Urge Incontinence

Urge IncontinenceWhat is urge incontinence?

Urge incontinence is caused by an overactive or spastic bladder (detrusor) muscle, and is often associated with symptoms of urgency, frequency and frequent nighttime urination.  Overactive bladder symptoms can be much worse if you have a bladder infection or by eating/drinking foods that are known to be bladder irritants.  Occasionally, women will have symptoms of urge incontinence which is due to incomplete bladder emptying, called overflow incontinence, which is like a full bucket constantly leaking over the edge.

What causes urge incontinence?

The pelvic floor muscles normally fit snugly around the neck of the bladder. They form a ring of muscle that prevents urine from escaping through the urethra, which is the tube that carries urine out of the bladder. However, the pelvic floor muscles can be stretched or torn during childbearing. There may also be further loss of muscle tone after menopause due to a thinning of tissues caused by a lack of estrogen. Sudden pressure on the bladder (for example, from coughing or sneezing) can overcome the weakened muscles and cause a little urine to escape. Diabetes, obesity, and urinary tract infections also contribute to stress incontinence.

What are the symptoms?

Symptoms include urgency, frequency and frequent nighttime urination.

How is it diagnosed?

Your health care provider will take a careful history and examine you to see if the incontinence is caused by an underlying condition that can be corrected. Your blood and urine will be checked for infection or other abnormalities. You may be asked to complete a bladder voiding diary and have urodynamic studies to further evaluate your bladder function and cause of your leakage.

How is it treated?

Urge incontinence is treated with a combination of behavioral therapy and anticholinergic medications, which is successful in the majority of patients.  Patients with an overactive bladder that do not respond to medical and behavioral therapy may be candidates for surgical intervention with the implantation of a bladder pacemaker called an InterStim device.  We also offer Urgent PC peripheral neuromodulation, which stimulates the bladder through a small wire place just above your ankle to the tibial nerve and is done in the office.  Botox injections to the bladder have also been used in experimental protocols with variable success, but are associated with a high rate of urinary retention.

Complications of Anticholinergic medications include: dry mouth, constipation, headache, and dizziness. *Patients with untreated narrow angle glaucoma and urinary retention cannot use these medications. The medications are most effective when used in together with behavioral therapy including timed voids (emptying by the clock), avoidance of bladder irritants and pelvic floor exercises.  Other useful Behavior Modifications include weight loss, caffeine/alcohol reduction, fluid management, decreased heavy lifting, cessation of smoking, and improving constipation.