In urge incontinence, there is a sudden urge to urinate which leads to leakage of urine through the sphincters because the bladder contracts inappropriately. It is also called overactive bladder, irritable bladder, bladder spasms, detrusor instability, or spasmodic bladder.
Urge incontinence is not a disease by itself but it is a symptom of a medical disease or physical problem.
Urge incontinence represents a subtype of urinary incontinence which spans from urine leakage following a cough to an overactive bladder.
It is essential to see a doctor who will then make a diagnosis on the type of incontinence.
Causes of urge incontinence
Most times it is difficult to tell the exact cause of urge incontinence. The common causes include:
- Bladder infection or inflammation
- Bladder stones
- Blockade of the bladder opening
- Prostate enlargement
- Bladder cancer
- Nervous system disorders such as multiple sclerosis
- Nervous system injuries such as trauma to the spinal cord or a stroke
When should I consult my doctor?
Some people experience mild forms of the condition which does not need a doctor’s attention.
When severe, ensure you see a doctor as you may be having any of the following:
- Bladder infection or inflammation
- Bladder stones
- Kidney stones
Watch out for additional symptoms such as pelvic pain, painful urination, and prolonged symptoms as they are indicative of an ongoing medical condition.
Also, endeavor to see a doctor if urge incontinence interferes with your daily activities.
Diagnosis of urge incontinence
To effectively make a diagnosis of urge incontinence, a proper medical history is needed. A physical examination will be done (including a pelvic floor assessment to test the strength of the pelvic floor muscles), and urine analysis will also be carried out to check for signs of infections.
Additional tests that may be requested include:
- Urine culture: can detect the particular microorganism responsible.
- Bladder ultrasound scan: this gives information on the amount of urine left in the bladder after voiding.
- Cystoscopy: this examines the urethra and bladder, a tiny camera is attached to a fiberoptic scope and inserted into the urethra.
- X-rays: various x-ray studies can be used to diagnose incontinence. They include:
- Intravenous pyelogram: here, a dye is injected into the bloodstream and fluoroscopic x-rays are taken to track the dye as it moves through the urinary tract.
- Kidney, ureter, and bladder study: it is a plain film x-ray that can be used to diagnose problems of the urinary tract and gastrointestinal system.
- CT scan: this takes detailed images of the organs
- Urodynamic studies: used to assess the functionality of the urethra and bladder. They include tests such as cystometrogram and uroflowmetry which check the bladder functionality and the urine flow parameters respectively.
- Stress testing: Here, activities that cause incontinence symptoms are done for the health worker to see.
A bladder diary is also necessary as it keeps a chart of fluid intake and urinary output and this will further help treatment.
Treatment is specific to an individual and depends on the symptoms shown.
The doctor usually recommends lifestyle modifications such as bladder training and retraining, and kegel exercises before moving on to more invasive treatment.
Home remedies for urge incontinence
Those with mild cases of urge incontinence may not require treatment as some home remedies can control it. However, if symptoms become severe, do well to see a doctor.
Available home remedies include:
- Lifestyle modification: this includes diet change, limit intake of alcohol, caffeine, spicy foods, acidic food, or artificial sweeteners. This helps to reduce bladder irritation.
Since constipation puts pressure on the bladder and makes one void frequently, it is best to prevent it by taking plenty of fiber.
Glucose control for diabetics and weight loss will help control urinary incontinence.
Smoking cessation will also help to reduce urge incontinence.
Wear an absorbent pad when performing activities that increase urine leakage.
- Kegel exercises: these exercises help strengthen the pelvic floor muscles which hold urine till one is ready to void. It is usually the first option for urge incontinence.
It is done by contracting the pelvic floor for about 5-10 seconds, the process is the same as that done when urine flow is stopped midstream. This exercise can be done three or more times daily. It helps to activate the correct muscles. It can be done at any location.
When supervised by a doctor, kegel exercise can be assisted with kegel cones which are lightweight cones held in the vagina when the pelvic floor is contracted.
Another option is the use of electrical probes which when inserted into the vagina or anus, stimulate the pelvic floor muscles to contract. It takes a longer duration to be effective.
- Bladder retraining: this will help to strengthen the muscles involved in urination. It has to do with the timing of urination. You can only urinate at a specific time of the day even though you have the urge to urinate at other times.
The timing can be graded, initially, urination should be done every hour then gradually increase the wait hour interval by half an hour until you can go 3-4 hours without urine leakage.
Another way is to delay urination when the urge is felt, being able to hold urine also strengthens the muscles. You can also try urinating and afterward go again immediately to ensure that the bladder is completely emptied.
Medical treatment for urge incontinence
Medications or surgery to help with muscle strength and sphincter functioning will be recommended by the doctor. Other treatment options include:
- Botox injections: Botox stands for botulinum toxin. It is effective in preventing bladder muscles from over contracting thereby relaxing the urinary bladder. It usually requires multiple doses. The drawback here is the possibility of urinary retention.
- Nerve stimulators: they are tiny devices that look like pacemakers. They are inserted underneath the abdominal skin till it hooks to the sacral nerve and sends pulsation to the nerve that helps control bladder functioning.
- Urinary catheter: this is another treatment option for incontinence especially for the overflow type. It helps empty the bladder after urination.
Complications of urge incontinence
The complications of urge incontinence are usually not much even when left untreated because the condition is a chronic one.
There’s a minimum risk of complication if urge incontinence occurs devoid of pain or burning sensation on urination.
There is a possibility of worsening of untreated urge incontinence to the extent of interfering with daily life activities and relationships. For incontinence caused by an infection, bladder stones, or an inflammation, a doctor should be seen as it could pose more serious problems.