Mindfulness and Transcranial Direct Current Stimulation (tDCS) to Attenuate Situational Urgency Urinary Incontinence (UUI): A randomized pilot study.

Introduction: Situational urgency urinary incontinence (UUI), triggered by situations such as approaching the front door and running water, accounts for up to half of all UUI episodes in women. We proposed a behavioral therapy to examine the independent and combined efficacy of mindfulness (MI) and transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex to attenuate reactivity to these scenarios and reduce UUI symptomatology. Methods: Women aged over 40 reporting regular situationally triggered UUI, with at least two leaks per week, completed a 5-session study with 1-week follow-up. Participants created personal urgency and safe (non-urgency) photographic cues and were randomized to either: MI (n=20), tDCS (n = 18), or MI+tDCS (n = 20) interventions conducted during exposure to personal urgency images over 4 sessions. Pre-post assessments of UUI via bladder diary and questionnaire, reactivity to urgency cues, and attentional bias on a UUI-focused modified Stroop task were collected. Results: Reactivity to personal cues was significantly reduced in all groups and attentional bias to toileting words was reduced in the MI+tDCS group. Number of leaks decreased in all groups between 0.81 (0.23) and 0.95 (0.23) episodes per day (p < 0.01). Daily urgency decreased significantly in the MI+tDCS group by 1.76 (0.47) episodes (p < 0.01). ICIQ-FLUTS score reduction was clinically meaningful at 1-week follow-up. The interventions demonstrated high feasibility and high rates of acceptability (>80/100) with participant compliance over 90% across groups. Conclusion: Mindfulness and tDCS offer promising non-invasive therapeutic benefit for reducing UUI symptoms in women with potential for easy dissemination and high adherence without additional pharmaceutical burden.