Urge Incontinence

Urge incontinence is another major type of incontinence. People with this type usually have the sensation that they are about to lose urine and try to get to the bathroom quickly before they leak. Typically, they will try to void frequently to keep the bladder empty. In comparison to stress incontinence, these patients will leak a larger volume of urine with each episode, and usually will not be able to just use a panty-liner for protection.

• Because of the embarrassment of suddenly wetting themselves, they will avoid social gatherings and, with time, may become depressed. In fact one of the medications used to treat urge incontinence (Imipramine) is an anti-depressant; this is probably how it was discovered as a treatment.
• Unlike stress incontinence patients with urge incontinence will also have a lot of nocturia (night-time voiding) and many times bed-wetting can be a problem. Not uncommonly there is a history of late bed wetting as a child.
• Urge incontinence is caused by abnormal contractions of the bladder. These contractions occur when they are not supposed to.

There are several new medications that work very well to treat urge incontinence. Both Detrol and Ditropan XL are effective. Each has its own advantages and disadvantages and should be tried. There are several contraindications to using these medications, so check with your physician first.

Causes

• Urge incontinence is due to abnormal contractions (spasms) of the bladder that occur as the bladder fills. Normally the bladder fills to capacity before any contractions occur. When a contraction occurs, the patient senses that they are about to leak (urgency). Sometimes they can suppress the contraction or "hold their urine" until the contraction quits, but quite often they will leak during the contraction. There is usually not a problem with the urethra, the problem is with the nerve control of the bladder. In many patients there is not a neurologic lesion that can be identified. However, any process that can damage or stimulate the nerves that control the bladder can cause urge incontinence to occur. Sometimes even just a bladder infection can do this.

Patients that suddenly develop urge incontinence, without any history of recent back injury or pelvic surgery, must undergo a careful neurologic evaluation to look for underlying central nervous system lesions. Any patients with severe urgency that have a urinalysis that shows blood in the urine, that do not have an infection, need careful evaluation for bladder tumors by a urologist. (i.e. cystoscopy and IVP) . The most common cause is usually "idiopathic" (unknown). Most patients do not have a serious underlying problem. Very commonly there is a congenital component to this type of incontinence, and childhood voiding problems are common in women that later develop urge incontinence.