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Urge Incontinence

What is Urge Incontinence?

People with Urge Incontinence experience an urgent desire to pass urine and are not able to reach a toilet in time before passing urine (the feeling of the sudden desire to pass urine is known as "Urgency"). People who experience urgency or urge incontinence, may also find they tend to pass urine more often than normal (this is called frequency). This may be during both day and night times. Some women with urge incontinence may also find that they leak urine during sex, most likely during orgasm.

How common is Urge Incontinence?

Urge incontinence, otherwise known as unstable or overactive bladder, is the second most common type of incontinence. About 3 in 10 cases of incontinence are due to urge incontinence. It can occur at any age but commonly first starts in early adult life. Women are more commonly affected than men.

What Causes Urge Incontinence?

Urge incontinence is caused when the bladder muscle contracts too early and normal control bladder control is reduced. Urge Incontinence is often a symptom of an unstable or overactive bladder. The bladder muscle is technically known as the detrusor muscle, so this condition may also be referred to as detrusor instability.

Normally, the bladder muscle is relaxed as the bladder gradually fills up. Then, when the bladder is roughly half full, your bladder muscle tells the brain and you start to get a feeling of needing to pass urine. However, for people with urge incontinence (overactive bladder), the bladder muscle seems to give the message to the brain that it is actually fuller than it really is. This causes the bladder to  contract too early, giving the feeling that you have to pass urine urgently

For the majority of people who experience Urge Incontinence the reason they develop an overactive bladder develops is not known. However the symptoms may get worse during times of stress and the condition may also be influenced by the intake of caffeine (e.g. tea, coffee, cola, etc) and by alcohol.

Some women develop urge incontinence after the menopause and this is thought to be due to the lining of the vagina shrinking (vaginal atrophy) caused by lowering of oestrogen levels.

Urge incontinence may be experienced by people with certain neurological disorders such as Parkinson's disease, Multiple Sclerosis, spinal cord injury or after a stroke.

Similar symptoms to Urge Incontinence may be exhibited if there is irritation in the bladder such as a urinary tract infection (UTI) or stones in the bladder. The bladder may also be irritated if people cut back on fluid intake (often to reduce the need to go to the toiler). Cutting back fluids causes urine to become more concentrated and this may irritate the bladder.

Also going to the toilet too often can make symptoms worse as the bladder becomes used to holding less urine and can then bcome more sensitive and overactive at times when it is stretched a little.

Diagnosing Urge Incontinence

To diagnose Urge Incontinence, your health professional should ask about your symptoms and medical history. You may be asked to keep a ‘bladder diary’ for a week or so. This should record your fluid intake (what and how much you drink) and fluid output (the amount of urine you produce, and when you pass urine), whether you had an urge to urinate and the number of times you unintentionally pass urine.

They may also carry out a test on a sample of your urine to check that your urge incontinence isn't being caused by a secondary cause such as an infection in your urinary tract and they may also do a blood test to check that your kidneys are working properly.

In some cases you may be referred to a Urologist who specialises in treating conditions of the urinary system). Alternatively, depending on the results of the examination, women may find themselves referred to a Gynaecologist (a specialist in women’s reproductive health) or Urogynaecologist (a specialist in urinary and associated pelvic problems in women).

These specialists may carry out more detailed tests such as an Ultrasound (commonly used to check that your bladder is emptying properly), Cystoscopy (Looking inside the bladder and urinary system to identify abnormalities that may be causing the incontinence) or Urodynamic testing. Urodynamic testing measures the pressure in your bladder and the flow of urine. A catheter, is inserted into your bladder through your urethra and water is then passed through the catheter so the pressure on the bladder can be recorded.

How can I manage Urge Incontinence?

Your GP may recommend bladder training, either alone or in combination with other therapies. Bladder training involves relearning how to urinate, and how to ignore or suppress the need to pass urine by gradually increasing the time between urinating.

There are few other, simple steps you can take to help with urge incontinence. These include trying  losing any excess weight, moderating caffeine intake, and ensuring a balanced fluid intake.

Your health professional may also recommend doing Pelvic Floor exercises. Although these are generally associated with managing Stress Incontinence, strengthening the bladder muscles helps with all continence conditions and can assist in bladder control for urge incontinence. 

If bladder training and other actions haven't been effective, your doctor may consider prescribing medicine specifically for the treatment of Urge Incontinence. Anticholinergics are the most commonly prescribed type medicine for urge incontinence. These drug relax the bladder muscles and help reduce the number of times you feel the need to pass urine. Many of the drugs have side effects so it’s important that you read any information that comes with the medicine and discuss these with your doctor.

More recent treatments that have been developed for Urge incontinence include the injection of Botox (Botulinum A toxin) into the bladder to help relax overactive muscles and Sacral nerve or Tibial nerve stimulation (these involve stimulating the nerves to your bladder and help to correct wrong or unwanted messages sent along these nerves to retrain the bladder muscles). If other treatments haven't been effective, then surgical options such as Bladder Augmentation or Detrusor myectromy may be considered by your specialist however these procedures are rarely carried out.

No matter what type of Incontinence you or the person you care for is experiencing it is important you discuss this with a Health Professional. Incontinence is often a symptom of an underlying condition and in many cases simple steps can help improve the condition.