Urogynaecology Urge Incontinence / Overactive Bladder

Urge Incontinence

Urge incontinence is a common form of incontinence. You have an urgent desire to pass urine and sometimes urine leaks before you have time to get to the toilet. It is usually due to an overactive bladder. Treatment with bladder retraining often helps the problem. Medication may also be helpful. Pelvic floor exercises are often of benefit as can simple things like excluding caffeine from your intake.

What is urge incontinence?

  • Urgency is a symptom where you get a sudden urgent desire to pass urine. You are not able to put off going to the toilet.
  • Urge incontinence is when urine leaks before you get to the toilet when you have urgency.
  • Urgency and urge incontinence are often symptoms of an unstable or overactive bladder, also known as detrusor instability. (The detrusor muscle is the medical name for the bladder muscle.)
  • If you have urgency or urge incontinence, you also tend to pass urine more often than normal (this is called frequency). Sometimes this is several times during the night as well as many times during the day. Some women also find that they leak urine during sex, especially during orgasm.

How common is urge incontinence?

Urge incontinence is the second most common cause of incontinence. About 3 in 10 cases of incontinence are due to urge incontinence. It can occur at any age but commonly first starts in early adult life. Women are more commonly affected than men.

What causes urge incontinence?

  • In this condition, the bladder muscle (detrusor) seems to become overactive and squeeze (contract) when you don’t want it to.
  • Normally, the bladder muscle is relaxed as the bladder gradually fills up. When the bladder is about half full, you start to get a feeling of wanting to pass urine. In people with overactive bladder and urge incontinence, the bladder muscle seems to give the message to the brain that the bladder is fuller than it actually is. This results in the bladder contracting too early, giving you the feeling that you have to pass urine urgently.
  • In most people, the reason why an overactive bladder develops is not known. In such cases, the condition is called overactive bladder syndrome or idiopathic urge incontinence. Symptoms may get worse at times of stress. They may also be made worse by caffeine in tea, coffee, cola, etc and by alcohol (see below).
  • Some women develop urge incontinence after the menopause and this is thought to be due to the lining of the vagina shrinking (vaginal atrophy) due to a drop in the level of the female hormone oestrogen.
  • In some cases, symptoms of an overactive bladder develop as a complication of a nerve- or brain-related disease. Examples are following a stroke or spinal cord damage, or with illnesses such as Parkinson’s disease or multiple sclerosis (MS). Similar symptoms may occur if there is irritation in the bladder. Bladder irritation can occur when you have a urinary tract infection (UTI) or stones in your bladder.

Some general lifestyle measures which may help

  • Getting to the toilet. Make this as easy as possible. If you have difficulty getting about, consider special adaptations like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.
  • Caffeine. This is in tea, coffee, cola, and is part of some painkiller tablets. Caffeine has a diuretic effect. This means that the kidneys increase their urine production. Caffeine may also directly stimulate the bladder to make urgency symptoms worse. A trial of avoiding caffeine for a week or so to see if symptoms improve is definitely worth doing. If symptoms do improve, you may wish to cut down your caffeine intake.
  • Alcohol. In some people, alcohol may make symptoms worse. The same advice applies as with caffeine-containing drinks.
  • Drink normal quantities of fluids. It may seem sensible to cut back on the amount that you drink so that the bladder does not fill so quickly. However, this can make symptoms worse as the urine becomes more concentrated. This may irritate the bladder muscle (detrusor). On the other hand, if you drink excessively, moderation may improve your symptoms.
  • Go to the toilet only when you need to. Some people get into the habit of going to the toilet more often than they need (“just in case”).  However, this can actually make symptoms worse in the long run. If you go to the toilet too often, the bladder becomes used to holding less urine. The bladder may then become even more sensitive and overactive at times when it is stretched a little.
  • Try to lose weight if you are overweight. It has been shown that even 5-10% weight loss can help symptoms. This applies to people with both stress and urge incontinence.

Overactive Bladder

Overactive bladder syndrome is common. Symptoms include an urgent feeling to go to the toilet, going to the toilet frequently, and sometimes leaking urine before you can get to the toilet (urge incontinence). Treatment with bladder training often cures the problem. Sometimes medication may be advised in addition to bladder training to relax the bladder.

