Urge Incontinence

What is urge incontinence?

Urge incontinence is a type of urinary incontinence or leakage. It causes a sudden urge to urinate (pee) and you can’t hold it. You may accidentally leak pee before you make it to the bathroom. Some people who have urinary incontinence pee more than eight times while they’re awake and get up several times while they’re asleep to pee.

What are the other types of urinary incontinence?

There are different types of urinary incontinence. All of them cause you to leak pee. They include:

• Stress incontinence. Stress incontinence causes pee to leak because of pressure on your bladder from coughing, laughing or physical activity.
• Mixed incontinence. Mixed incontinence is when you have both urge and stress incontinence. More than half of people assigned female at birth (AFAB) who have urge incontinence also have stress incontinence.
• Overflow incontinence. Overflow incontinence causes you to leak pee because your bladder is too full or you can’t completely empty it.
• Functional incontinence. Functional incontinence is when another condition makes reaching a bathroom in time difficult or prevents you from recognizing you need to pee.

How common is urge incontinence?

Approximately 40% of people AFAB and 30% of people assigned male at birth (AMAB) experience urge incontinence at some point in their lives.

What is the most common cause of urge incontinence?

The most common cause of urge incontinence is an overactive bladder. An overactive bladder causes muscles in your bladder to squeeze (contract) more than they should. This makes you feel like you have to pee before your bladder is actually full.

A squeezed bladder also causes the sphincter muscle inside your urethra to relax. When this muscle opens, it lets pee leak out.

What are the symptoms of urge incontinence?

The main sign of urge incontinence is an urgent, uncontrollable need to pee that results in leakage.

Other symptoms of overactive bladder include:

• Peeing more than eight times while you’re awake (frequent urination).
• Getting up to pee more than twice while you’re asleep (nocturia).
• Leaking pee before you can make it to the bathroom or just after you pee.
• Wetting the bed (enuresis).

Urge incontinence can also affect your mental health. Some people with severe urge incontinence may be afraid to go out in public. They may worry about being too far from a restroom or not knowing where the nearest restroom is when they have an urge to pee. These worries may increase your risk of stress, anxiety and depression.

Who does urge incontinence affect?

People AFAB are twice as likely to have urge incontinence as people AMAB. Urge incontinence becomes more common as you get older. But healthcare providers don’t consider it a normal part of aging. That means treatment is possible.

Other risk factors for urge incontinence include:

• Diabetes.
• Hysterectomy or other pelvic surgery.
• Medications, including antidepressants, diuretics and blood pressure medicine (antihypertensives).
• Menopause.
• Neurological disorders, including Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis (MS).
• A body mass index (BMI) greater than 25 (having overweight/obesity).
• Smoking.
• Stroke.
• Urinary tract infections (UTIs).
• Pregnancy and childbirth, especially vaginal delivery.
• Prior radiation therapy on your pelvis for any reason.
• Prostate conditions, including prostate cancer or an enlarged prostate (benign prostatic hyperplasia).

Why have I suddenly become incontinent?

It’s possible you’ve had mild urge incontinence symptoms for a while. Over time, overactive bladder symptoms can get worse and become more noticeable. Contact a healthcare provider if urge incontinence symptoms develop after a recent medical procedure, injury or the start of a new medication. A nerve injury or another problem may be causing urge incontinence.

How is urge incontinence diagnosed?

A healthcare provider will review your medical history and ask about your symptoms to diagnose urge incontinence. Additional workup will include a physical exam. This may include a pelvic exam if you have a vagina or a digital rectal exam if you have a prostate. To help your provider make an accurate diagnosis, they may ask you to keep a bladder diary for two to three days. In your bladder diary, you’ll record:

• What you drink.
• How much you drink.
• How often you use the bathroom.
• How often you leak pee and how much.
• What you were doing when you leaked.

Your provider may also order tests, including:

• Urinalysis to rule out UTIs (bladder infections), blood in your pee (hematuria) and other conditions.
• Abdominal ultrasound to look at your bladder, kidneys and other organs.
• Cystoscopy to examine your urinary system.
• Urodynamic testing, including a post-void residual urine test, to examine how well your urinary system holds and releases pee.

Does urge incontinence go away?

Urge incontinence usually doesn’t go away on its own. But treatments can help alleviate your symptoms.

What is the most appropriate treatment for urge incontinence?

Urge incontinence treatment depends on the severity of your symptoms. A healthcare provider may ask questions to determine how much urge incontinence affects your life, including:

• How often do you pee when you’re awake?
• How often do you get up to pee while you’re sleeping?
• Do you leak pee?
• How much pee do you leak?
• What causes you to leak pee?
• What type of fluids do you drink?

According to your responses and the results of any testing, a provider may recommend the following:

• Pelvic floor physical therapy, which may include Kegel exercises and/or pelvic muscle relaxation.
• Bladder retraining.
• Lifestyle changes.

Kegel exercises

Kegel exercises (pelvic floor exercises) help strengthen the muscles that support your urinary system, which can improve your symptoms.

