Urge Incontinence

Urge incontinence is the sudden, uncontrollable urge to urinate (pee) accompanied by the loss of bladder control. It can affect people of any sex and has various causes, from infections and nervous system problems to bladder cancer.

Urge incontinence can be a source of embarrassment and anxiety, interfering with a person's relationships, sleep, and quality of life. It is important to see a healthcare provider if symptoms are distressing, worsening, or accompanied by severe flank pain and blood in the urine.

Symptoms of Urge Incontinence

Urinary incontinence is the loss of bladder control. Urge incontinence is one of several forms of urinary incontinence. It is characterized by the following symptoms:

• The inability to control when you pee
• The need to pee suddenly and urgently
• The frequent need to pee during the day and night
• Wetting the bed

In addition to these physical symptoms, urge incontinence can also affect your mental health and well-being.

Causes of Urge Incontinence

To better understand the causes of urge incontinence, it helps to know how urination works.

The bladder is a hollow organ that receives urine from the kidneys. As it begins to fill, the walls of the organ will gradually stretch. When it fills with around 1 cup (240 milliliters) of urine, nerve signals will be sent to the brain signaling the urge to urinate.

To prevent urine from leaking, a circular muscle called a urethral sphincter will tighten around the neck of the bladder as the bladder itself relaxes to hold more urine. When it is time to urinate, the opposite occurs: The bladder will squeeze as the urethral sphincter relaxes.

Urge incontinence occurs because the bladder muscles either squeeze at the wrong time or squeeze convulsively (spasm). At the same time, the bladder sphincter is either unable or less able to hold the urine back.

Many conditions can interfere with bladder control and lead to urge incontinence. These include:

• Cystitis (bladder inflammation)
• Bladder infection
• Urinary tract infection (UTI)
• Bladder outlet obstruction (BOO)
• Bladder stones
• Enlarged prostate
• Diabetes
• Hysterectomy or other pelvic surgery
• Menopause
• Pregnancy or childbirth
• Spinal cord injury
• Prior pelvic radiation
• Nervous system problems, like Alzheimer's disease, Parkinson's disease, multiple sclerosis (MS), or stroke
• Prostate cancer
• Bladder cancer

In many cases, the underlying cause of urge incontinence will never be found.

What Medications Can Cause Urge Incontinence?

Because the underlying causes are complex, medications are not seen to "cause" urge incontinence per se but may contribute to it, especially in those already at risk.

Among the classes of drugs associated with urinary incontinence are:

• Diuretics: These medications, also known as water pills, help treat hypertension (high blood pressure) by promoting urination.
• Selective serotonin reuptake inhibitors (SSRIs): This is a class of antidepressants that includes such drugs as Prozac (fluoxetine) and Paxil (paroxetine).
• Calcium channel blockers: These are drugs like Procardia (nifedipine) and Norvasc (amlodipine) that help treat hypertension and heart rhythm disorders.

How to Treat Urge Incontinence

The treatment of urge incontinence varies by the underlying cause. In some cases, finding the right treatment can take time and requires a process of trial and error. The options range from exercises and lifestyle changes to medications and surgery. Oftentimes, a combination of treatments is needed.

Bladder Retraining

Bladder retraining involves relearning the skills needed to hold and release urine. It involves setting regularly scheduled pee breaks during the day and avoiding peeing outside of these breaks.

You might start by scheduling breaks every 30 minutes, holding urination for as long as possible if the urge to pee is strong. Over time, you would increase the intervals by 15 minutes until you can hold it for three to four hours.

Pelvic Floor Muscles Training

Pelvic floor muscles contribute to bladder control but can weaken with age or certain medical conditions. By training these muscles as you would any other muscle, you may be able to avoid bladder leakage.

Training options include:

• Kegel exercises: This exercise strengthens the pelvic floor muscles when you consciously squeeze them, typically in intervals of 10 repetitions three times a day.
• Vaginal cones: This is a weighted device inserted into the vagina that you wear up to 15 minutes at a time, twice daily.
• Electrical stimulation: This is an office-based procedure in which an electrical probe is inserted into the vagina or anus to cause powerful contractions of the pelvic floor muscles.
• Percutaneous tibial nerve stimulation (PTNS): This is another office-based procedure in which electrical stimulation is delivered through a needle inserted into the back of the ankle.

Lifestyle Changes

The aim of lifestyle changes is to pay attention to how much water you drink and when you drink it. You may also need to avoid foods and beverages that either promote urination or cause bladder irritation.

Here are some tips to better manage urge incontinence:

• Drink only small amounts of fluid throughout the day, generally less than 8 ounces (240 milliliters) at one time.
• Avoid drinking a lot of water with meals.
• Avoid fluids two hours before bedtime.
• Limit your intake of caffeine or alcohol, both of which are diuretics.
• Avoid highly spicy or acidic foods that can irritate the bladder.
• Avoid artificial sweeteners that can increase urination.

Medications

Several prescription medications can help ease or control bladder contractions that contribute to urge incontinence. Some of the more common are:

• Anticholinergics: These drugs work by relaxing the bladder muscles and include Detrol (tolterodine), Enablex (darifenacin), Oxytrol (oxybutynin), Sanctura (trospium), and VESIcare (solifenacin).
• Myrbetriq (mirabegron) and Gemtesa (vibegron): These are prescription drugs approved specifically for the treatment of overactive bladder (OAB).
• Tofranil (imipramine): This is a type of antidepressant sometimes used to treat mixed incontinence (a combination of urge incontinence and stress incontinence).
• Urispas (flavoxate): This is a smooth muscle relaxant that may help ease bladder spasms in some people.
• Botox (botulinum): This is an injectable drug that can provide longer-term control of bladder spasms. It is delivered by entering the bladder through the urethra (the tube through which urine exits the body).
  

