Urge incontinence

This factsheet is for people who have urge incontinence, or who would like information about it.

Urinary incontinence is the unintentional leaking of urine. Urge incontinence is when you have a sudden and urgent need to pass urine that is usually followed by an uncontrollable leak.

About urge incontinence

A sudden intense need to pass urine and having to rush to get to the toilet is called 'urgency '. If you have urge incontinence, you may leak if you don’t get to a toilet in time. Most cases of urge incontinence are caused by an overactive bladder (the muscles contract involuntarily before the bladder is full), although sometimes the cause is never found. Urge incontinence is the most common type of incontinence in older people.

Other types of urinary incontinence include the following.

• Stress incontinence – when you suddenly leak urine because of an increase of pressure on your bladder. This could be from sneezing, coughing or lifting something heavy.
• Mixed urinary incontinence – when you unintentionally pass urine because of both stress and urge incontinence.
• Overflow incontinence (also known as chronic urinary retention) – this happens when your bladder doesn't empty properly, causing urine in it to spill out. It can be caused by weak bladder muscles or a blocked urethra (the tube that carries urine from your bladder out of your body). Overflow incontinence is rare in women.

Symptoms of urge incontinence

Urge incontinence is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and you may find that you only have a few seconds’ warning that you need to pass urine. You may not be able to reach a toilet in time and as you result, you may leak urine unintentionally.

Some people have a similar feeling of urgency when they hear running water. You may also need to urinate more often than other people, including throughout the night.

Causes of urge incontinence

Urge incontinence can be temporary or permanent. It can be caused by your lifestyle, underlying medical conditions or physical problems. However, often there is no clear cause.

Causes of temporary urge incontinence include those listed below.

• An infection in your urinary tract, such as cystitis. Your urinary tract consists of your kidneys, two ureters (the tubes that connect each kidney to your bladder), your bladder and your urethra.
• Alcohol and caffeine. These are diuretics (which cause the body to lose water by increasing the amount of urine your kidneys produce) and bladder stimulants, meaning that they can cause you to need to urinate suddenly.
• Overhydration – drinking a lot of fluid increases the amount of urine you produce.
• Constipation.
• Medicines, such as sedatives, muscle relaxants and blood pressure medicines.

It’s thought that persistent urge incontinence may be caused by changes in a part of the brain that controls urination. These changes disrupt the nervous system's ability to control the bladder.

Causes of permanent urge incontinence include:

• diseases that affect your nerves, such as multiple sclerosis and Parkinson’s disease
• the menopause – in postmenopausal women, a lack of oestrogen contributes to thinning of the vaginal tissue, which causes irritation and can worsen urinary urgency
• an illness or injury that interferes with mobility – this makes it harder for you to get to the bathroom quickly
• brain disorders, such as stroke and dementia
• bladder cancer or bladder stones
• irritable bowel syndrome

Diagnosis of urge incontinence

Your GP will first ask you about your symptoms and medical history. He or she will usually do a test on a sample of your urine to check that your incontinence isn’t being caused by an infection in your urinary tract. Your GP may also do a blood test to check that your kidneys are working properly.

Your GP may ask you to keep a ‘bladder diary’ for at least three days. This involves recording how much you drink, when you pass urine, the amount of urine you produce, whether you had an urge to urinate and the number of times you unintentionally leak.

You may be referred to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system) or, if you're a woman, a gynaecologist (a doctor who specialises in women’s reproductive health) or urogynaecologist (a doctor who focuses on urinary and associated pelvic problems in women).

Your GP may examine you. A rectal (back passage) examination will check if you’re constipated or whether the nerves to your bladder are damaged. In men, a rectal examination will determine if the prostate is enlarged. If you’re a woman, your GP will check for weakness of your pelvic floor and look for a prolapse – this is when organs near your vagina, such as your womb, bowel or bladder, slip down from their normal position.

Examining you may also enable your GP to determine if you have a problem with mental function or an underlying condition, for example, multiple sclerosis, that may be causing your incontinence.

You may need to have urodynamic testing. These tests measure the pressure in your bladder and the flow of urine. A thin, flexible tube, called a catheter, is inserted into your bladder through your urethra. Water is then passed through the catheter and the pressure in your bladder is recorded.

