Urge incontinence

Urge incontinence
Urinary bladder (Detrusor labeled at top)
Classification and external resources
ICD-10	N39.4
ICD-9	788.31
MedlinePlus	001270
MeSH	D053202

Urge incontinence is a form of urinary incontinence characterized by the involuntary loss of urine occurring for no apparent reason while feeling urinary urgency, a sudden need or urge to urinate.

Causes

The most common cause of urge incontinence is involuntary and inappropriate detrusor muscle contractions.^[1] Idiopathic Detrusor Overactivity – Local or surrounding infection, inflammation or irritation of the bladder. Neurogenic Detrusor Overactivity – Defective CNS inhibitory response.

Presentation and pathophysiology

Medical professionals describe such a bladder as "unstable", "spastic", or "overactive". Urge incontinence may also be called "reflex incontinence" if it results from overactive nerves controlling the bladder.

Patients with urge incontinence can suffer incontinence during sleep, after drinking a small amount of water, or when they touch water or hear it running (as when washing dishes or hearing someone else taking a shower).^[2]

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's Disease, stroke, spina bifida^[3] and injury—including injury that occurs during surgery—can all harm bladder nerves or muscles.

Treatment

Timed voiding or bladder training

Timed voiding (urinating) is a form of bladder training that uses biofeedback to reduce the frequency of accidents resulting from poor bladder control. This method is aimed at improving the patient’s control over the time, place and frequency of urination.

Timed voiding programs involve establishing a schedule for urination. To do this a patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak. Some individuals find it helpful to use a vibrating reminder watch to help them remember to use the bathroom. Vibrating watches can be set to go off at certain intervals or at specific times throughout the day, depending on the watch.^[4] Through this bladder training exercise, the patient can alter their bladder’s schedule for storing and emptying urine.^[5]

Surgery

Urodynamic testing seems to confirm that surgical restoration of vault prolapse can cure motor urge incontinence.^[6]

Behavior

Behavior techniques for incontinence include retraining the bladder to hold more urine. The goal is to lengthen the time between periods of urination. This includes relaxation techniques and learning how to cope with urges to urinate. Fluid management is the cornerstone of all urinary incontinence. Techniques include not drinking lots of fluids and avoiding certain foods and beverages which stimulate or irritate the bladder, for example alcohol, caffeine and acidic foods.^[7]

A randomized controlled trial in men of behavioral therapy versus the anticholinergic medication oxybutynin (no control group) found similar effectiveness.^[8] The behavioral treatment included:

• Pelvic floor muscle training
  • "Contract and relax pelvic floor muscles while keeping abdominal muscles relaxed"
  • "Contract their muscles for 2- to 10-second periods separated by 2 to 10 seconds of relaxation.
    • "Initial contraction duration was based on the ability demonstrated by each participant in the training session.”
  • "Daily practice included 45 exercises”
    • "Divided into manageable sessions”
    • "Usually three sessions of 15 exercises each”
  • "Duration was increased gradually to a maximum of 10 seconds"
• Urge suppression techniques when awakened at night with the urge to void
  • "Remain still in bed and attempt to diminish the urgency with repeated pelvic floor muscle contractions.
  • "If successful, they could go back to sleep; if not, they could void and return to bed."
• Fluid restriction (after 6:00 p.m.)

Medications

• Oxybutynin,^[9] Tolterodine,^[9] Darifenacin,^[9] Solifenacin,^[9] Topical vaginal estrogen,^[9] Tricyclic antidepressants,^[9] Mirabegron,^[10] Botulinum toxin.^[11] Many other putative drugs are under investigation.^[12][13][14]

See also

• Overflow incontinence
• Overactive bladder

References