Surgery

Surgery may be explored if all other options fail to help treat urge incontinence. These are last-resort options that carry significant risks, including the risk of urinary retention (the inability empty the bladder) and bowel obstruction.

Two surgeries sometimes used are:

• Sacral nerve stimulation: This involves the implantation of a small device that sends electrical pulses to a network of nerves (called the sacral plexus) that provide sensory information to the pelvic organs. Stimulating these nerves may help normalize bladder function.
• Augmentation cystoplasty: This is a surgery used to increase the size of the bladder by taking a section of the bowel and grafting it onto the bladder. By doing so, more urine can be stored.

Are There Tests to Diagnose the Cause of Urge Incontinence?

If you are struggling with urge incontinence, your primary care provider will likely refer you to a specialist called a urologist, who diagnoses and treats disorders involving the urinary system.

The diagnosis will start with a review of your symptoms and medical history and be accompanied by a physical exam. This would generally involve a pelvic exam in females and a genital exam (and sometimes a digital rectal exam) in males.

Lab Tests

As part of the diagnosis, the urologist will order urine and blood tests to check for conditions associated with urge incontinence. The tests may include:

• Urinalysis: Used to check for infection or evidence of blood in the urine
• Urine culture: Used to detect and identify specific bacterial or fungal infections
• Prostate-specific antigen (PSA): A blood test that can detect prostate inflammation
• Urine cytology: Used to help detect bladder cancer

Imaging Tests

Imaging studies, both direct and indirect, are commonly used to evaluate the structure and function of the bladder. These include:

• Pelvic or abdominal ultrasound: This is a noninvasive imaging technique that uses reflected sound waves to create images of the bladder and adjacent structures.
• X-ray with contrast dye: This imaging technique uses ionizing radiation and injectable dyes to create high-contrast images of the bladder and kidneys.
• Computed tomography (CT): This imaging technique composites multiple X-ray images to create three-dimensional "slices" of the bladder and adjacent structures.
• Magnetic resonance imaging (MRI): This imaging technique uses powerful magnetic and radio waves to create highly detailed images of soft tissues and vessels.
• Cystoscopy: This is a direct method of visualizing the bladder in which a flexible scope, called a cystoscope, is inserted into the urethra and fed to the bladder.
  

Urination Studies

Certain in-office and at-home tests may be recommended to determine the characteristics and severity of your condition. These include urodynamic studies that evaluate how well your bladder and urethra sphincter work.

These tests can help direct the appropriate treatment and help establish if the cause is muscular (related to the bladder or pelvic floor muscles), neurological (nerve-related), or functional (related to a person's functional limitations).

Options for testing include:

• Pad test: This involves wearing an incontinence pad to collect all of the urine leaked in a day. The pad is then weighed to measure the total volume of urine collected.
• Voiding diary: This involves accurately recording your fluid intake, urine output, and urination frequency.
• Urinary stress test: This is a simple in-office test in which you stand with a full bladder and cough to see how much urine is released.
• Uroflowmetry: This in-office test measures how much and how fast you urinate with a full bladder.
• Cystometry: This test uses a urinary catheter to measure the pressure inside your bladder. 
  
• Post-void residual measurement: The test measures the amount of urine left in the bladder after peeing. The amount can either be measured with ultrasound or by draining the bladder with a catheter.
• Electromyography: This test can check for nerve or muscle damage by placing sensors around the bladder and sphincter and measuring the level of electrical activity.
  

When to See a Healthcare Provider

Urge incontinence does not need to be severe for you to seek treatment. If it is affecting your quality of life, interfering with sleep, or causing social isolation, speak with a healthcare provider.

Studies show that urinary incontinence can increase your risk of depression, anxiety, and sleep disturbances. These conditions tend to get worse the longer or more severe your urinary symptoms are.

There are also times in which urge incontinence is a sign of a serious medical condition, such as bladder outlet obstruction (BOO). While symptoms alone cannot diagnose BOO, certain signs warrant immediate medical investigation, including:

• Blood in the urine
• Frequent urge to urination
• Pain or burning with urination
• Difficulty emptying the bladder
  
• Flank pain (pain in the abdomen, lower back, or sides)
• Nausea or vomiting

Summary

Urge incontinence is the sudden, uncontrollable urge to urinate accompanied by the loss of bladder control. The causes of urge incontinence are many, including infections, bladder obstruction, enlarged prostate, pelvic surgery, and neurological conditions like stroke. Some cases have no known cause.

Urge incontinence can often be diagnosed with a physical exam, urine and blood tests, imaging tests, and urodynamic studies. Treatments include bladder retraining, pelvic floor muscle training, lifestyle changes, medications, and, in rare cases, surgery.

A Word From Verywell

Urge incontinence is a condition that some people regard as "just one of those things" that happens as you get older. While it is true that older adults have a higher incidence of this condition, urge incontinence is not a facet of aging.

There are many people of any sex over 60 and even 70 who have completely normal urinary function. By dismissing urinary incontinence as a fact of life, you may miss the opportunity to start treatments that can ease or even fully resolve symptoms. More importantly, you may discover an underlying medical condition in need of immediate treatment.

If in doubt, call a healthcare provider or schedule a telehealth appointment with your primary care provider or a certified urologist.