with completion rates of 100 percent in the mindfulness and mindfulness plus tDCS groups and 90.4 percent in the tDCS group. Self-reported compliance to daily mindfulness practice was also remarkably high, ranging from 93 to 94.4 out of 100. Overall, the interventions were positively received by participants, with mean acceptability scores falling between 80.4 and 85.6 (SD 9.9) out of 100.

Brain-mediated link

“Reports of regular situations that trigger urgency and leakage are common and make up a significant portion of UUI burden in older adults. The mechanisms underlying this effect remain poorly understood and rarely studied, but recent research supports it being a conditioning effect,” the authors explained.

For example, routinely delaying bathroom use until returning home (the unconditioned stimulus) can cause the home’s entry point (eg, front or garage door) to become a conditioned stimulus, they said. This conditioned stimulus, in turn, triggers urgency and/or leakage.

“Such symptoms can be experimentally reproduced in a laboratory by exposing individuals to photographs of their urgency-related situations, leading to cue-provoked urgency and leakage during urodynamic testing,” the authors noted. [Neurourol Urodyn 2020;39:2520-2526]

Imaging studies have shown evidence of the involvement of key attentional networks and the prefrontal cortex in the link between conditioned behaviour, brain reactivity to urgency cues, and situational UUI. [J Urol 2015;194:708-715; Int Urol Nephrol 2015;47:927-935; Am J Obstet Gynecol 2021;224:498.e1-498.e10]

“The prefrontal cortex is the seat of cognitive control. It’s the executive function centre of the bladder, the bit that is telling you, ‘Okay, it’s time to go. You should find somewhere to go’,” said senior study author Dr Becky Clarkson from the University of Pittsburgh in Pittsburgh, Philadelphia, US.

In the study, mindfulness and/or tDCS proved beneficial in terms of reducing cue reactivity and attentional bias, as well as bladder symptoms, indicating that the mechanisms by which symptom reduction occurs are mediated by the brain, Clarkson added. “These interventions are believed to increase cognitive control over, and facilitate learning of, new responses to disorder-related cues.”

Promising noninvasive therapies

Clark and colleagues stressed that mindfulness and tDCS—with their little risk of side effects and high acceptability and compliance—represent a promising potential adjunctive or alternative therapy, especially for those with predominant or bothersome situational UUI and those who may prefer to delay or refuse pharmacological or invasive treatments.

Moreover, the interventions could be widely disseminated and help extend treatment access to a broader population in need, including those with advanced disabilities or individuals residing in remote areas where regular travel poses a challenge, they added.

A total of 58 women over 40 years of age (mean 61.0 years, 75.9 percent White) with situational UUI and reporting at least two leaks per week participated in the pilot study. These women were randomly assigned to undergo mindfulness training (n=20), tDCS (n=18), or mindfulness plus tDCS (n=20).

Mindfulness was a 20-min body scan exercise, which encouraged the participants to acknowledge their bodily sensations, starting at the toes and moving to the head, without judgement. For tDCS, electrodes were placed on the right temple and left bicep to deliver 20 mins of 2.0-mA anodal stimulation of the dorsolateral prefrontal cortex. Participants in the combination group received the tDCS intervention while engaging in mindfulness training. All interventions consisted of four 20-min sessions delivered in-office over 5–6 days. During the sessions, the participants viewed wall-projected images of their bladder urgency triggers.