LAUSR

BACKGROUND Prior study of patients with urgency urinary incontinence by functional magnetic resonance imaging showed altered function in areas of the brain associated with interoception and salience and with attention. Our randomized controlled trial of hypnotherapy for urgency urinary incontinence demonstrated marked improvement in urgency urinary incontinence symptoms at two months. A sub-sample of these urgency urinary incontinent women underwent functional magnetic resonance imaging before and after treatment. OBJECTIVE To determine if hypnotherapy treatment of urgency urinary incontinence compared to pharmacotherapy was associated with altered brain activation or resting connectivity on functional Magnetic Resonance Imaging. STUDY DESIGN A sub-sample of women participating in a randomized control trial comparing hypnotherapy versus pharmacotherapy for treatment of urgency urinary incontinence was evaluated with functional magnetic resonance imaging. Scans were obtained pretreatment and 8-12 weeks after treatment initiation. Brain activation during bladder-filling and resting functional connectivity with an empty and partially filled bladder were assessed. Brain regions of interest were derived from those previously showing differences between healthy controls and untreated urgency urinary incontinence participants in our prior work, and included regions in the interoceptive and salience, ventral attentional and dorsal attentional networks. RESULTS Following treatment, participants in both groups demonstrated marked improvement in incontinence episodes (p < .001). Bladder filling task functional magnetic resonance imaging data from the combined groups (n=64, 30 Hypnotherapy, 34 Pharmacotherapy) demonstrated decreased activation of the left temporoparietal junction, a component of the ventral attentional network (p<.01) compared to baseline. Resting functional connectivity differed only with the bladder partially filled (n = 54). Compared to pharmacotherapy, hypnotherapy participants manifested increased functional connectivity between the anterior cingulate cortex and the left dorsolateral prefrontal cortex, a component of the dorsal attentional network (p<.001). CONCLUSIONS Successful treatment of urgency urinary incontinence with both pharmacotherapy and hypnotherapy was associated with decreased activation of the ventral (bottom up) attentional network during bladder filling. This may be attributable to decreased afferent stimuli arising from the bladder in the pharmacotherapy group. In contrast, decreased ventral attentional network activation associated with hypnotherapy may be mediated by the counterbalancing effects of the dorsal (top down) attentional network.