Urge incontinence or overactive bladder, is a condition involving bladder storage and urine control. There is a sudden and frequent uncontrollable need to urinate. Urine leakage may accompany these urges.
Urge incontinence may cause isolation due to social embarrassment or impairment from working due to the frequency of bathroom visits. It may also cause chronic fatigue from frequent nighttime bathroom visits. Overactive bladder is not a normal condition of aging and may signal a more serious underlying medical problem that should be further investigated. Read more in our urge incontinence patient education guide.
Written by Barbara Hales, M.D.Show All
Doctors Who Treat Urge Incontinence
Patients generally consult with the physicians that they have a current medical relationship with, including:
- Internists — physicians who focus on prevention, diagnosis, and treatment of adult illnesses
- General practitioners — doctors who deal with prevention, diagnosis, and treatment of medical problems in all age groups
- Gerontologists — doctors who specialize in senior and elder medicine
- Gynecologists — doctors who specialize in maintaining and treating women’s health
You may be referred to a specialist for further workup and treatment of your overactive bladder. Specialists include:
- Urologists — doctors who specialize in the health, diagnosis, and treatment (both medical and surgical) of the urinary tract
- Urogynecologists — doctors with a surgical sub-specialty of urology and gynecology
How to Prepare for Your Doctor Visit for Urge Incontinence
The first step to prepare for your consultation about urge incontinence is to maintain a bladder diary for a week. This is a record of:
- Volume and types of fluids consumed over a 24-hour period
- Any urges to urinate
- When you urinate
- Any incontinence (involuntary loss of urine) with urgency, coughing, sneezing, or laughing
- What activities improve the symptoms
- What activities intensify the symptoms
When going to the doctor’s office, bring:
- Bladder diary
- List of all medications
- Record of prior medical history including surgery and dates
- Questions that you have prepared for the doctor
Questions to Ask Your Doctor about Urge Incontinence
From your initial diagnosis throughout treatment and care, you will have questions about your condition. This urge incontinence patient education guide lists questions to discuss with the doctor so you can make informed decisions about your condition and care.
Questions About My Diagnosis
- Could my symptoms be indicative of another problem (i.e. hormonal or structural problem)?
- Could my symptoms be caused by certain foods or beverages?
- What kinds of tests confirm the diagnosis?
- Are there brochures or forums that I can reference about the condition?
- Is this problem short-term or life-long?
- Will my symptoms get worse? Does stress worsen my symptoms?
- Should I see a specialist and if so, what type?
Questions About My Treatment
- Will I need surgery to correct my problem?
- Is there medication that would relieve my symptoms?
- What side effects are associated with the medication?
- Are there any alternative therapies (i.e. supplements) that I can try?
Questions About Lifestyle & Family
- Are there exercises that you would recommend to alleviate my overactive bladder problem?
- How much fluid can I drink in a day? Is there a time of day that I should refrain from drinking?
- Does caffeine make the problem worse? Does alcoholic beverages?
- Is there a special diet that you recommend?
- Does this run in families?
Common Tests or Labs to Diagnose Overactive Bladder
When first evaluating an overactive bladder, a doctor will take an extensive history from the patient and review the bladder diary. Then a thorough physical examination is performed, including the pelvis and genital regions.
Additional tests can be found on the chart below.
Purpose of Test
Results (Normal vs. Abnormal)
|Cystoscopy||Visualizes inside the bladder and urethra||While lying on your back with your legs in a frog-leg position, a thin tube with lens and light (often with attachment to a video camera for better visualization) is inserted into the urethral opening and advanced to the bladder, allowing the doctor to see the urethra and the bladder lining.||Abnormal findings include bladder stones, tumors, and urethral narrowing (strictures).Normal findings include a pink lining with no growths and normal urine flow without obstruction.|
|Ultrasound (sonogram)||Visualizes the urinary system from the kidneys to the bladder||After lying down on the table, the technician places clear water-based gel on your abdomen and pelvic area. A hand-held probe is then moved back and forth over the area transmitting sound waves. The echoes of these waves create an image on a computer monitor.||Normal findings show an intact bladder, ureters, kidney, and urethra.Abnormal findings include tumors, growths, strictures or narrowing of ureters or urethra, abnormal shape of bladder, or stones.|
|Cystometry||Measures filling pressure of bladder and pressure at which urgency is felt or leakage occurs||While lying on your back with your legs in a frog-leg position, a catheter (thin flexible rubber tube) is inserted into the bladder, gradually filling it with water. A second catheter is placed in the vagina or in rectum for men to detect involuntary muscle contractions, determining pressure level at which urge is felt or leakage occurs as well as the pressure for bladder evacuation.||Normal: urgency felt at 175-250 mL and the point where urination is felt to be imminent is 350-450 mL(The maximum amount of liquid in bladder capacity is 400-500 mL normally.)