What is overactive bladder syndrome?

An overactive bladder is when the bladder contracts suddenly without you having control, and when the bladder is not full. Overactive bladder syndrome is a common condition where no cause can be found for the repeated and uncontrolled bladder contractions. (For example, it is not due to a urine infection or an enlarged prostate gland.)  Overactive bladder syndrome is sometimes called an irritable bladder or detrusor instability. (Detrusor is the medical name for the bladder muscle.) Symptoms include:

  • Urgency. This means that you get a sudden urgent desire to pass urine. You are not able to put off going to the toilet.
  • Frequency. This means going to the toilet often – more than seven times a day. In many cases it is a lot more than seven times a day.
  • Nocturia. This means waking to go to the toilet more than once at night.
  • Urge incontinence occurs in some cases. This is a leaking of urine before you can get to the toilet when you have a feeling of urgency.

How common is overactive bladder syndrome?

In two large studies it was found that about 1 in 6 adults reported some symptoms of an overactive bladder. Symptoms vary in their severity. About 1 in 3 people with an overactive bladder have episodes of urge incontinence.

What causes overactive bladder syndrome?

The cause is not fully understood. The bladder muscle seems to become overactive and contract (squeeze) when you don’t want it to. Normally, the bladder muscle (detrusor) is relaxed as the bladder gradually fills up. As the bladder is gradually stretched, we get a feeling of wanting to pass urine when the bladder is about half full. Most people can hold on quite easily for some time after this initial feeling until a convenient time to go to the toilet. However, in people with an overactive bladder, the bladder muscle seems to give wrong messages to the brain. The bladder may feel fuller than it actually is. The bladder contracts too early when it is not very full, and not when you want it to. This can make you suddenly need the toilet. In effect, you have much less control over when your bladder contracts to pass urine.

In most cases, the reason why an overactive bladder develops is not known. This is called overactive bladder syndrome. Symptoms may get worse at times of stress. Symptoms may also be made worse by caffeine in tea, coffee, cola, etc, and by alcohol (see below).

In some cases, symptoms of an overactive bladder develop as a complication of a nerve- or brain-related disease such as following a stroke, with Parkinson’s disease, with multiple sclerosis or after spinal cord injury. Also, similar symptoms may occur if you have a urine infection or a stone in your bladder. These conditions are not classed as overactive bladder syndrome as they have a known cause.

What are the treatments for overactive bladder syndrome?

Some general lifestyle measures may help.

Bladder training is a main treatment. This can work well in up to half of cases.

Medication may be advised instead of, or in addition to, bladder training.

Pelvic floor exercises may also be advised in some cases.

Some general lifestyle measures which may help

  • Getting to the toilet. Make this as easy as possible. If you have difficulty getting about, consider special adaptations like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.
  • Caffeine. This is in tea, coffee, cola, and is part of some painkiller tablets. Caffeine has a diuretic effect (will make urine form more often). Caffeine may also directly stimulate the bladder to make urgency symptoms worse. It may be worth trying without caffeine for a week or so to see if symptoms improve. If symptoms do improve, you may not want to give up caffeine completely. However, you may wish to limit the times that you have a caffeine-containing drink. Also, you will know to be near to a toilet whenever you have caffeine.
  • Alcohol. In some people, alcohol may make symptoms worse. The same advice applies as with caffeine drinks.
  • Drink normal quantities of fluids. It may seem sensible to cut back on the amount that you drink so the bladder does not fill so quickly. However, this can make symptoms worse as the urine becomes more concentrated, which may irritate the bladder muscle. Aim to drink normal quantities of fluids each day. This is usually about two litres of fluid per day – about 6-8 cups of fluid, and more in hot climates and hot weather.
  • Go to the toilet only when you need to. Some people get into the habit of going to the toilet more often than they need. They may go when their bladder only has a small amount of urine so as “not to be caught short”. This again may sound sensible, as some people think that symptoms of an overactive bladder will not develop if the bladder does not fill very much and is emptied regularly. However, again, this can make symptoms worse in the long run. If you go to the toilet too often the bladder becomes used to holding less urine. The bladder may then become even more sensitive and overactive at times when it is stretched a little. So, you may find that when you need to hold on a bit longer (for example, if you go out), symptoms are worse than ever.