Urge incontinence is a condition where a person has a sudden and strong urge to urinate resulting in involuntary loss of urine. In urge incontinence, there is unwanted contraction of the bladder causing some leakage of urine through the sphincter muscles. Sphincters are the strong muscles which control the flow of urine from the bladder. In people suffering from urge incontinence, the bladder muscles become "overactive" and contract with lot of force, which supersedes the strength of the sphincter muscles of the urethra causing urine leakage. Urge incontinence is also known as Bladder Spasms/Overactive Bladder/Spasmodic Bladder/Detrusor Instability/Irritable Bladder. Urge incontinence is not a disease, but a symptom of some other underlying problem. The problem could be lifestyle issues or medical or physical problems. Women and elderly individuals are at an increased risk for developing this condition; however, it can affect anyone and is quite common a problem.
Urge incontinence is one of a type of urinary incontinence. There are different variations of urinary incontinence, which range from small amounts of urine leakage to overactive bladder. For many individuals they think of urge incontinence as an inconvenience and do not seek treatment for it. However, if urge incontinence is affecting a person's daily activities and quality of life, then it is imperative to consult a doctor for managing and treating this condition, especially if it is also accompanied by other symptoms such as pain and burning with urination.
Treatment depends on the symptoms of the condition and is tailored according to different patients. Treatment plan generally consists of behavioral techniques (bladder retraining & Kegel exercises), electrical stimulation, medications and surgery if needed. Your physician will diagnose the specific type of incontinence, the cause, and decide on proper treatment course. A combination of different treatments can also be used depending on the need.
Causes of Urge Incontinence
- Infection of the bladder.
- Inflammation of the bladder.
- Bladder stones
- Prostate enlargement in men.
- Obstruction in the bladder opening.
- Bladder cancer.
- Nervous system diseases, (e.g. multiple sclerosis).
- Nervous system injury (e.g. trauma to the spinal cord or stroke).
- Many a times there is no identifiable cause for urge incontinence.
Risk Factors for Urge Incontinence
- Older individuals are at an increased risk for developing urge incontinence.
- Pregnant women or women who have just delivered are at an increased risk for developing urge incontinence.
- Women who have had pelvic surgery, such as a C-section, are at an increased risk for developing urge incontinence.
- Obese/overweight individuals are at an increased risk for developing urge incontinence.
- Individuals suffering from recurrent urinary tract infections are at an increased risk for developing urge incontinence.
- Men suffering from prostate problems, such as prostatitis, prostate enlargement or who have had prostate surgery are at an increased risk for developing urge incontinence.
- People having cancers, especially of prostate and bladder, are at an increased risk for developing urge incontinence.
- Medical conditions such as stroke, diabetes or injury which causes nerve damage increases the risk for urge incontinence.
Signs & Symptoms of Urge Incontinence
Given below are some symptoms which a patient experiences along with urge incontinence:
- Sudden and uncontrollable urge to urinate.
- Patient may leak urine.
- Patient has pain in the lower abdominal or pelvic region.
- Patient experiences pain/burning with urination.
- These symptoms can continue for many days.
Investigations for Urge Incontinence
- Post-void residual measurement.
- Patient is advised to keep a bladder diary.
- Urodynamic testing.
- Pelvic ultrasound.
Treatment for Urge Incontinence
Many patients do not seek treatment for urge incontinence and continue their life as before. If the urge incontinence is severe, then the patient should seek a doctor where the doctor will decide on treatment according to severity of the condition. Given below are some treatment plans which the doctor will advise starting from conservative treatment to invasive treatment.
Dietary Changes: Making changes in the diet helps in reducing the irritation to the bladder. Patient should cut down on foods and drinks, which act as diuretics, such as patient should limit the intake of caffeine, alcohol, foods which are acidic, spicy and high in sugar content. If the patient is overweight, then he/she should try to lose the excess weight which will benefit in this condition.
Kegel Exercises: These are pelvic floor exercises which are extremely beneficial in any type of urinary incontinence. The aim of these exercises is to strengthen the pelvic muscles which are involved with urination. The method to do Kegel exercises are:
- First contract the pelvic floor muscles as if you are trying to hold urine for about 5 seconds.
- Then relax for 5 seconds then again contract.
- You can increase this up to 10 seconds.
