Editor's Commentary - The effect of acute increase in urge to void on cognitive function in healthy adults

BERKELEY, CA (UroToday.com) -

Acute Increase in Urge Shown to Affect Cognitive Function

Functionally, the urinary system acts in a straightforward manner whereby the bladder fills to a threshold and then an urge to void is initiated with micturition occurring soon thereafter. In healthy adults, the retention of urine is associated with increased bladder pressure that can lead to sensations of pain. There are three distinct sensations associated with bladder filling. The sensation of filling is followed by an experience of the urge to void, followed by a strong urge to void. The urge to void and pain abate with micturition. Prolongation of the time to void beyond these phases gives rise to sensations of pain and increased sensation of urgency to void, as anyone with IC/BPS knows only too well.

If the symptoms of IC/BPS are an exaggeration of the normal urge and discomfort with a “full” bladder that results in micturition, then the findings of Lewis and colleagues from Melbourne, Australia and Connecticut and Rhode Island deserve a careful look. Acute pain and distraction arising from somatic signals can interfere with cognitive function in otherwise healthy adults. The authors note that common anterior cortical regions in the control of pain and aspects of cognitive function, such as attention and working memory. Currently there are no data available on the cognitive effects of voluntary inhibition of the urge to void.

Lewis and coworkers had 8 healthy young adults consume 250ml of water every 15 minutes until they could no longer inhibit voiding. Performance on standardized measures of cognitive function was measured at hourly intervals which were classified as baseline, when individuals reported an increase in the urge to void, a strong increase in the urge to void, an extreme increase in the urge to void, and post micturition. They found that sensations of the urge to void and pain increased with time of inhibition of the urge to void and with amount of water consumed. Having an extreme urge to void exerted a large negative effect on attentional and working memory functions. The magnitude of deterioration associated with the extreme urge to void was equivalent to that observed in adults with a blood alcohol level of 0.05% or that observed after 24 hours of sustained wakefulness.

I found this study to be very interesting. If you combine the repeated severe urge and pelvic pain seen in some patients with IC/BPS with lack of sleep from nocturia, one could anticipate similar cognitive impairment during acute exacerbations of the disorder. Further work on this aspect could be illuminating.

Lewis MS, Snyder PJ, Pietrzak RH, Darby D, Feldman RA, Maruff P

Neurourol Urodyn. 2011 Jan;30(1):183-7.
10.1002/nau.20963

PubMed Abstract
PMID: 21058363

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