Have you ever felt a sudden, intense urge to urinate that's difficult and often impossible to control? If so, you may be suffering from urge incontinence. This frustrating condition can happen unexpectedly and frequently, taking a toll on your quality of life. You may feel embarrassed, isolate yourself from others, and worry about having accidents. But there is hope - urge incontinence can be managed with the right techniques and treatments. This article will provide you with a thorough understanding of urge incontinence, its causes, and the many ways it can be treated and coped with.
Keep reading on to learn how urge incontinence happens, what factors potentially put you at risk, what tests are used to diagnose it, and the different lifestyle changes, therapies, and even surgical options that could drastically improve your condition.
With the right knowledge and care, urge incontinence can be treated!
Definition of urge incontinence
Urge incontinence (also known as overactive bladder) is the sudden and urgent need to urinate, which can result in accidental loss of urine. It happens when the bladder muscles contract involuntarily, leading to an uncontrollable urge to pass urine.
It is a common yet undertreated condition that can negatively impact the quality of life if not properly understood and managed.
Significance and impact on quality of life
Some studies estimate that between 1.8 to 30.5% of all adults in Europe suffer from urge incontinence.7 In the United States, the prevalence ranges from 1.7 to 36.4%. Urge incontinence symptoms are usually more common in women, with about 43.1% of women being affected in the United States, compared to just 27.2% of men.2 In general, the condition affects millions worldwide, though the reported rates differ significantly based on factors like age, sex, and geographic location.
Despite the highest prevalence occurring among older women due to their higher risk of ageing-related contributing factors, urge incontinence can impact adults of all ages in any region when precipitated by illnesses or other triggers.
Symptoms can occur as early as age 25, and the occurrence tends to increase with age.1 Despite how common it is, many refrain from discussing bladder control issues due to embarrassment.
However, urge incontinence should not be an inevitable consequence of ageing. With proper diagnosis and treatment, symptoms can be improved at any age. Ignoring symptoms and curtailing activities out of fear of incontinence can unnecessarily restrict social, physical, and sexual well-being. Regaining bladder control is vital for restoring quality of life.
Understanding the urinary system
The role of the bladder
The bladder is a hollow, muscular organ that stores urine produced by the kidneys. It expands like a balloon as it fills up, with a healthy adult bladder capable of holding 300-400 mL of urine.3 The muscles surrounding the bladder are known as detrusor muscles, and they allow it to contract when emptying urine through the urethra.4
Normal urination process
Normally, as the bladder reaches its capacity (around 400 mL), signals are sent to the brain, triggering the need to urinate.5 Voluntary control of muscles of the pelvis and muscles at the bladder opening (sphincters) allows urine to be held until reaching a toilet. Voiding of urine is initiated by relaxation of the external sphincter and detrusor muscle contraction, squeezing urine out through the urethra.5 This coordination allows complete emptying at appropriate times.
How nerves control the bladder
Bladder filling and emptying are regulated by a complex interaction of nerves within the nervous system. To simplify it, the sympathetic nerves maintain muscle relaxation to keep the bladder relaxed as it fills with urine, while the parasympathetic nerves initiate voiding through detrusor muscle contraction.5 Sacral spinal nerves carry messages between the bladder and brain, regulating storage and emptying.5 Disruption of these neural pathways can lead to bladder control issues.
Types of urinary incontinence
Overview of different types
There are several types of urinary incontinence, characterised by different causes:6
- Stress incontinence – urinary leakage when pressure is exerted like coughing, sneezing or exercise
- Urge incontinence - sudden urge to void and involuntary loss of urine
- Overflow incontinence - frequent dribbling/leaking of urine due to the bladder not emptying fully
- Mixed incontinence – a combination of urge and stress incontinence symptoms
Focus on urge incontinence
While all types of incontinence impair quality of life, urge incontinence can be exceptionally intrusive due to its unpredictable nature. It is caused by involuntary bladder contractions rather than issues with sphincter or pelvic floor weakness. Understanding the key characteristics of urge incontinence allows optimal identification/diagnosis and management.
