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.

Woman entering restroom, has urgent need to urinate

sasirin pamai / Getty Images

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.

Incontinence and Depression

A 2020 review of studies in the Journal of International Medical Research concluded that people with urinary incontinence are nearly twice as likely to experience depression and anxiety than those without.

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:

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

Who Is at Risk of Incontinence?

Females are twice as likely as males to experience urinary incontinence. While urge incontinence is more common in older adults and those with obesity, younger people and those of healthy weight can also experience incontinence.

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:

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.

How Effective Is Bladder Retraining?

A 2013 study published in the International Neurourology Journal reported that bladder training improved urge incontinence symptoms in 57% to 83% of people.

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.


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 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:

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:

When to Call 911

The inability to urinate is considered a medical emergency and can be life-threatening. This is especially true if accompanied by severe flank pain and nausea or vomiting.


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.

Frequently Asked Questions

  • How common is urinary incontinence?

    Urinary incontinence is a common problem affecting females more than males and older people more than younger people. According to a 2020 study in the Journal of International Medical Research, anywhere from 35% to 65% of the world's population has urinary incontinence to some degree.

  • How does urge incontinence differ from overflow incontinence?

    Urge incontinence is the loss of bladder control accompanied by the sudden, overwhelming urge to urinate. Overflow incontinence occurs when the bladder doesn't entirely empty and urine starts to accumulate, causing it to overflow. Unlike most types of urinary incontinence, overflow incontinence is more common in males than in females.

  • Is urge incontinence the same thing as overactive bladder?

    Although urge incontinence and overactive bladder (OAB) are often used interchangeably, there is one small difference. Urge incontinence is characterized by bladder leakage, while with OAB, you may have an urgent need to run to the bathroom, but bladder leakage is not always involved.

17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. MedlinePlus. Urge incontinence.

  2. Cheng S, Lin D, Hu T, et al. Association of urinary incontinence and depression or anxiety: a meta-analysis. J Int Med Res. 2020;48(6):0300060520931348. doi:10.1177/0300060520931348

  3. Hickling DR, Sun TT, Wu SR. Anatomy and physiology of the urinary tract: relation to host defense and microbial infection. Microbiol Spectr. 2015;3(4):10.1128/microbiolspec.UTI-0016-2012. doi:10.1128/microbiolspec.UTI-0016-2012

  4. Sharma N, Chakrabarti S. Clinical evaluation of urinary incontinence. J Midlife Health. 2018;9(2):55–64. doi:10.4103/jmh.JMH_122_17

  5. Aoki Y, Brown HW, Brubaker L. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. doi:10.1038/nrdp.2017.42

  6. Patel M, Vellanki K, Leehey DJ. Urinary incontinence and diuretic avoidance among adults with chronic kidney disease. Int Urol Nephrol. 2016;48(8):1321-6. doi:10.1007/s11255-016-1304-1

  7. Izci F, Koc MI, Blici R, Yalcin M, Bestepe EE. Urinary incontinence during sleep associated with extended release form of bupropion HCI. Case Rep Psychiatry. 2015;2015:906294. doi:10.1155/2015/906294

  8. Hall SA, Chiu GR, Kaufman DW, Wittert GA, Link CL, McKinlay JB. Commonly-used antihypertensives and lower urinary tract symptoms: results from the Boston Area Community Health (BACH) survey. BJU Int. 2012;109(11):1676–84. doi:10.1111/j.1464-410X.2011.10593.x

  9. Funada S, Yoshioka T, Luo Y, Sato A, Akamatsu S, Watanabe N. Bladder training for treating overactive bladder in adultsCochrane Database Syst Rev. 2020;2020(4):CD013571. doi:10.1002/14651858.CD013571

  10. Lee HE, Cho SY, Lee S, Kim M, Oh SJ. Short-term effects of a systematized bladder training program for idiopathic overactive bladder: a prospective study. Int Neurourol J. 2013;17(1):11–7. doi:10.5213/inj.2013.17.1.11

  11. DeMaagd GA, Davenport TC. Management of urinary incontinence. P T. 2012;37(6):345-61,361B-361H.

  12. Nightingale G. Management of urinary incontinence. Post Reprod Health. 2020;26(2):63-70. doi:10.1177/2053369120927112

  13. Meeratterapillay R, Thorpe AC, Harding C. Augmentation cystoplasty: contemporary indications, techniques and complications. Indian J Urol. 2013;29(4):322–7. doi:10.4103/0970-1591.120114

  14. O'Connor E, Nic an Riogh A, Karavitakis M, Monagas S, Nambiar A. Diagnosis and non-surgical management of urinary incontinence – a literature review with recommendations for practice. Int J Gen Med. 2021;14:4555–65. doi:10.2147/IJGM.S289314

  15. Siddiqui NY. Wiseman JB, Cella D, et al. Mental health, sleep, and physical function in treatment-seeking women with urinary incontinence. J Urol. 2018;200(4):848–55. doi:10.1016/j.juro.2018.04.076

  16. Sussman RD, Drain A, Brucker BM. Primary bladder neck obstruction. Rev Urol. 2019;21(2-3):53-62. 

  17. Leron E, Weintraub AY, Mastrolia SA, Schwarzman P. Overactive bladder syndrome: evaluation and management. Curr Urol. 2018;11(3):117–25. doi:10.1159/000447205

By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.