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The relationship between cognition and sensation in determining when and where to void: the concept of cognitive voiding

Lookup NU author(s): Dr Joan Harvey, Professor James Gillespie


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OBJECTIVE To investigate the inter-relationship between conscious decision-making processes and bladder sensation in determining the need, time and place to void SUBJECTS AND METHODS The approach used interview focus groups and qualitative thematic analysis. In this preliminary study, 25 women were included (aged 2190 years) meeting in groups of one to five on four occasions. RESULTS The thematic analysis yielded six themes: temporal and cognitive maps, risk issues, habituation and opportunistic behaviour and awareness of the bladder. For most voids, the decision to void was not based on sensation but determined by multiple factors: personal knowledge of time of last void, anticipated time to next void, proximity of toilets, a risk assessment or habituated behaviour. As the bladder filled the subjects described an increasing awareness of their bladder. Such sensations were not immediately associated with desire to void. Rather, these sensations were described as influencing the cognitive processes of considering when and where to void. A sub-group of subjects reported little awareness as their bladder filled, experiencing only sudden strong sensations that needed immediate action for fear of leakage. CONCLUSIONS The decision to void is primarily a cognitive process influenced by multiple elements of which bladder awareness is only one. Mechanisms generating awareness may be intensified or lost reflecting possible different pathological states. The importance of these observations in relation to current views of normal and abnormal voiding is discussed.

Publication metadata

Author(s): Gillespie J; Harvey J; Finney S; Stewart L

Publication type: Article

Publication status: Published

Journal: BJU International

Year: 2012

Volume: 110

Issue: 11

Pages: 1756-1761

Print publication date: 29/05/2012

ISSN (print): 1464-4096

ISSN (electronic): 1464-410X

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/j.1464-410X.2012.11078.x


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