Treatment of urge incontinence

Self-help

There are several ways you can help yourself if you have been diagnosed with urge incontinence. These include the following.

• If you’re overweight or obese, lose excess weight. Eat a healthy, balanced diet and try to do 150 minutes (two and a half hours) of moderate exercise over a week. You can do this by carrying out 30 minutes on at least five days each week.
• Try not to have too much caffeine, or have decaffeinated coffee or tea instead.
• Eat plenty of fruit and vegetables, and other foods that contain fibre. This will help stop you from becoming constipated.
• You might need to drink more or less fluid. Your GP will be able to advise you on this.
• Pass urine frequently so you don’t get a full bladder.
• Wear absorbent pads to absorb any leaks – you can buy these from pharmacies and some supermarkets.

Your GP may recommend bladder training, either alone or in combination with other therapies. Bladder training involves relearning how to urinate, and how to ignore or suppress the need to pass urine by gradually increasing the time between urinating. It’s most often used by women with urge incontinence, however, it’s also used for stress and mixed incontinence. For more information, see Common questions.

Physical therapies

Your GP will usually ask you to do pelvic floor muscle exercises (Kegel exercises). These exercises, if done correctly, can strengthen your bladder muscles and help you control urinating. To do pelvic floor muscle exercises, squeeze the muscles you would use to stop urinating and hold for a count of three. Your GP will recommend that you do these exercises frequently for several months. These exercises are helpful, but more commonly used to help stress incontinence. For more information, see Common questions.

If you're having problems doing your pelvic floor muscles, your GP or nurse may recommend biofeedback. Biofeedback therapy uses a computer and electronic instruments to tell you when you're using the right pelvic floor muscles.

If you’re a woman, your GP might recommend vaginal cones. These are weights that you hold in your vagina that help you strengthen the pelvic floor.

Medicine

Your GP might prescribe you medicine if pelvic floor muscle exercises and bladder training haven’t been effective.

Anticholinergics are the most commonly prescribed medicine for urge incontinence. They relax your bladder muscles and help reduce the number of times you need to pass urine. Anticholinergics are available as tablets, a liquid or a patch. The two most commonly prescribed medicines in this category are oxybutynin and tolterodine. Newer drugs in this category include solifenacin, darifenacin, fesoterodine and trospium. Your GP might consider these medicines if oxybutynin and tolterodine aren’t effective.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatments

Botulinum A toxin (eg Botox) can be injected into your bladder to help relax its overactive muscles. A flexible tube-like instrument called a cystoscope is passed through your urethra into your bladder and a fine needle is used to inject the botulinum A toxin. This procedure can be done under either a general anaesthetic (meaning you will be asleep during the procedure) or a local anaesthetic (this completely blocks pain from the area and you will stay awake during the procedure). The effects last for nine to 12 months.

You may be offered neuromodulation (also known as sacral nerve stimulation) if physical treatments or medicines don’t work for you. This involves stimulating the nerves to your bladder and helps to correct wrong or unwanted messages sent along these nerves. A small device is surgically implanted under the skin and fat of your lower back to stimulate your sacral nerve with mild electrical pulses.

You might be offered percutaneous tibial nerve stimulation. This stimulates the nerves responsible for bladder control. A small, fine needle is inserted at your ankle near your tibial nerve. This is then connected to a stimulator device and electrical impulses travel along your nerves to help retrain your bladder function.

Surgery

If other treatments haven’t been effective, you may wish to consider surgery. As with every procedure, there are some risks associated with having surgery for bladder problems. Talk to your GP or surgeon about your options and the risks that are associated with each one.

Surgical options include the following.

• Bladder augmentation. This is a major operation that increases the size of your bladder. Your surgeon will cut open your bladder and sew a patch of tissue taken from your bowel between the two halves. You will need to stay in hospital after your operation for about 10 days, but it can take up to four months to completely recover.
• Detrusor myectomy. This is a major operation that involves removing some or all of the outer muscle layer that surrounds your bladder. This procedure aims to reduce the number of bladder contractions you have and the strength of them. About half of all people who have this operation are cured and around two-thirds have improvements in their symptoms. This procedure is not commonly practiced.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.