Could mind/body medicine alleviate incontinence? Quite possibly, at least for some among the one in 11 adults who suffer from overactive bladder.

Researchers at Loyola University Health System studied whether cognitive therapy is helpful to women with “urge incontinence,” also known as overactive bladder. Fourteen women who had been diagnosed with this condition attended an educational session that explained how cognitive therapy might help their problem, then listened to a 15-minute recording describing a set of relaxation and visualization exercises that they were to do at home twice a day for two weeks.

These visualization exercises involved imagining a powerful connection between the brain and the bladder, specifically that the brain is “in charge of giving the bladder permission to urinate” when it is socially convenient. When they receive urgent messages from their bladder to urinate, patients focus on this strong connection — picturing the presence of a white light traveling or a sensation of warmth emanating from the brain, down the spine, to the bladder (or whatever imagery the patient finds works for him/her). Patients recorded the number of incontinence episodes in a pre- and post-therapy diary. Published in a supplement to the April 28, 2009, issue of The Journal of Urology, the study showed that the average number of urge incontinence incidents per week decreased from 35 to 13, while “dry time” increased from 38 to 81 hours a week. The researchers concluded that cognitive therapy appears to be a simple treatment for treating overactive bladder.


Urge incontinence occurs when the muscles in the bladder wall become overactive, involuntarily contracting more often than normal, while the brain may exert less control than previously. “When the brain gets messages from the bladder, it normally has the power to defer urinating until you’re in the bathroom,” says Shameem Abbasy, MD, a urogynecologist fellow at Loyola University Health System and coauthor of the study. “In people with urge incontinence, that connection between brain and bladder has gotten lost.”

Whereas most current treatments, such as medications, an implanted bladder pacemaker and botox injections, all come with some kind of risk or side effect, cognitive therapy is totally safe, inexpensive and risk-free. Cognitive therapy works at the level of the brain and offers patients a way to manage their own health. “The bladder becomes more relaxed, and patients have more control. Instead of panicking when they get the urge to go, they learn to tell themselves, ‘I am in control of when I urinate, and I have plenty of time to get to the bathroom,’ ” says Dr. Abbasy. He points out that though urge incontinence occurs more often in older people, it is not just a normal part of aging. With a little training, adults of all ages can be free again.