Overactive Bladder – The Relationship Between Environment and Symptoms

Overactive Bladder – The Relationship Between Environment and Symptoms

Knowing More May Help Improve Behavioral Treatment Of Overactive Bladder Symptoms

Overactive bladder syndrome (OAB) is a widespread and problematic condition, especially among older patients. The resulting increased need to urinate and sleep interruption can be quite disturbing to patients.

Current methods of treatment include medications and/or behavioral intervention to improve urinary control. Of course, medications can be costly and have unpleasant side affects. What if behavioral treatments could be improved by knowing more about the environmental cues to urgency and leakage in patients with OAB? That’s the point of a pilot study summarized here.

Patients diagnosed with OAB were interviewed and asked whether they associated various cues with episodes of urinary urgency and leakage. In addition to environmental cues, they were asked about stress incontinence cues, interoceptive (mood or internal) cues, and improbable or “non-cues.” 1

Most respondents associated at least one environmental cue with urgency and leakage, respectively.

On average, 6 urgency-related and 4 leak-related environmental cues were reported. The most frequently reported environmental cues were: “on the way to the bathroom” (88%) “in cold weather” (76%) and “opening the front door” (71%).

While the authors note some limitations in this pilot study, they also reference a more extensive study that also associated environmental cues with bladder symptoms of urgency and incontinence. 2 The authors go on to suggest that, “If cues provoke bladder symptoms in the ways that conditioned stimuli lead to conditioned responses, then a Pavlovian conditioning paradigm may explain the development of some lower urinary tract symptoms.” 1

They also propose that new work on extinction of Pavlovian conditioning 3 might extend to treating urinary urgency and incontinence through stimulus control training. In conclusion, the authors recommend, “researchers include protocols for extinction of bladder responses or avoidance of conditioned stimuli for OAB treatment and prevention.”

1 Victor, E. O’Connell, K. and Blaivas, J. (2012). Environmental Cues to Urgency and Leakage Episodes in Patients With Overactive Bladder Syndrome. Journal of Wound, Ostomy and Continence Nursing. 39(2), 181-186.

2 Ghei, M. and Malone-Lee, J. (2005). Using the Circumstances of Symptom Experience to Assess the Severity of Urgency in Overactive Bladder. Journal of Urology. 174, 972-976.

3 Bouton, ME. (2004). Context and Behavioral Processes in Extinction. Learning & Memory. 11, 485-494.

For more information on how to care for your overactive bladder, see our article on foods that can help or hurt your bladder leakage –Healthy Bladder: Foods That Help or Irritate Your Overactive Bladder or for information on exercises that can help – What Are Pelvic Exercises?