Urge incontinence causes and treatments

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Urge incontinence, also known as overactive bladder, is the involuntary contraction of bladder wall muscles, causing a sudden and unstoppable need to urinate. Not a normal part of aging, urge incontinence is nonetheless more common in older people, particularly women. Urge incontinence is not a disease but a symptom of medical or lifestyle issues.

Causes of Urge Incontinence

Before diagnosing overactive bladder, health professionals will first attempt to determine if the symptom is caused by another medical problem that needs treatment, such as:

  • Bladder infection
  • Inflammation of bladder
  • Stones
  • Obstruction of bladder opening
  • Bladder cancer

If the medical history, physical exam, and tests do not indicate an infection, disease or blockage, urge incontinence is the likely diagnosis. In some cases, the cause of urge incontinence may be difficult to pinpoint. However, some potential causes are:

  • Enlarged prostate
  • Nervous system diseases
  • Trauma injury to spinal cord or nervous system
  • Stroke

Lifestyle Treatments for Urge Incontinence

Many people with urge incontinence can find relief with treatments they can do at home. These include:

  • Limiting caffeine and alcohol: beverages with either caffeine or alcohol can cause a greater urge to urinate. Eliminating or decreasing these beverages can be helpful.
  • Eliminating irritating goods: foods that are high in sugar, or are spicy or acidic can also cause bladder irritation so it helps to reduce consumption of these.
  • Increasing fiber: constipation can put pressure on the bladder, so eating more fiber or taking fiber supplements can help.
  • Maintaining a healthy weight: losing weight can reduce the stress on the bladder and improve symptoms.
  • Using absorbent pads: Wearing absorbent underwear or pads occasionally or regularly can help an individual avoid embarrassment, especially in situations where there is no easy access to restroom facilities.

Behavioral Treatments for Urge Incontinence

Significant relief of symptoms can be obtained by helping individuals strengthen the muscles of the pelvic floor and bladder that have been weakened. Whether done by the individual at home or with a doctor or specially trained physical therapist, two behavioral treatments are often prescribed:

  • Kegel exercises: these exercises strengthen the pelvic floor which can help prevent leakage of urine. Some people can learn to tighten these muscles by practicing stopping urine midstream. A Kegel exercise should replicate that feeling of tightening. For women, doctors may help them locate these muscles using Kegel cones. Other options are using electrical treatments to stimulate and strengthen the muscles.
  • Bladder retraining treatment: these techniques are aimed to force the bladder muscles to get stronger so that the urge to urinate will not be as strong. One technique is to ignore urges and urinate on a set schedule. A second technique just instructs individuals to delay urination when they feel the urge. Sometimes, urinating and then going again immediately afterward can help individuals learn to empty their bladders more completely.

Medications for Urge Incontinence

A variety of drugs help to relax the bladder and reduce episodes including:

  • Tolterodine
  • Oxybutynin as a skin patch or gel
  • Trospium
  • Solifenacin
  • Fesoterodine
  • Mirabegron
  • Darifenacin

Unfortunately, a side effect of many of these medications is dry mouth and thirst, and drinking more water can actually increase urge incontinence. Another side effect, constipation, can also aggravate symptoms. Biotene for dry mouth or sugar-free candy or gum can be helpful to relieve side effects, and stool softeners might be prescribed to counteract constipation.

Medical Treatments for Urge Incontinence

For individuals who do not have enough relief through lifestyle and behavioral treatment, or those who have very significant life disruption because of urge incontinence, other treatments may be considered including:

  • Nerve stimulators: devices like pacemakers which are inserted under the skin and hooked up to the sacral nerve. The device sends pulses up the nerve to help control the bladder function.
  • Collagen implants: injections of collagen in the urethra wall can help weak sphincter muscles to work better. Although not permanent, this is a relatively easy treatment to provide relief.
  • Catheterization: If part of the patient's problem is an inability to void completely, using a catheter to periodically empty the bladder can help.
  • Bladder injections: small doses of Botox can be injected into bladder tissues to paralyze overactive bladder muscles but effects are temporary and can make emptying the bladder effectively more difficult, requiring catheterization regularly.
  • Bladder surgery: used only on people with severe symptoms who do not respond to other treatments, surgery to increase bladder capacity can be done by using pieces of the person's bowel to replace a portion of the bladder.
  • Bladder removal: only done as a last resort, this procedure removes the bladder and constructs an opening in the body to attach a bag for urine.

Urge incontinence is a difficult medical condition but can be successfully treated, though not necessarily cured, through lifestyle changes, behavioral therapies, medications, and when necessary medical treatments.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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