No urine should leak from your bladder during the stress test.
|Video Urodynamics||Creates images during ultrasound and cystometry to view filling and emptying of bladder||A catheter is introduced into the bladder through your urethra while you are lying on your back with your legs spread away from your body.The bladder is filled with water and a special dye that can be seen on X-rays. Using X-ray or sonograms with the cystometry and pressure-flow study, the filling and emptying of the bladder is visualized and images are obtained.||Normal results involve visualization of the bladder with normal size and shapeNo obstructions, growths, or strictures are present with a normal filling and voiding of urine.|
|Post Void Residual Urine||Measures the amount of urine left in the bladder after you have voided||After urination is complete, a catheter is inserted into the bladder through the urethral opening.This tube then drains any remaining urine and the volume is measured.||The amount of urine remaining after urination should be less than 30 milliliters (mL).|
|Uroflowmetry||Measures the speed and volume of urine flow released and duration of the release||You urinate into a special toilet with a measuring device, which measures speed and volume.||Normal results:Males – Age 66-80: 9 mL/sec
Age 46-65: 12 mL/s
Age 14-45: 21mL/s
Age 8-13: 12 mL/s
Females – Age 66-80: 18 mL/sec
Average flow for boys and girls age 4-7 is the same: 10 mL/sec
|Electromyography||Evaluates the nerve impulses between urinary sphincter and bladder muscles||Special sensors are placed on cleansed skin adjacent to the urethra and rectum, or a catheter is inserted into the urethra or rectum.A machine records nerve and muscle activity. The pattern is evaluated to determine if the impulses sent to the bladder and sphincters are properly coordinated.
Local anesthesia may be applied if sensors are placed on a catheter.
|Normal results show minimal electrical activity of a muscle at rest.Muscle flexing (contracting) creates electrical activity, which produces a pattern that is assessed to see if the muscle responded appropriately.
Abnormal results can be elicited from any nerve and muscle disorder or dysfunction.
Conditions that could cause this include:
Common Medications and Treatments for Urge Incontinence
There are several options for the treatment of an overactive bladder including behavioral changes, drugs, or a combination. These are listed below in our urge incontinence patient education guide.
Natural (behavioral change) treatments can slash the episodes of urge incontinency in half with no side effects.
- Pelvic floor exercises (aka Kegels)
- Tighten, hold, and release the muscles used to start and stop urination. Gradually achieve 3 sets of 10.
- Electrical stimulation to pelvic floor muscles can also be used for strengthening by sending pulses to the site from electrodes inserted into the vagina or rectum.
- Bladder training
- Establish scheduled voiding. Set times for urination and wait for that time, gradually increasing the interval between voiding.
- Avoid drinking fluids at bedtime and decaffeinate.
Depending on the basis for urge incontinence, a medication protocol may be necessary.
How the Drug Works
Benefits and Risks
|Beta-3 Adrenergic agonist||Relaxes the smooth muscle surrounding the bladder.||
|Anticholinergics||Block the nerve impulse to bladder muscles to inhibit contraction frequency.||
|Tricyclic Antidepressant||Relaxes bladder muscles||Decreases urgency May cause:
|Botulinum Toxin||Relaxes bladder muscles||Relief from overactive bladder symptoms|
|Estrogen||Restores hormone in menopausal women||
*Results are inconclusive
|Capsaicin (from chili peppers)||Affects bladder nerves||Decreases nerve stimulation which may decrease symptoms *Research is ongoing|
Surgical correction of the overactive bladder may be recommended if all prior methods fail or symptoms are so severe that the individual can’t function.
Surgical techniques include:
- Bladder augmentation
- A bowel segment is added to the bladder wall for capacity enhancement.
- Implant application
- A device is inserted under the skin that emits electrical pulses to the sacral nerves (located at the base of the spine) which control the bladder and surrounding muscles.