It’s important to target and use the correct muscles. This can be more difficult than you might think. A physical therapist who specializes in pelvic floor disorders can teach you the proper techniques. They can also use biofeedback to ensure you get the most benefit from the exercises. It can take up to four to six weeks of regular pelvic floor exercises to see improvements in your urge incontinence symptoms.

It’s also possible that spasms or excess tension in your pelvic floor muscles can make overactive bladder symptoms worse. In this case, a pelvic floor physical therapist can teach you how to relax and coordinate these muscles.

Bladder retraining

Bladder retraining involves only using the restroom at set times. The goal is to wait a little longer between when you pee, even if you really have to go. This helps build up your pelvic floor muscle strength so you can hold your pee longer and longer.

Some people require timed voiding and pee more often. If you don’t get an urgency to pee until your bladder is very full, it may be too late. If you try to go more often, like every two hours, you’ll keep your bladder emptier and are less likely to have a leakage problem.

Lifestyle changes

Lifestyle changes that can help ease urge incontinence include:

• Quitting smoking.
• Drinking fewer beverages that can irritate your bladder, including coffee or any caffeinated drinks, carbonated beverages (like soda pop or seltzer water) and alcohol.
• Maintaining a healthy weight for you.
• Eating high-fiber foods and drinking lots of water to help prevent constipation. Constipation can make urge incontinence worse.
• Treating any conditions that may cause urge incontinence.

Therapies

If bladder retraining and lifestyle changes don’t help, a healthcare provider may recommend:

• Botulinum toxin (Botox®) injections.
• Neuromodulation.

Botox

Botox helps relax your bladder muscles so it can hold more pee. But it isn’t permanent. You’ll need additional injections as it wears off and your muscles contract again, about every six months.

Neuromodulation

There are three approaches to gently stimulating the nerves that supply your bladder. This helps regulate how your nervous system communicates with your bladder. These approaches include:

• Percutaneous tibial nerve stimulation (PTNS). PTNS stimulates a nerve right above your ankle. You’ll undergo weekly sessions for 12 weeks, initially. It’s an in-office procedure, and it’s the least invasive.
• Implantable tibial nerve stimulation (ITNS). This involves a procedure to place a small implant near your ankle to stimulate your posterior tibial nerve. You deliver the stimulation at home, rather than weekly office visits.
• Sacral neuromodulation (SNM). This is an implant in your lower back. A provider inserts a small wire near the base of your spine to provide constant, gentle stimulation more directly to the nerve that supplies your bladder. They’ll implant a small battery under your skin.

How can I reduce my risk of urge incontinence?

The same steps that help treat urge incontinence can also help prevent it. These include:

• Maintaining a healthy weight for you.
• Preventing constipation.
• Quitting smoking.
• Cutting back on caffeinated and carbonated beverages and alcohol.
• Peeing regularly to keep your bladder empty.

What can I expect if I have urge incontinence?

Urge incontinence can cause you a lot of stress. At-home therapies, like Kegel exercises and bladder retraining, can help reduce urge incontinence. But it may take over a month or more before you notice any changes, and your symptoms may never completely disappear. It’s important to talk to a healthcare provider. They can tell you how severe your case is and recommend the best ways to manage urge incontinence so it has the smallest possible impact on your life.

What happens if urge incontinence is left untreated?

Without treatment, urge incontinence can get worse. You may have to go to the bathroom more often or leak larger amounts of pee. These problems are more likely to occur if you smoke or don’t maintain a healthy weight for you.

How do you deal with urge incontinence?

Because urge incontinence causes you to leak pee, you may want to wear absorbent underwear or urinary pads until treatments take effect. Unfortunately, constant exposure to pee can lead to skin rashes (diaper rash) and sores. To protect your skin, it’s a good idea to apply a layer of petroleum jelly (Vaseline®). If irritation doesn’t go away with just petroleum jelly, you can try a cream or ointment that contains zinc oxide and see a healthcare provider.

If urge incontinence causes you stress, depression or anxiety, it can be helpful to talk to a therapist (counselor) or psychologist. They can help you manage your mental health.

When should I see a healthcare provider?

Talk to a healthcare provider when you first notice symptoms of urge incontinence or changes in your bathroom habits. They can help determine what’s causing urge incontinence and help treat it or manage your symptoms. It’s also important to make sure you don’t have an active bladder infection (UTI) if your symptoms become worse.

What questions should I ask a healthcare provider?

You may want to ask your healthcare provider:

• What’s causing my urge incontinence?
• What tests will you perform or order?
• How severe is my urge incontinence?
• Do you think I need Botox, nerve therapy or surgery?
• What are the risks of Botox, nerve therapy or surgery?

What is the difference between urge incontinence and stress incontinence?

Urge incontinence and stress incontinence have different causes and symptoms:

• Stress incontinence is due to abdominal pressure on your bladder. It causes you to leak small amounts of pee.
• Urge incontinence usually results from an overactive bladder. It causes you to leak more pee than stress incontinence.