Urge incontinence is the loss of urine due to the inability to control the urge to urinate.  Young children frequently have the urge to "I gotta go now!!", as a result of the immaturity of the nerves supplying the bladder and sphincter.  The vast majority of us outgrow the need though we all know someone who is always in search of a bathroom, or seen doing the cross-legged dance. As we age, mild nerve degeneration occurs and the problem recurs in many of the elderly.  Women are especially susceptible to  urgency and urge incontinence as the nerves to the bladder and sphincter can be damaged during pregnancy and delivery, or as the tissues of the vagina weaken and the bladder "falls", stretching the nerves.

Another term for urge incontinence is unstable bladder. Some people get the urge as a result of changing position, especially going from sitting to standing.  This is call orthostatic instability. The afflicted person is fine sitting in the car but as soon as she stand up, she needs to make a beeline for the lavatory.

Urge incontinence may also be instigated by turning on the water, coughing or laughing.  Not the involuntary gush of stress incontinence, but the sudden, hard to resist urge to void.

Causes of urge incontinence:  Urge incontinence is usually as a result of malfunction of some nerves either in the brain, the spinal cord or in the peripheral nerves, although it is not uncommon in an infected or irritated bladder.

Evaluation:  The doctor will usually take a history, paying special attention to the history of urinary infections, neurologic diseases or symptoms, back problems, childbirth, prior surgery, etc.  Then a physical examination is performed and the doctor may especially pay attention to an examination of the nerves and pelvic anatomy.  Either during the examination or later during evaluation, a pelvic and rectal examination will be performed.

The urologist may then perform any of several tests to determine the cause and severity of the problem.  

Cystometrogram (CMG):  A small catheter is inserted in the bladder, after the patient has voided and the residual urine is noted.  Then the bladder is filled through the catheter either with water, or carbon dioxide gas, and the bladder volumes and pressures are recorded as the patient, senses a  desire to void,  urgency and voids.   Depending on the needs for special evaluation, a catheter may be placed in the rectum or the vagina as well to determine abdominal pressure.  When orthostatic instability is suspected. the procedure may be performed both while lying down and when standing.

Electromyogram (EMG):  Sometimes it is necessary to evaluate the function of the sphincter muscles that help retain urine.  This is performed simultaneously with the CMG, either by using a special catheter in the bladder, electrodes near the rectum, or in special urodynamic laboratories by the use of needles in the sphincter.

Urinalysis or urine culture: This may be done to rule out infection.

Cystoscopy:  The urologist places a small telescope into the bladder to evaluate its size, shape, the presence of trabeculations, a sign that the bladder has overdeveloped muscles.   The presence of infection, inflammation, or other conditions such as stones or tumors.

Neurological consultation:  Occasionally the urologist may refer the patient to a nerve specialist for evaluation.

Treatment of urge incontinence:  If infection is found it will be treated with antibiotics.  If that is the sole source of urge incontinence, the problem will rapidly resolve.

Those patients who have a neurologic problem may respond to treatment of the condition although this is  infrequently successful.

Most patients with urge incontinence will eventually be treated with anticholinergic or bladder relaxing drugs.  There are many such drugs some of which are advertised in the media.  These drugs treat the problem, they do not cure it, and so long term medication may be needed.  Most of the urge incontinence drugs have a side affect of dry mouth.  This may vary significantly from drug to drug and patient to patient.  In general the rule of "Dry bottom, dry mouth, wet bottom, wet mouth" applies.  Some of the drugs are: oxybutinin/Ditropan/Ditropan XL, Detrol, Levsin/hyoscamine, flavoxalate.  Some of the drugs such as Urised contain combinations of drugs, frequently adding a mild sedative.

Some patients may learn to control their bladder spasms and urge incontinence by using biofeedback techniques.  Bladder pressures are reported to the patient and the patient learns to control the bladder by exercising nerve pathways.

In a few extreme cases, surgery to cut some of the nerves to the bladder is performed.  This is not always successful and may cause other problems as well. Rarely, a urinary diversion may be done for this problem, and recently,  implantable spinal cord stimulators have become available for severe, intractable cases

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Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc

Greenbelt - Bowie - Laurel     Maryland

(301) 441-8900               Fax (301) 982 0453

7500 Hanover Parkway   Suite 206    Greenbelt, MD   20770

e-mail: wfurology@gmail.com

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Rev:03/08