Urge Incontinence

If you have a sudden need to urinate - and you involuntarily leak wherever and whenever - you may have urge incontinence. The condition isn't a disease, but it may be a sign that there is an underlying problem.

While urge incontinence is sometimes referred to as "overactive bladder," that condition is slightly different; people with an overactive bladder feel an urge to urinate but don't necessarily leak urine.

What Causes Urge Incontinence?

Urge incontinence is caused by abnormal bladder contractions. Normally, strong muscles called sphincters control the flow of urine from the bladder. With urge incontinence, the muscles of an "overactive" bladder contract with enough force to override the sphincter muscles of the urethra, which is the tube that takes urine out of the body.

The bladder may experience abnormal contractions for the following reasons:

• The bladder may not be functioning properly because its nerves are damaged by various diseases -- for example, diabetes, stroke, multiple sclerosis, or Parkinson's disease.
• The spinal cord may be damaged.
• The bladder may be irritated.

In many cases, the cause of urge incontinence cannot be identified.

What Are the Symptoms of Urge Incontinence?

The main symptom of urge incontinence is the sudden urge to urinate and the involuntary loss of urine at inappropriate times. For instance, you may leak urine in public or while you are sleeping.

What Are the Risk Factors for Urge Incontinence?

People at greater risk for urge incontinence include:

• Older adults
• Women who have had a C-section or other pelvic surgery
• People who are obese
• Men who have had prostate surgery or prostate conditions, such as enlarged prostate or prostatitis
• People who have nerve damage from conditions such as diabetes, stroke, or injury
• People with certain cancers, including the bladder and prostate
• People who are suffering from urinary tract infections

Being constipated may also put you at risk for urge incontinence.

How Is Urge Incontinence Treated?

Urge incontinence can be treated with a variety of behavioral treatments, medications, electrical stimulation, or with surgery. Sometimes a combination of treatments is used.

Behavioral Treatments for Urge Incontinence

One way of dealing with urge incontinence is to simply change some of your behaviors. For instance, if you can anticipate when your bladder is overactive and may be contracting abnormally, you can take action to avoid any mishaps or urine leakage.

Here are some techniques that may be helpful:

Two biofeedback techniques are timed voiding and bladder training. To practice timed voiding, you use a chart to record the times that you urinate and when you leak urine. This will give you an idea of your leakage "patterns." Then you can avoid leaking in the future by going to the bathroom at those times.

With bladder training, you "stretch out" the intervals at which you go to the bathroom. You do this by waiting a little longer before you go. For instance, to start, you can plan to go to the bathroom once an hour. You follow this pattern for a period of time, and then you change the schedule so that you are going to the bathroom every 90 minutes. Then eventually, you lengthen the interval to every two hours, and so on, until you are up to three or four hours between bathroom visits.

To do Kegel exercises, pretend you are trying to stop the flow of urine (although not when you are urinating, as this may hurt the bladder muscle) or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor. While doing these exercises, try not to move your leg, buttock, or abdominal muscles. In fact, no one should be able to tell that you are doing Kegel exercises.

Kegel exercises should be done every day, five sets a day. Each time you contract the muscles of the pelvic floor, hold for a slow count of five and then relax. Repeat this 10 times for one set of Kegels.

Other behavioral tips for preventing urge incontinence include:

• going to the bathroom on a regular basis, especially before physical activity
• avoiding drinking caffeine or a lot of fluids before activities
• not drinking any fluids right before you go to bed
• avoiding lifting heavy objects
• losing weight

Medical and Surgical Treatments for Urge Incontinence

If behavioral modifications such as timed voiding and bladder training do not improve the symptoms of urge incontinence, your doctor may decide to try various medical or surgical treatments. These methods have the same goal -- relief of the symptoms and inconvenience of urge incontinence.

Medical treatments for urge incontinence include:

Darifenacin (Enablex)

Fesoterodine (Toviaz)

Mirabegron (Myrbetriq)

Oxybutynin (Ditropan, Ditropan XL, Gelnique, Oxytrol)

Solifenacin (Vesicare)

Tolterodine (Detrol, Detrol LA)

Trospium (Sanctura)

Oxytrol for women is the only drug available over the counter.

Your health care provider may also recommend other medications that may help control bladder spasms. They include hyoscyamine (Anaspaz, Cystospaz, Hyosol, Hyospaz, Levbid, Levsin) or dicyclomine (Antispas, Bentyl, Byclomine, Di-Spaz, Dibent, Or-Tyl, Spasmoject).

If behavioral treatments and medications do not help, other options for treatment include:

The drug Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity and reducing episodes of leakage. It can be used in adults that do not respond to or cannot use other medications that treat overactive bladder.

Another drug treatment that may be helpful for some women is hormone therapy, which uses estrogen alone or in combination with progesterone. However, evidence of benefit for urge incontinence has been mixed. In addition, because of the possible risks of hormone therapy -- including a potential increased risk of blood clots and breast cancer -- you should discuss this therapy with your doctor.

Sacral nerve stimulation: An electronic device is implanted in the back through a minimally invasive procedure. The device delivers an electric signal to the sacral nerve. This signal helps to control the bladder muscles and decrease the number of abnormal contractions.

Percutaneous Tibial Nerve Stimulation: An electric current is applied to the tibial nerve in the region of the patient's ankle. This nerve is thought to affect bladder contraction.

Another technique is to use small electrodes placed in either the vagina or the rectum. The electrodes produce electric pulses that cause contraction of the muscles of the pelvis and the urethra. This strengthens these muscles to help reduce the incidence of urge incontinence.

Surgical procedures for urge incontinence include:

• increasing the storage capacity of the bladder
• limiting nerve impulses to the control muscles
• diverting the flow of urine

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