Overview Of Urge Incontinence
Urge Incontinence occurs when you have a sudden need to urinate in which the bladder then squeezes, or spasms, leading you to leak urine.
Commonly Associated With
Detrusor instability; Overactive bladder; Spasmodic bladder; Irritable bladder; Unstable bladder; Bladder spasms; Detrusor hyperreflexia;
Causes Of Urge Incontinence
Your bladder stretches to make room for urine from the kidneys and the urge to urinate comes when there is a about 240 milliliters (1 cup) of urine in your bladder. Most people can hold over 480 milliliters (2 cups) of urine in their bladder.
Two muscles help prevent the urine flow:
- The sphincter muscle around the opening of the bladder which squeezes to prevent urine from leaking into the urethra.
- The bladder wall muscle which relaxes so the bladder can expand and hold urine.
During urination, bladder wall muscles squeeze to force urine out and as this happens, the sphincter muscle relaxes to allow the flow of urine.
These systems must work together to control urination:
- Bladder muscles and other parts of the urinary tract
- Nerves controlling your urinary system
- Your ability to feel and respond to the urge to urinate
- Nervous system problems or bladder irritation may contract too often from .
With urge incontinence, you leak turning because bladder muscles contract at the wrong times.
These contractions often occur no matter how much urine is in the bladder.
In most cases of urge incontinence, no cause can be found but it may result from:
- Bladder cancer
- Infection
- Bladder inflammation
- Something blocking urine from leaving the bladder
- Brain or nerve problems, such as stroke or multiple sclerosis
- Bladder stones
- Nerve injury
For men, urge incontinence may be due to:
- Bladder changes caused by an enlarged prostate (benign prostatic hyperplasia)
- An enlarged prostate blocking urine flow
Urge incontinence is more common in women and older adults although it can occur at any age.
Symptoms Of Urge Incontinence
Symptoms include:
- Inability to control when you pass urine
- Urinating often both during the day and night
- A sudden need to urinate
Exams & Tests
Your health care provider will examine your belly and rectum.
Women are given a pelvic exam whilst men are taken through a genital exam. The physical exam will not find any problems most of the time.
Other problems may be found if there are nervous system causes.
Tests include:
- Cystoscopy to assess the inside of your bladder.
- Pad tests (a pad is worn to collect leaked urine then the pad is weighed to find out how much urine you lost).
- Abdominal or pelvic ultrasound.
- Uroflow study to check how much and how fast you urinate.
- Post void residual to measure the urine left in your bladder after urination.
- Urinalysis to check urine for blood.
- Urine culture to check for infection.
- Urinary stress test (standing with a full bladder and coughing).
- Urine cytology (to rule out the possibility of bladder cancer).
- Urodynamic studies to measure urine flow and pressure.
- X-rays with contrast dye to check kidneys and bladder.
- Voiding diary to assess fluid intake, urine output, and urination frequency.
Treatment Of Urge Incontinence
Treatment of Urge Incontinence depends on how bad symptoms are and how they affect daily living.
There are four main approaches to treating urge incontinence:
- Bladder and pelvic floor muscle training
- Medication
- Lifestyle changes
- Surgery
Bladder Retraining
Managing urge incontinence often begins with bladder retraining because this helps you become aware of when you lose urine because of bladder spasms.
You then relearn the skills you need to hold and release urine.
You can also set a schedule of times when you should try to urinate and try to avoid urination between these periods.
Another method is to force yourself to wait 30 minutes between trips to the bathroom, ignoring the urge to urinate in between these times.
As you become better at waiting, gradually increase the waiting time by 15 minutes until you are urinating every 3 to 4 hours.
Pelvic Floor Muscle Training
Sometimes, Kegel exercises, biofeedback, or electrical stimulation may be used with bladder retraining.
These methods help strengthen the muscles of your pelvic floor:
Kegel exercises — Though mainly used to treat people with stress incontinence, they may also help relieve urge incontinence symptoms.
- You squeeze your pelvic floor muscles like you are trying to stop urine flow.
- Do this for 3 to 5 seconds and then relax for 5 seconds.
- Repeat this 10 times, 3 times daily.
Vaginal cones — This is a weighted cone inserted into the vagina to strengthen the pelvic floor muscles.
- You place the cone into the vagina.
- Try to squeeze pelvic floor muscles to hold the cone in place.
- You can wear the cone for up to 15 minutes at a time, 2 times daily.
Biofeedback — This can help you identify and control your pelvic floor muscles.
- A sensor is placed in the vagina (for women) or the anus (for men) to tell when they are squeezing pelvic floor muscles.
- A monitor displays a graph showing which muscles are squeezing.
- The therapist can then help find the right muscles for performing Kegel exercises.
Electrical stimulation — This uses a gentle electrical current to contract bladder muscles. The current is delivered with an anal or vaginal probe and can be done at the provider’s office or at home.
Treatment sessions usually last 20 minutes and can be done every 1 to 4 days.
Percutaneous tibial nerve stimulation (PTNS) — This treatment may help people with overactive bladder.
- An acupuncture needle is placed behind the ankle for 30 minutes of electrical stimulation.
- Treatments mostly will occur weekly for around 12 weeks, and perhaps monthly after that.
Lifestyle changes
- Pay attention to how much and when you drink water.
- Drink less than 8 ounces (240 milliliters) of water at a time so your bladder does not need to handle large amounts of urine at one time.
- Do not drink large amounts of fluids when eating.
- Sip small amounts of fluids between meals.
- Stop drinking fluids about 2 hours before bedtime.
It also may help to cut out foods or drinks that may irritate the bladder, such as:
- Caffeine
- Acidic foods like citrus fruits and juices
- Alcohol
- Spicy foods
- Artificial sweeteners
Also, avoid activities that irritate the urethra and bladder such as taking bubble baths or using harsh soaps.
Medicines
Medicines are used to treat urge incontinence, relax bladder contractions, as well as help, improve bladder function.
Several types of medication may be used:
- Anticholinergic medicines tp help relax the muscles of the bladder. Examples are oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (VESIcare).
- Beta agonist drugs to help relax the muscles of the bladder. Mirabegron (Myrbetriq) is the only medicine of this type.
- Flavoxate (Urispas), a drug that calms muscle spasms. Studies have shown that it is not always effective.
- Tricyclic antidepressants (imipramine) to help relax the smooth bladder muscle.
- Botox injections are commonly used to treat overactive bladders.
These treatments may result in side effects such as constipation, dizziness or dry mouth. Consult your provider if you notice bothersome side effects.
Your provider will prescribe antibiotics if you have an infection.
Surgery
Surgery can relieve pressure and help a bladder store more urine for people who do not respond to or who have side effects associated with medication.
A small unit can be implanted under your skin with sacral nerve stimulation to send small electrical pulses to the sacral nerve (one of the nerves that come out at the base of your spine).
Electrical pulses are adjusted to help relieve your symptoms.
Augmentation cystoplasty can be performed as a last resort for severe urge incontinence.
Part of the bowel is added to the bladder with this surgery to increase bladder size and allows it to store more urine.
Possible complications include:
- Blood clots
- Bowel blockage
- Slightly increased risk of tumors
- Infection
- Inability to empty your bladder
- Urinary tract infection
