The effect of acute increase in urge to void on cognitive function in healthy adults

This one is in line for the Ig Nobel 2011 awards. And since most survivors have this great urge to void., you need to read up on the negative effects on memory and cognition. Your cognition and memory are not bad because of stroke damage it's because your bladder is full.
http://onlinelibrary.wiley.com/doi/10.1002/nau.20963/full

Aims

In healthy adults, voluntary inhibition of micturition is associated with an increasing sensation in the urge to void and pain, and acute pain has been associated with transient deterioration in aspects of cognitive function.

Methods

Eight healthy young adults consumed 250 ml of water every 15 min 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 postmicturition.

Results

Sensations of the urge to void and pain increased with time of inhibition of 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 (d > 0.8). These cognitive functions returned to normal levels after micturition.

Conclusion

The magnitude of decline in cognitive function associated with an extreme urge to void was as large and equivalent or greater than the cognitive deterioration observed for conditions known to be associated with increased accident risk. Neurourol. Urodynam. 30:183–187, 2011. © 2010 Wiley-Liss, Inc.

INTRODUCTION

The neural control of bladder function is complex and involves both spinal and supraspinal inhibitory and excitatory networks.1, 2 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.1 Although this process occurs automatically in healthy adults, micturition itself is under voluntary control so that it will occur only when deemed appropriate.3 The voluntary control of micturition means, that in healthy adults, urinary retention can occur beyond the normal threshold for voiding. For example, in some occupational settings, shift and task demands may make it impractical for individuals to void when the bladder is full, requiring active prolongation of the time to micturition.

In healthy adults, the retention of urine is associated with increased bladder pressure that can lead to sensations of pain.2 There are three distinct sensations associated with bladder filling. First, there is the sensation of filling itself; second, there is an experience of the urge to void; and third, there is a strong urge to void.2 Sensations of the urge to void and pain abate once voiding has occurred.4 Prolongation of the time to void beyond these phases gives rise to sensations of pain and increased sensation of urgency to void, however there is individual variation in the magnitude of the sensations and time of urge and the level of pain experienced.4 If the voluntary prolongation of time to void occurs often, there is an increased risk of developing obstructive uropathy and urinary tract infections.5 Further, in disorders of the lower urinary tract, sensations of pain and a sudden overpowering urge to void are common symptoms.6

It is well recognized that both acute pain and distraction arising from somatic signals can interfere with cognitive function in otherwise healthy adults.7, 8 There is also strong neurobiological evidence implicating common anterior cortical regions in the control of pain and aspects of cognitive function, such as attention and working memory (e.g.9, 10). Consequently, it is likely that pain and distraction associated with the voluntary retention of urine will also interfere with some aspects of cognitive functions. Pain has the ability to interrupt behavior and to continue to do so until the pain is attended to or removed.11 This is important as tasks requiring continuous and complex attention such as driving could be negatively affected if the magnitude of any effect on cognitive function from the voluntary inhibition of the urge to void is large. Thus, like low levels of alcohol intoxication or fatigue, inhibiting the urge to void in occupational settings could increase the risk of accidents.

Currently there are no data available on the cognitive effects of voluntary inhibition of the urge to void. Under experimental control and using standardized cognitive tasks, it is possible to examine the effect and magnitude of an increasing sense of urgency to void on cognition. By comparing cognitive outcomes under these conditions with cognitive performance using the same tools under other conditions that are known to increase accident risk, such as an elevated blood alcohol concentration (BAC) or fatigue, the magnitude of the risk can be placed in context. This approach would provide a useful first step in an examination designed to understand the relationship between voluntary urinary retention and accident risk.

This study has been developed as a pilot to measure the effect of an increasing urge to void urine on cognitive function. The first hypothesis was that the self rated level of pain and urge to void would be positively associated as participants drank a volume of water designed to stimulate a need to void. The second hypothesis was that cognitive function would decline as the length of time of voluntary urinary retention and the associated pain increased. The third hypothesis was that cognitive function would return to baseline levels following micturition.

METHODS