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Urge incontinence

Overactive bladder; Detrusor instability; Detrusor hyperreflexia; Irritable bladder; Spasmodic bladder; Unstable bladder; Incontinence - urge; Bladder spasms; Urinary incontinence - urge

Urge incontinence occurs when you have a strong, sudden need to urinate. The bladder then squeezes, or spasms, and you lose urine.

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Female urinary tract
Male urinary tract

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Bladder function - neurological control

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Causes

As your bladder fills with urine from the kidneys, it stretches to make room for the urine. You should feel the first urge to urinate when there is a bit less than 1 cup (240 milliliters) of urine in your bladder. Most people can hold more than 2 cups (480 milliliters) of urine in the bladder.

Two muscles help prevent the flow of urine:

When you urinate, the bladder wall muscle squeezes to force urine out of the bladder. As this happens, the sphincter muscle relaxes to allow the urine to pass through.

All of these systems must work together to control urination:

The bladder may contract too often from nervous system problems or bladder irritation.

URGE INCONTINENCE

With urge incontinence, you leak urine because the bladder muscles squeeze, or contract, at the wrong times. These contractions often occur no matter how much urine is in the bladder.

Urge incontinence may result from:

In men, urge incontinence also may be due to:

In most cases of urge incontinence, no cause can be found.

Although urge incontinence may occur in anyone at any age, it is more common in women and older adults.

Symptoms

Symptoms include:

Exams and Tests

During a physical exam, your health care provider will look at your belly and rectum.

In most cases, the physical exam will not find any problems. If there are nervous system causes, other problems also may be found.

Tests include the following:

Treatment

Treatment depends on how bad your symptoms are and how they affect your life.

There are four main treatment approaches for urge incontinence:

BLADDER RETRAINING

Managing urge incontinence most often begins with bladder retraining. This helps you become aware of when you lose urine because of bladder spasms. Then you relearn the skills you need to hold and release urine.

PELVIC FLOOR MUSCLE TRAINING

Sometimes, Kegel exercises, biofeedback, or electrical stimulation may be used with bladder retraining. These methods help strengthen the muscles of your pelvic floor:

Kegel exercises -- These are mainly used to treat people with stress incontinence. However, these exercises may also help relieve the symptoms of urge incontinence.

Vaginal cones -- This is a weighted cone that is inserted into the vagina to strengthen the pelvic floor muscles.

Biofeedback -- This method can help you learn to identify and control your pelvic floor muscles.

Electrical stimulation -- This uses a gentle electrical current to contract your bladder muscles.

Percutaneous tibial nerve stimulation (PTNS) -- This treatment may help some people with overactive bladder.

LIFESTYLE CHANGES

Pay attention to how much water you drink and when you drink.

It also may help to stop eating foods that may irritate the bladder, such as:

Avoid activities that irritate the urethra and bladder. This includes taking bubble baths or using harsh soaps.

MEDICINES

Medicines used to treat urge incontinence relax bladder contractions and help improve bladder function. There are several types of medicines that may be used alone or together:

These medicines may have side effects such as dizziness or dry mouth. Talk with your provider if you notice bothersome side effects.

If you have an infection, your provider will prescribe antibiotics. Be sure to take the entire amount as directed.

SURGERY

Surgery can help your bladder store more urine. It can also help relieve the pressure on your bladder. Surgery is only used for people who have too many spasms and are not able to store much urine.

Augmentation cystoplasty is the surgery most often performed for severe urge incontinence. In this surgery, a part of the bowel is added to the bladder. This increases the bladder size and allows it to store more urine.

Possible complications include:

There is a risk of forming tube-like passages from the bladder to other organs or your skin. These are called urinary fistulae. They can lead to:

Sacral nerve stimulation -- A small unit is implanted under your skin. This sends small electrical pulses to the sacral nerve (one of the nerves that comes out at the base of your spine). The electrical pulses can be adjusted to help relieve your symptoms.

Urinary incontinence is a long-term (chronic) problem. While treatments can cure your condition, you should still to see your provider to make sure you are doing well and check for possible problems.

Outlook (Prognosis)

How well you do depends on your symptoms, diagnosis, and treatment. Many people must try different treatments (some at the same time) to reduce symptoms.

Getting better takes time, so try to be patient. A small number of people need surgery to control their symptoms.

Possible Complications

Physical complications are rare. The condition may get in the way of social activities, careers, and relationships. It can also make you feel bad about yourself.

Rarely, this condition can cause severe increases in bladder pressure, which can lead to kidney damage.

When to Contact a Medical Professional

Call your provider if:

Prevention

Starting bladder retraining techniques early may help relieve your symptoms.

Related Information

Stress urinary incontinence
Urinary incontinence
Enlarged prostate
Urinary incontinence - injectable implant
Urinary incontinence - retropubic suspension
Urinary incontinence - urethral sling procedures
Urinary incontinence - tension-free vaginal tape
Urinary incontinence - what to ask your doctor
Urinary catheters - what to ask your doctor
Sterile technique
Urinary incontinence surgery - female - discharge
When you have urinary incontinence
Indwelling catheter care
Kegel exercises - self-care
Urine drainage bags
Self catheterization - female
Urinary incontinence products - self-care

References

Drake MJ. Overactive bladder. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 76.

Hersh L, Salzman B. Clinical management of urinary incontinence in women. Am Fam Physician. 2013;87(9):634-640. PMID: 23668526 www.ncbi.nlm.nih.gov/pubmed/23668526.

Newman DK, Burgio KL. Conservative management of urinary incontinence: behavioral and pelvic floor therapy and urethral pelvic devices. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 80.

Resnick NM. Incontinence. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 26.

Stiles M, Walsh K. Care of the elderly patient. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 4.

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Review Date: 8/26/2017  

Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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