Welcome to our Incontinence Inside Scoop series! For our second deep dive into all things incontinence, we are going to take a look at urge incontinence.
What is Urge Incontinence?
Urge incontinence, also known as overactive bladder, is a sudden and intense need to urinate, often resulting in involuntary urine leakage before reaching a toilet. This condition can occur at any age but is more prevalent in older adults. Unlike stress incontinence, which is triggered by physical activities that increase abdominal pressure, urge incontinence is caused by the involuntary contraction of the bladder muscles. These contractions can happen unexpectedly, even when the bladder is not full, leading to frequent and urgent urination.
Causes of Urge Incontinence?
The underlying causes of urge incontinence are varied and can include neurological disorders such as Parkinson’s disease, multiple sclerosis, or spinal cord injuries, which disrupt the nerve signals between the brain and bladder. Other contributing factors can be bladder irritants like caffeine or alcohol, urinary tract infections, bladder stones, or conditions such as diabetes that affect bladder function. In some cases, no specific cause can be identified, and the condition is then referred to as idiopathic overactive bladder.
Diagnosis of urge incontinence involves a thorough medical history and physical examination, along with tests such as urinalysis to rule out infections, bladder diaries to track symptoms, and urodynamic studies to assess bladder function. Cystoscopy may also be performed to look inside the bladder and urethra for abnormalities.
Treatments for Urge Incontinence
Treatment for urge incontinence typically starts with conservative measures aimed at behavioral modification. Bladder training, which involves scheduled voiding and gradually increasing the intervals between urination, can help improve bladder control. Dietary changes, such as reducing intake of bladder irritants and managing fluid consumption, are also beneficial. Pelvic floor muscle exercises can help strengthen the muscles that support the bladder and urethra, though they are generally less effective for urge incontinence compared to stress incontinence.
When behavioral strategies are insufficient, pharmacological treatments are often prescribed. Medications such as anticholinergics or beta-3 adrenergic agonists work by relaxing the bladder muscle and increasing its storage capacity. In cases where medication is ineffective or causes significant side effects, other treatments such as Botox injections into the bladder muscle or nerve stimulation techniques like percutaneous tibial nerve stimulation (PTNS) or sacral neuromodulation may be considered. These therapies aim to alter the nerve signals that trigger bladder contractions, thus reducing the frequency and urgency of urination. For severe and refractory cases, surgical interventions might be explored, though they are less commonly needed.
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