Urge incontinence occurs when you have a strong, sudden need to urinate. The bladder then squeezes, or spasms, and you lose urine.
Overactive bladder; Detrusor instability; Detrusor hyperreflexia; Irritable bladder; Spasmodic bladder; Unstable bladder; Incontinence - urge; Bladder spasms
As your bladder fills with urine from the kidneys, it stretches to allow urine. You should feel the first urge to urinate when there is a bit less than 1 cup of urine in your bladder. Most people can hold more than 2 cups of urine in the bladder.
Two muscles help prevent the flow of urine:
When you urinate, the bladder wall muscle squeezes to force urine out of the bladder. As this happens, the sphincter muscle relaxes to allow the urine to pass through.
All of these systems must work together to control urination:
The bladder may contract too often from nervous system problems or bladder irritation.
With urge incontinence, you leak urine because the bladder muscles squeeze, or contract, at the wrong times. Often these contractions occur no matter how much urine is in the bladder.
Urge incontinence may result from:
In men, urge incontinence also may be due to:
In most cases of urge incontinence, no cause can be found.
Although urge incontinence may occur in anyone at any age, it is more common in women and older adults.
During a physical exam, your health care provider will look at your belly and rectum.
In most cases, the physical exam will not find any problems. If there are nervous system causes, other problems also may be found.
Tests include the following:
Treatment depends on how bad your symptoms are and how they affect your life.
There are four main treatment approaches for urge incontinence:
Managing urge incontinence usually begins with bladder retraining. This helps you become aware of when you lose urine because of bladder spasms. Then you relearn the skills you need to hold and release urine.
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. These are mainly used to treat people with stress incontinence. However, these exercises may also help relieve the symptoms of urge incontinence.
Vaginal cones. This is a weighted cone that is inserted into the vagina to strengthen pelvic floor muscles.
Biofeedback. This method can help you learn to identify and control your pelvic floor muscles.
Electrical stimulation. This uses a gentle electrical current to contract your bladder muscles.
Pay attention to how much water you drink and when you drink.
It also may help to stop eating foods that may irritate the bladder, such as:
Avoid activities that irritate the urethra and bladder. This includes taking bubble baths or using harsh soaps.
Medications used to treat urge incontinence relax bladder contractions and help improve bladder function. There are several types of medications that may be used alone or together:
These medicines may have side effects such as dizziness or dry mouth. Talk with your doctor if you notice bothersome side effects.
If you have an infection, your health care provider will prescribe antibiotics. Be sure to take the entire amount as directed.
Surgery can help your bladder store more urine. It can also help relieve the pressure on your bladder. Surgery is only used for people who have too many spasms and are not able to store much urine.
Augmentation cystoplasty is the surgery most often performed for severe urge incontinence. In this surgery, a part of the bowel is added to the bladder. This increases the bladder size and allows it to store more urine.
Possible complications include:
There is a risk of forming tube-like passages from the bladder to other organs or your skin. These are called urinary fistulae. They can lead to:
Sacral nerve stimulation is a newer type of surgery.
Urinary incontinence is a long-term (chronic) problem. While treatments can cure your condition, you should still to see your health care provider to make sure you are doing well and check for possible problems.
How well you do depends on your symptoms, diagnosis, and treatment. Many patients must try different treatments (some at the same time) to reduce symptoms.
Getting better takes time, so try to be patient. A small number of people need surgery to control their symptoms.
Physical complications are rare. The condition may get in the way of social activities, careers, and relationships. It can also make you feel bad about yourself.
Rarely, this condition can cause severe increases in bladder pressure, which can lead to kidney damage.
Call your health care provider for an appointment if:
Starting bladder retraining techniques early may help relieve your symptoms.
Deng DY. Urinary incontinence in women. Med Clin North Am. 2011;95:101-109.
Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and urinalysis. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 3.
Resnick NM. Incontinence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.
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