Causes and risk factors
Diseases like multiple sclerosis, Parkinson’s, stroke and dementia can impair neural pathways involved in bladder regulation and continence.6,8 The urgent need to urinate may thus stem from neurological disruption.
Infection and inflammation
Recurring bladder infections, bladder stones, and bladder cancer can cause inflammation, irritating bladder walls and triggering sudden contractions. This inflammation-related urge often resolves with treating the underlying cause.
Medications and diet
Certain foods, beverages and medications can irritate the bladder or increase urine production, causing urgency and frequency. Common culprits include caffeine, artificial sweeteners, spicy foods and diuretics.6,8
Ageing and hormonal changes
Oestrogen loss in postmenopausal women, hormonal changes during pregnancy, and testosterone decrease in ageing men contribute to urinary control issues. Bladder muscles weaken and cannot store as much urine with age.8 Risk also increases due to age-related neurological changes.
Symptoms and diagnosis
Frequent symptoms of urge incontinence include:6,8
- Sudden, intense urge to urinate that is difficult to delay/control
- Frequent urination, typically in small amounts
- Nocturia - interrupted sleep by the need to urinate
- Inability to finish urinating or empty bladder completely
- Passing urine during sex/orgasm
Medical history and physical examination
To diagnose urge incontinence, physicians first take a detailed history, asking about symptoms, onset and severity. Other medical conditions, surgeries, and medication are reviewed. Physical examination and further investigations (urine or blood tests and imaging tests) assess neurological function and bladder and pelvic organ abnormalities.6,8
Tests that may be used include:6,8
- Urinalysis – checks for blood, bacteria or other abnormalities
- Bladder diary – tracks the frequency of urination and circumstances around urination
- Urodynamic testing – measures bladder capacity and pressure during filling and voiding
- Cystoscopy – visual inspection of the bladder with a tiny camera
These tests help to identify causes and guide appropriate treatment approaches.
Management and treatment
Urge incontinence has a variety of treatment options, from conservative lifestyle changes to surgical interventions. Usually, a hybrid therapy combining different techniques is the most effective.
Lifestyle and behavioural interventions
- Pelvic Floor Exercises - Kegel exercises to strengthen pelvic muscles can reduce the urgency and frequency of symptoms.8
- Bladder Training - Following a timed voiding schedule can reestablish control.8
- Diet and Fluid Management - Limiting bladder irritants like caffeine and monitoring fluid intake can improve urge incontinence.8
Anticholinergic drugs like oxybutynin can block nerve signals that cause stimulation/spasms of the bladder and detrusor muscles. Mirabegron relaxes detrusor muscles.
Electrical stimulation of certain nerves (sacral nerve and percutaneous tibial nerve stimulation) modulates nerve signals, reducing urge symptoms. Non-invasive magnetic stimulation is also an option.8
Augmentation to enlarge bladder capacity or urinary diversions may be considered if other treatments fail. These invasive surgeries involve risks of complications.9
Coping strategies and quality of life
The unpredictable nature of urge incontinence can lead to anxiety, frustration, depression and embarrassment - further exacerbating the condition. Seeking support and understanding from loved ones is important.
Managing incontinence in daily life
Strategies can include:
- Keeping a change of clothes handy
- Wearing absorbent pads
- Mapping bathroom locations
- Avoiding any known triggers
Support and resources
One should never feel apprehensive about reaching out to support groups, helplines, and online resources to provide a community for managing emotional challenges. Continence nurses and specialised physical therapists also assist patients.
Prevention and maintenance
Maintaining bladder health
Avoiding known bladder irritants, practising pelvic exercises, urinating regularly, and treating infections promptly promote bladder health and control.6
Lifestyle changes to reduce risk
Smoking cessation, managing fluid intake, maintaining a healthy weight, and regularly exercising can lower urge incontinence risk.6
Annual exams monitoring symptoms allow early intervention for emerging bladder control issues before severe urgency and frequency develop or progress.
