Environmental Cues to Urgency and Leakage Episodes in Patients With Overactive Bladder Syndrome - A Pilot Study

Sep 7, 2026

Study objectives focused on quantifying how frequently environmental cues, conceptualized as Pavlovian-conditioned stimuli, coincide with urgency and leakage symptoms in patients with overactive bladder syndrome (OAB). A convenience sample of 17 adults diagnosed with OAB participated in semistructured interviews addressing interoceptive and environmental cues linked to urinary urgency and leakage. Most respondents reported at least one relevant cue, with multiple cues averaging across urgency and leakage. Findings support a Pavlovian conditioning role in OAB symptoms and suggest that treatment may benefit from Pavlovian extinction procedures.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Overactive bladder syndrome overview

Pavlovian conditioning and latchkey incontinence

Prior related study and rationale

Methods

Participants and recruitment

Interview procedures

J Wound Ostomy Continence Nurs. 2012;39(2):181-186 . Published by Lippincott Williams & Wilkins CONTINENCE CARE Environmental Cues to Urgency and Leakage Episodes in Patients With Overactive Bladder Syndrome A Pilot Study Elizabeth Victor 􀀂 Kathleen A. O’Connell 􀀂 Jerry G. Blaivas PURPOSE: To assess the frequency with which environmental cues, which might constitute Pavlovian-conditioned stimuli, occur with urgency and leakage symptoms associated with overactive bladder syndrome (OAB) . SUBJECTS AND SETTINGS: The sample group comprised 17 adults (13 women and 4 men); their median age was 74.71 years. METHODS: A semistructured interview was conducted with a convenience sample of 17 patients diagnosed with OAB. Patients were interviewed about interoceptive and environmental cues they related to instances of urinary urgency and leakage. Interviews persisted for 6.11 to 59.38 minutes (M 􀀂 21.86 minutes) and were conducted by an interviewer who was trained to administer the interview guide. RESULTS: Most respondents associated at least 1 environmental cue with urgency and leakage, respectively. A mean of 6.1 urgency-related and 4.0 leak-related environmental cues were reported. The most commonly reported environmental cues were “on my way to the bathroom” reported by 88% and“opening the front door of my home” reported by 71% . CONCLUSION: These ﬁndings support the hypothesis that Pavlovian conditioning plays a role in OAB symptoms and suggest that treatment might be enhanced by inclusion of Pavlovian extinction procedures. ■ Introduction Overactive bladder syndrome (OAB) is a highly prevalent condition1 that the International Continence Society deﬁnes as a symptom syndrome characterized by urinary urgency that occurs with or without urgency urinary incontinence, and is usually associated with voiding frequency and nocturia.2 The condition is often reported tobe bothersome3 and costly to society1 and to negatively affect quality of life.4 Overactive bladder syndrome is usually treated with antimuscarinic medications5 and/or behavioral interventions aimed at providing patients with improved urinary control skills.6,7 While these treatments have proven effective for some OAB symptoms,8 pharmacological treatments are costly and have adverse side effects, and behavioral treatments may not adequately relieve all bothersome symptoms.9 The purpose of this study was to investigate the extent to which environmental cues are related to OAB symptoms. The cue that is most often mentioned is an individual’s front door. Referred to as “latchkey incontinence,”this is a loss of urine that occurs when one arrives home and puts the key in the lock of one’s front door. While latchkey incontinence is frequently described in publications and consumer Web sites about incontinence,10 the etiology of this symptom is rarely recognized. Like Pavlov’s classic experiment leading a dog to salivate to the sound of a bell, latchkey incontinence is an example of a conditioned response. Frequent concurrence of immediate urination with arriving home leads to a conditioned response of a strong urge to urinate and, at times, actual loss of urine upon arriving home. Pavlovian conditioning (formerly called classical conditioning) has been found to underlie a wide range of responses, from drug tolerance to emotional reactions.11,12 We identiﬁed 1 study that speciﬁcally addressed environmental stimuli associated with bladder symptoms of urgency and incontinence. Ghei and Malone-Lee13 used responses to 4 environmental cues (“latchkey,” waking/ 􀀂 Elizabeth Victor, MA, Graduate Student, Clinical Psychology, Teachers College, Columbia University, New York 􀀂 Kathleen A. O’Connell, PhD, RN, Professor of Nursing Education, Teachers College, Columbia University, New York. 􀀂 Jerry G. Blaivas, MD, Clinical Professor of Urology, Weill Medical College, Cornell University, and Adjunct Professor of Urology, SUNY Downstate College of Medicine, Brooklyn, New

FAQs

What is the purpose of this pilot study?

The study evaluates how often environmental cues occur with urgency and leakage symptoms in patients with overactive bladder syndrome, treating these cues as possible Pavlovian-conditioned stimuli.

How were participants and data collected?

A convenience sample of 17 adults diagnosed with OAB completed semistructured interviews about interoceptive and environmental cues associated with urinary urgency and leakage, lasting about 6 to 59 minutes.

What were the main findings about environmental cues?

Most respondents linked at least one environmental cue to both urgency and leakage. The most frequently reported cues were going on the way to the bathroom and opening the front door of the home.

How do the results inform treatment approaches?

The results support a Pavlovian conditioning contribution to OAB symptoms and suggest enhancing treatment by including Pavlovian extinction procedures through stimulus control training.

Sep 7, 2026

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