Urge incontinence (also known irritable 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.
Urge incontinence is not a normal condition of aging and may signal a more serious underlying medical problem that should be further investigated.
Causes and Risks
Reasons associated with urinary incontinence include:
- Bladder infection or inflammation
- Bladder cancer
- Bladder stones *
- Obstruction of the bladder opening
- Hypertrophic (Enlarged) prostate in men
- Nervous system disease (i.e. stroke, multiple sclerosis)
- Trauma to spinal cord or nervous system
- Acidic or spicy diet
- Frequency of bathroom visits
* More than 95% of bladder stones are developed in men. Children form stones from severe dehydration.
According to the NIH, 45,000 men and 17,000 women are diagnosed with bladder cancer annually.
In addition to wetness, signs to watch out for include:
- Pain or burning with urination
- Pain in the pelvic area (Suprapubic)
- New spate of symptoms that last for several days
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
Having made your appointment with a healthcare provider, there are certain actions that you need to take in order to maximize the benefit of your visit.
The first step to prepare for your consultation about urinary 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:
- Bring a list of all medications that are currently being taken including vitamins and herbal supplements
- Bring a list of all symptoms experienced, with a time line and any activities that make the symptoms worse
- Take a list of allergies
- Have a list of all past medical history including surgery, medical problems and the dates of each
- Bring a list of questions with you
- Bladder diary
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 certain food or beverages cause my symptoms?
- 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
- What treatments are available to me?
- Will I need surgery
- How frequently will I need follow-up exams?
- Will I need to take medication chronically or a limited time?
- What are the side effects of the treatment?
- What if I choose not to be on the medication?
- Is there a natural supplement or holistic approach for this?
Questions About My 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 Urge Incontinence
First, the physician will review past medical history and assess your various complaints or symptoms. Next an internal examination is performed with insertion of gloved fingers into the vagina or rectum to assess the bladder, prostate, or pelvic organs and feel for any lumps or enlargements.
Additional diagnostic tests may be found in the chart below.
Purpose of Test
Results (Normal vs. Abnormal)
|Cystoscopy||Visualizes the inside of the bladder and urethra for any growths or obstructions.||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.||Normal findings include a pink lining with no growths and normal urine flow without obstruction.Abnormal findings include bladder stones, tumors, and urethral narrowing (strictures).|
|Ultrasound (sonogram)||Visualizes images inside the body created by sound waves 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.|
|CT Scan||Seeks any growths, stones, obstructions or blood vessel abnormalities.||After donning a gown, you lie on a table that passes slowly through a large x-ray machine. The table then remains motionless while the machine moves around you. Whirring sounds can be heard during the process. Sporadically, you may be asked to hold your breath.||Normal findings show no enlargements, tumors or vascular changes.|
|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).|
|Urinalysis||Checks for infection, crystallization, sugar, protein, blood and pH.||Urine is placed in a cup for analysis. The technician dips a special paper into the urine for analysis with color changes.||Glucose, protein and blood should be absent in a normal specimen.If the above is present, the urine is sent to the laboratory in a sterile cup for a culture.|
|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
Treatment is based on the cause of your bladder overactivity. Once infections, stones and pathological causes have been ruled out, there are steps that you can take at home to lessen urine leakage.
Natural (behavioral change) treatments can slash the episodes of urinary incontinency in half with no side effects.
- Pelvic floor exercises (Kegels)
- Done at home (or any location), this strengthens the muscles of the pelvic floor involved with bladder control.
- Tighten, hold, and release the muscles used to start and stop urination. Gradually achieve 3 sets of 10.
- Contract the pelvic floor (as though you were stopping the urine flow midstream) and hold for 5-10 seconds. Rest and repeat as tolerated. Try this several times each day.
- Bladder training
- Urinate at scheduled times rather than when you have the urge. Initially this may be hourly and then increase by 30-minute intervals with a goal of 3-4 hours without leakage.
- Try urinating a second time right after urinating to empty the bladder completely.
- Reducing foods that are irritating to the bladder (acidic, spicy or high in sugar) helps.
- Avoid alcoholic beverages and caffeine. Discontinue smoking and drink more fluids to soothe the throat and reduce coughing.
- Eat more fiber to prevent constipation.
- If overweight, try reduction diet.
- Vaginal insert, which comes in various, shapes and sizes. Your physician fits you with the appropriate size. You insert the pessary into the vagina to help support the bladder and decrease leakage. It can be worn all day. After removal, wash with mild soap and water.
- Urethral insert
- Similar to small tampons, these are self-inserted into the urethra before certain activities where leakage may be a problem. This device is not designed for daily usage.
- Especially useful for those having overflow incontinence, the catheter is self- inserted after urination to help empty your bladder completely.
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 urgencyMay 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:
- Vaginal sling
- Surgical procedure creating a support sling from the bladder neck where urethra and lower stomach muscles connect.
- Urethra is closed more (especially used with stress incontinence). While urine leakage is lessened, it may only be a temporary fix.
- 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.