When to seek medical help
Recognizing severe symptoms:11
- Leakage accidents multiple times per day make things difficult
- Skin redness, sores, or ulcers due to constant moisture
- Foul-smelling urine, burning urination, or groin pain suggest a potential infection
- Falls, injuries, or limited daily activities due to uncontrolled feelings of urgency
- Sleep deprivation or emotional distress severely impacting work, relationships and quality of life
These symptoms signify potential serious illness, requiring prompt evaluation.
Importance of consulting a healthcare provider
Don’t resign yourself to living with severe urge incontinence. Consulting a doctor can determine contributing factors and the most effective treatment options to regain bladder control. Significant improvement is possible.
Recap of key points
Urge incontinence results from involuntary bladder contractions involving complex neurological factors. Lifestyle modifications, medications, nerve stimulation, and sometimes surgery can help manage symptoms. Support and open discussions go a long way to reduce stigma, and continence can be restored at any age with proper diagnosis and treatment!
Incontinence is not an inevitable result of ageing. Regaining bladder control is possible at any age through consulting healthcare experts, trying therapies, and using tools and techniques to cope with symptoms. Don’t suffer in silence. Seek help to improve your quality of life.
- Stewart W, Van Rooyen J, Cundiff G, Abrams P, Herzog A, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol [Internet]. 2003 May [cited 2023 Sep 26];20(6):327–36. Available from: http://link.springer.com/10.1007/s00345-002-0301-4
- Coyne KS, Sexton CC, Vats V, Thompson C, Kopp ZS, Milsom I. National community prevalence of overactive bladder in the United States stratified by sex and age. Urology [Internet]. 2011 May [cited 2023 Sep 26];77(5):1081–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0090429510016754
- University Hospitals Sussex NHS Foundation Trust [Internet]. 2022 [cited 2023 Sep 26]. Bladder training. Available from: https://www.uhsussex.nhs.uk/resources/bladder-training/
- Pal M. Does temporary catheter drainage of urine improve detrusor function in chronic urinary retention in patients with bladder outlet obstruction? UNOAJ [Internet]. 2017 Jan 18 [cited 2023 Sep 26];4(1). Available from: https://medcraveonline.com/UNOAJ/does-temporary-catheter-drainage-of-urine-improves-detrusor-function-in-chronic-urinary-retention-in-patients-with-bladder-outlet-obstruction.html
- Fowler CJ, Griffiths D, De Groat WC. The neural control of micturition. Nat Rev Neurosci [Internet]. 2008 Jun [cited 2023 Sep 26];9(6):453–66. Available from: https://www.nature.com/articles/nrn2401
- nhs.uk [Internet]. 2017 [cited 2023 Sep 26]. Urinary incontinence. Available from: https://www.nhs.uk/conditions/urinary-incontinence/
- Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ. Global prevalence and economic burden of urgency urinary incontinence: a systematic review. European Urology [Internet]. 2014 Jan [cited 2023 Sep 26];65(1):79–95. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0302283813008592
- Mayo Clinic [Internet]. [cited 2023 Sep 26]. Urinary incontinence - Symptoms and causes. Available from: https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808
- Primiceri G, Castellan P, Marchioni M, Schips L, Cindolo L. Bladder neck contracture after endoscopic surgery for benign prostatic obstruction: incidence, treatment, and outcomes. Curr Urol Rep [Internet]. 2017 Aug 9 [cited 2023 Sep 26];18(10):79. Available from: https://doi.org/10.1007/s11934-017-0723-6
- Wu S, Wu F. Association of urinary incontinence with depression among men: a cross-sectional study. BMC Public Health [Internet]. 2023 May 25 [cited 2023 Sep 26];23(1):944. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15961-9
- Urinary incontinence: practice essentials, background, anatomy. 2023 Aug 17 [cited 2023 Sep 26]; Available from: https://emedicine.medscape.com/article/452289-overview#a7