Monday, January 28, 2013

To Pee, or Not to Pee? That is the Question...

To Pee, or Not to Pee? That is the Question...

A look into why really needing to pee really messes with your head. 
By Camille Longmore  

Who hasn’t been in class and ALL you can think of as you sit there squirming impatiently is how much you need to pee?? All class lessons fly right over your head as you simply can’t THINK, focusing exclusively on the acute pain in your lower abdomen, and you sit there cursing your damn small bladder.  Why can’t you just forget the feeling and focus??

Well, now science can explain your frustration.  A study released in 2011 (and, might I add, a winner of the ultra-prestigious IG Nobel prize!) by Lewis et al. found a significant correlation between decreased cognitive function and increased urge to “void.” Lewis himself and seven of his friends undertook the task of drinking, a LOT (of water, they did take this semi-seriously), and measuring their level of “void urgency,” as well as pain, every fifteen minutes. At one-hour intervals everyone took standardized tests to measure the effect of increasingly needing-to-go on speed of decision-making and memory. This continued until they reached the point of “extreme urge,” or when they just couldn’t hold it anymore, at which time they fled to the bathroom, and then they took the tests again.  As the urge got worse, the pain got worse, and, interestingly, speed of decision-making got worse (I personally pictured more being snappy whilst squirming). Memory was also negatively affected; the stronger the need to pee, the more the adults were unable to remember what they had just seen. As soon as their bladders were emptied, however, cognitive levels went right back to normal (and so did pain level- whew! Don’t we wish every physical pain could be relieved so easily!). Also, accuracy was not affected in any test; it just took longer to get the right answer. Presumably, they were a little side tracked by the insane discomfort caused by an overflowing bladder.

So we know that really, really needing to go can elicit some short-term mental disabilities. The question we now have to pose is, why?  The vital sensation here is pain. It has been well established that acute pain can interfere with cognitive function (Crombez et al., 1996), and it turns out there is a neurophysiological basis to this. The control of pain and certain aspects of cognitive functional abilities (such as memory and decision making) occur in a common region of the brain, called the anterior cingulate cortex, or ACC (Bantick et al., 2002, Blok et al., 1997).  When studies paired physical pain with attention demanding cognitive tasks and examined the brain by use of an MRI, the tasks increased the signal intensity in the ACC that was present from just pain alone (Davis et al., 1997).

The Anterior cingulate cortex is the site of pain registration as well as decision
 making and memory. 

One has to also wonder about the benefits of this pain associated with an intense urge to urinate. An obvious explanation is the increased risk of developing urinary tract infections if one often refrains from satiating this visceral desire. Are there benefits to be gained by keeping a full bladder? After all, though the urinary system’s process occurs automatically in our bodies, this ends at the bladder; after that, it is primarily up to a conscious decision on our parts to relieve ourselves. Well it turns out if we hold it, we could gain some self-control! Another study found that with high “bladder pressure,” one is more likely to choose a more long-term (but greater) reward over an immediate (lesser) reward option (Tuk et al., 2011). This finding was curious because studies show that other visceral drives often have the opposite effect on people. For example, a hungry person is more likely to buy more unhealthy food, or a sexually aroused person is more likely to engage in unsafe sex even if aware of the potential consequences (Loewenstein, 1996, Ariely and Loewenstein, 2006).  Studies have indeed demonstrated, however, that when the ACC is active, people tend to make fewer errors in a task that involved monetary reward (Gehring et al., 1993), and pain, we’ve found, makes it active. I wonder if, considering we all know how much alcohol makes us need to pee, this prudent resistance to immediate monetary indulgence could balance the often alcohol-induced poor decision-making at casinos?? Increased self-control could also maybe counteract some other alcohol-induced poor decision-making-- at bars for example....

So, in sum: If you let your bladder get really full, to the point where it HURTS… you’ll take forever to decide something, but you’ll make an accurate, and “wise” decision… buuuut then you might not remember what you decided. I personally don’t know if the benefits outweigh the costs here… and for the sake of my urinary tract health as well as my sanity, I think I’d rather just pee and feel better.

Take home lesson to be learned from all of this: to be able to LEARN your lessons (and remember them), visit the restroom before class! But maybe keep a full bladder at the bars, ladies J

By the way… if you’re interested in Lewis’s atypical study, here’s a video of one of the authors, Peter Synder, explaining it. Enjoy!

Literature Cited

Ariely, D., and G Loewenstein. 2006. The heat of the moment: The effect of sexual arousal on sexual decision making. Journal of Behavioral Decision Making 19: 87-98.

Bantick S.J., R.G. Wise, A. Ploghaus et al. 2002. Imaging how attention modulates pain in humans using functional MRI. Brain 125:310-319.

Blok B.F., A.T. Willemsen, G. Holstege. 1997. A PET study on brain control of micturition in humans. Brain 120:111-121.

Crombez G., C. Eccleston, F. Baeyens, et al. 1996. The disruptive nature of pain: An experimental investigation. Behavior Research and Therapy 34:911-918.

Davis, K.D., S.J. Taylor, A.P. Crawley, M.L. Wood, and D.J. Mikulis. 1997. Functional MRI of pain- and attention-related activations in the human cingulate cortex. Journal of Neurophysiology 77:3370–3380.

Gehring W.J., B. Goss, M.G.H. Coles, D.E. Meyer, E. Donchin. 1993.  A Neural system for error detection and compensation. Psychological Science 4 (6): 385–90. 

Lewis MS, P.J. Snyder, R.H. Pietrzak, D. Darby, R.A. Feldman and P. Maruff. 2011. The effect of acute increase in urge to void on cognitive function in healthy adults. Neurourology and Urodynamics 30 (1): 183-7.

Lowenstein, G. 1996. Out of control: Visceral influences on behavior. Organizational Behavior and Human Decision Processes 65: 272-292. 

Tuk M.A., D. Trampe and L. Warlop. 2011. Inhibitory spillover: increased urination urgency facilitates impulse control in unrelated domains. Psychological Science 22 (5): 627-33


  1. It would be interesting to see if other sources of pain would elicit similar decision making abilities

  2. I can definitely relate to this...I can never focus on anything when I really have to pee! It seems strange that the accuracy of people's answers were not affected in the study, since their memory was affected. It seems like one would affect the other quite a lot!