Urge Incontinence: Diagnosis and Treatment
Urge Incontinence Symptoms
Urge Incontinence is associated with a strong and overpowering urge to urinate that cannot be delayed followed by loss of a large amount of urine. The bladder contracts without warning and urine loss occurs involuntarily. Urge incontinence is also known as overactive, spastic, or unstable bladder. If you experience urge incontinence, "when you've got to go, you've got to go!"
There is no holding time that allows you to get to the bathroom quickly enough to prevent urine leakage. Urge incontinence is the most common type of incontinence in older people.
Causes
Urge incontinence occurs when the reflexes that control the bladder are disrupted. When the bladder contracts powerfully, the bladder outlet muscles cannot remain closed. When bladder-filling signals that are transmitted to the brain are not inhibited properly, strong urge sensations are felt even when the bladder is not full. Involuntary urine leakage occurs when these unusually strong urge sensations occur.
While a number of medical problems or other conditions may be associated with urge incontinence, in many instances the direct cause is unknown. In some cases, urge incontinence may be the result of medical problems such as...
- Neurological problems - Diabetes Mellitus, Parkinson's disease, stroke, spinal cord injuries, multiple sclerosis, dementia, Alzheimer's disease
- Urinary tract infection
- Urethritis or vaginitis
- Kidney or bladder stones or tumors
- Interstitial cystitis
- Decreased estrogen in the post-menopausal woman
- Previous bladder or pelvic surgery
- Side effect from diuretics (water pills)
Other conditions that may lead to urge incontinence includes...
- Constipation
- Bladder irritants such as caffeine
- Dehydration
- Excess urine production
Diagnosis
The primary goal of diagnosis is to identify the causes and the factors contributing to urge incontinence. Often there are multiple causes. Initial evaluation, therefore, include the following components.
- History - Your doctor needs to find out about the circumstances associated with the onset of urge incontinence and to determine any medical conditions that affect urinary tract function.
- Bladder Diary - This is used to determine the timing, symptoms, and associated or precipitating factors of the incontinence.
- Physical Exam - An exam is preformed to assess cognitive, neuromuscular, gastrointestinal, gynecological, or urological abnormalities.
- Urinalysis and Urine Culture and Sensitivity - These tests are performed to evaluate urinary system functioning and to test for urinary tract infection.
- Simple Cystometry - This is used to assess the function of the bladder when it is filled with fluid.
- Stress Maneuver - This is used to screen for incontinence during a cough or sneeze with a full bladder.
Other laboratory and radiological testing may be conducted if necessary to further evaluate possible abnormalities
Treatment
There are a number of treatments that may be used alone or together to treat urge incontinence. They include...
- Bladder training
- Identification and elimination of bladder irritants
- Bowel management to prevent constipation and fecal impaction
- Pelvic muscle exercises
- Bladder Urge Control
- Medications - Anticholinergic, antidepressants, and hormone replacement therapy (see "Drug Treatment for Urge Incontinence)
Treatment is tailored to the needs, symptoms, capabilities and preferences of the individual.