- Try to do 3 sets of 10 repetitions in each day.
- Concentrate on your pelvic floor region and contract the muscles situated there.
- Kegel exercises can be done anywhere and anytime of the day.
Kegelcones: Under doctor's supervision, you can also use Kegelcones. These are weighted cones held in the vagina by contracting the pelvic floor muscles. As you practice these more and as the muscles get stronger, you should be able to use heavier weights.
Electric Version of Kegels: There is also an electric version of Kegels which helps with the pelvic floor strengthening. In this procedure, a probe is inserted into the vaginal or anal openings and it transmits shock to the pelvic floor muscles. This will help in strengthening the muscles. However, this treatment takes many months to be effective.
Bladder Retraining: This process helps in strengthening the muscles involved in urination. You should try to hold urine and urinate only at a specific and scheduled time in a day. You cannot void at other times of the day even if you have the urge to go. Gradually the urge to urinate subsides as your bladder adapts to urinate at the specific times in a day. Initially, you should pass urine every hour, then move it up to 2 then 3 hours till you are voiding every 3 to 4 hours without leaking any urine. By delaying urination when the urge arises, you are strengthening your ability to hold urine.
Double voiding is another technique where you urinate, then wait for some time before attempting to urinate again. This will help in complete emptying of the bladder.
Lifestyle Changes: Making changes in one's lifestyle helps in improving the condition. Patient should increase fiber intake to prevent constipation, as hard impacted stool puts pressure on the bladder leading to urge incontinence, as the rectum lies close to the bladder. Patients who smoke should abstain from it, as smoking leads to coughing, which in turn leads to incontinence.
It is also better to wear absorbent pads when outside doing some activities to avoid embarrassing situations. Patient should avoid drinking lot of fluids before performing any physical activities.
Pessary: There are also pessarys available which can be inserted into the urethra before specific activities which lead to urine leakage. A Pessary should not be used daily and should be only used under a doctor's supervision. A pessary can also be inserted into the vagina to support the bladder in case of prolapse. A vaginal pessary helps in holding up the bladder and limiting the leakage of urine.
Medications used to treat urge incontinence include: Darifenacin, fesoterodine, mirabegron, oxybutynin, solifenacin, tolterodine , trospium, oxytrol, hyoscyamine, dicyclomine. Other than these, Botox can also be injected into the bladder muscle leading to its relaxation and increasing the storage capacity of the urine thus decreasing the episodes of urine leakage.
The above were conservative treatment options, other than these, there are surgical procedures to help with muscle strengthening and functioning of the sphincter. Given below are some of the surgical options:
Nerve Stimulators: These devices are small in size similar to Pacemakers. Nerve stimulators are inserted under the skin of the buttocks and are attached to the sacral nerve. These devices transmit impulses to the sacral nerve which help in controlling the bladder's function.
Collagen Implants: In this procedure, injections are given into the wall of the urethra to help in controlling the leakage of the urine, which occurs from weak sphincter muscles. This is an effective and simple method for treating urinary incontinence.
Catheters: These can be used to completely empty the bladder and are especially useful in overflow incontinence.
Tension-free vaginal tape: This surgical procedure is especially beneficial in women who have stress incontinence. A piece of synthetic tape is placed and secured under the urethra and is adjusted according to its tension. This will help in preventing urine leakage.
Vaginal Sling Procedures: A supportive sling using natural tissue or synthetic material is used from the bladder to the lower muscles of the stomach. This procedure helps in closing the urethra and is particularly useful in women suffering from stress incontinence.
Inflatable Artificial Sphincters: When the natural urinary sphincters are not working properly, they are surgically replaced with artificial ones. This procedure helps in decreasing leakage, although results may not be permanent.
Retropubic Urethral Suspension: This surgery is especially beneficial in limiting urine leakage from stress incontinence. In this procedure, urethra and the bladder neck is closed off, so that lesser quantity of urine leaks through.
Many people do not seek treatment for urge incontinence. However, if you are having other symptoms along with it such as pelvic pain, burning and pain when urinating, then you should seek medical advice immediately to treat the underlying condition causing Urge Incontinence. If there is infection or inflammation of the bladder causing urge incontinence and if it is left untreated, then the infection can spread to other parts of the body, such as kidneys, etc.