Definition of "Urge incontinence"

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Urge incontinence, is an overactive bladder (OAB) causing loss of bladder control, due to frequent feelings of needing to pee.

Patient information

What's urge incontinence?
It's where you accidentally wet yourself, because you frequently have a strong "urge" to pee.

How's that related to an overactive bladder. And what is a bladder?
The bladder is the organ that holds urine, after it is made by the kidney, but before you get rid of it when you go to the toilet. When we say that it's overactive, we are specifically talking about the "detrusor muscle".

Sx
  • Frequent urination, may occur during the day, at night, or both
  • The amount of urine passed during each urination is relatively small
  • Pain whilst urinating suggests there is a problem OTHER than an OAB

Patient information

What happens when you have a strong urge to pee?
You pee a lot. Which can be both day and night. Because you're peeing so much, each time you pee, you pee less. And there should not be any pain.

Pathophysiology
  • If the bladder's detrusor muscles contract strongly and without warning, the inhibitory muscles may not be able to keep urine from passing

Patient information

What's the detrusor muscle?
It's a smooth muscle, found in the wall of the bladder. It contracts when you urinate, and relaxes when you store urine. So, if it suddenly contracts strongly, you get no chance to prepare to get to the toilet...

Cause

Patient information

What causes a strong urge to pee?
If you have a lot of pee, because you've got diabetes, or drinking a lot. If you need to pee a lot, due to a urinary infection, or a big prostate if you're a bloke. Or if there's nerve damage, both centrally in the brain, or out further at the bladder.

Risk factors
  • Obesity
  • Caffeine
  • Constipation
  • Exacerbated by:
    • Poorly controlled diabetes
    • Poor functional mobility
    • Chronic pelvic pain

Patient information

What makes it more likely for you to have a strong urge to pee?
If you're overweight. Drink caffeine. Constipated. And it can be made worse if you have diabetes that is not well controlled. If you can't move around well. And if you've got chronic pelvic pain.

Dx
  • Sx
  • Diary to track problems, which can also determine whether Tx are working
  • Exclusion of other problems, e.g. UTI, or neurological conditions
Tx
  • Behavior Mx, including:
    • Weight loss in those overweight
    • Decreasing caffeine consumption
    • Drinking moderate fluids
    • Avoiding diuretics
  • Pelvic floor exercises
  • Bladder training
  • Anticholinergic/antimuscarinic drugs, which inhibit muscle muscle contraction of the bladder, to address overwhelming urge to pee, e.g. fesoterodine, tolterodine, oxybutynin (oxytrol patch), darifenacin, hyoscyamine, solifenacin (VESIcare), trospium
  • Beta3 adrenergic receptors, e.g. mirabegron. They are however, 2nd line due to risk of side effects
  • Injections of botox in the bladder
  • Urinary catheters or surgery are generally NOT recommended

Patient information

What can you do about a strong urge to pee?
You can make behavioral changes, like weight loss, drinking less caffeine, drinking less, not taking drugs that make you pee more. You can also exercise the muscles that control the bladder and the bowel, which we call pelvic floor muscles. You can train someone to wait until they really need to go to the toilet, before going, to strengthen the muscles of their bladder.

How about drugs or surgery?
You can give anticholinergics, which inhibit parasympathetics, which is your rest and digest system. Apart of rest and digest, is peeing. You can inject botox into the bladder, as it helps the muscle relax.

Should you catheterize someone with a strong urge to pee?
It does more harm than good, so we don't. And neither do we do surgery.

Prognosis
  • It is NOT life threatening
  • Most patients with the condition have problems for years
  • Paitents often have Sx for a long time, before seeking Tx, and the condition is sometimes identified by caregivers
  • Tx is not always required

Patient information

What's it like for my future if I have a strong urge to pee?
The key thing to remember is it's NOT life threatening. That's why we don't even catheterize patients, which is very low risk. These problems will generally continue for a long time.

Epidemiology
  • >40% of patients with an OAB have incontinence
  • 40-70% of urinary incontinence is due to an OAB
  • OAB occurs in 17% of men, and 26% of women
  • Becomes more common with age
  • Economic cost is $12.6bn USD, and $4.2bn Euro
See also

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Definition of Urge incontinence | Autoprac


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