The neurological basis for this conditioning was explored in a previous study by Dr. Clarkson and Dr. Conklin. Using MRI technology, they monitored the brain activity of participants as they were shown images of their own front doors or other personal triggers, alongside "safe" images that did not evoke urgency. The results were striking: when participants viewed their specific urgency-related triggers, a part of the brain known as the dorsolateral prefrontal cortex showed significantly higher levels of activity.
The prefrontal cortex is often described as the seat of cognitive control and executive function. In the context of bladder health, it acts as the executive center that processes signals and decides whether it is appropriate to act on them. It is the part of the brain that tells you, "It’s time to go," or conversely, "You can wait; find a bathroom first." In individuals with latchkey incontinence, this "control center" becomes hyper-reactive to environmental cues, essentially misfiring and triggering a sense of urgency at the wrong time.
Based on these findings, the researchers hypothesized that if they could help individuals better regulate the activity in this part of the brain, they could improve their ability to control their bladder responses. They proposed two methods for doing so: mindfulness and transcranial direct current stimulation (tDCS). The tDCS technique is a non-invasive method that uses a weak electrical current to stimulate specific areas of the brain—in this case, the prefrontal cortex—to enhance cognitive control.
The pilot study recruited 61 women over the age of 40, all of whom reported regular episodes of situationally triggered bladder leaks. These participants were randomly assigned to one of three intervention groups. The first group listened to a 20-minute mindfulness exercise while viewing photos of their personal triggers. The second group received tDCS stimulation while viewing the photos. The third group received both the mindfulness exercise and the brain stimulation simultaneously.
The mindfulness component of the study was specifically designed by co-author Dr. Carol Greco, an associate professor of psychiatry and physical therapy at Pitt. While it shared similarities with a traditional "body scan"—a practice where an individual systematically focuses their attention on different parts of their body to foster awareness and relaxation—this version was uniquely tailored for incontinence. It included specific acknowledgments of bladder sensations, teaching participants to observe the feeling of urgency without reacting to it with panic or immediate physical contraction. By bringing non-judgmental attention to the bladder, the goal was to decouple the environmental trigger from the frantic physical response.
The intervention was intensive but brief, consisting of four in-office sessions conducted over the course of five to six days. Despite the lack of a traditional control group—a common feature of pilot studies designed to test feasibility and initial efficacy—the results were highly encouraging. Participants across all three groups reported a significant reduction in the intensity of urgency when viewing their trigger photos. Furthermore, the women reported a decrease in the actual number of urgency episodes and leaks in their daily lives following the sessions.
