The National Institute for Health and Care Excellence defines urge (aka urgency) urinary incontinence as "involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to delay)". If you suffer, you will likely not be able to make it to a toilet without leaking a small amount of urine. Your urge to urinate may be triggered by certain things; such as standing after sitting for a long time, or arriving home (latch key urgency).
Urge incontinence is one of the most common forms of incontinence. A third of adults who suffer from urinary incontinence suffer from both urge and stress incontinence together - it is then called mixed incontinence. The group most vulnerable to developing urge incontinence are men older than 75 years old, with reports suggesting 42% of this group suffer. Women also suffer, however, with 31% of women over 75 suffering.
If left untreated you may begin to experience depression and social isolation, as you may no longer be comfortable leaving the house. However urge incontinence can be treated, often without the need for pharmaceutical drugs or surgery. Therefore there is no need to consider it an inevitable part of ageing and you should seek treatment as soon as possible.
Symptoms of Urge Urinary Incontinence
You may be suffering from urge incontinence if you:
- have a sudden or uncontrollable urge to urinate, often followed by leaking urine
- visit the toilet more than 8 times in a 24 hour period
- often do not make it to the toilet before beginning to urinate
- often wear incontinence pads to catch leaks before you reach a toilet
- feel the sensation to urinate when you change position; such as standing after sitting for a long period
- feel the sensation to urinate with a sensory stimulation; such as running water, cold weather or arriving home (latch key urgency)
Speak to your GP for a formal diagnosis before seeking treatment.
Causes of Urge Urinary Incontinence
Urge incontinence is caused by involuntary bladder contractions that occur as the bladder fills, but is usually not yet full (which is when you should normally experience the urge to empty it).
The bladder contracts involuntarily if you are suffering from an overactive, unstable detrusor muscle - the main muscle behind the bladder that is responsible for its contractions. This muscle can be made unstable if it becomes irritated or if you lose the conscious ability to relax it.
Urge incontinence can also occur when the bladder is directly stimulated by irritation, inflammation or infection. If this is the cause then the incontinence is considered sensory and the cause of the stimulation should be treated alongside the symptoms of the incontinence.
Issues can be caused by one or more of the following:
- Diuretics - Such as caffeine, spicy food and alcohol, increase your urine production, causing you to feel the urge to urinate more frequenty.
- Urinary tract infection (UTI) - Suffering from a UTI can stimulate the urge to urinate as it irritates both the bladder and urethra.
- Bladder stones - These crystals develop if you frequently have urine in your bladder, even after you urinate. These then irritate the bladder, stimulating the urge to go.
Nerve issues - Diseases such as multiple sclerosis and Parkinson's disease affect the nerves that are linked to the bladder, removing your ability to consciously relax and contract the detrusor muscle.
- Menopause - It is thought that the vaginal atrophy (dryness) that occurs as a result of the drop in oestrogen during menopause, irritates the bladder, leading to urge incontinence.
To read more about these causes, and the events that can lead to you developing any form of urinary incontinence, visit the Causes and Diagnosis page.
How to Stop Urge Urinary Incontinence
Once your GP has diagnosed you with urge incontinence, you will discuss an appropriate programme of treatment which resolves the symptoms alongside treating the original cause(s). The most common specific treatments for urge incontinence are:
Conservative therapy's - Conservative therapy's, such as lifestyle changes and non-surgical medical treatments, resolve 25% of incontinence cases, and are the first course of treatment.
- Pelvic floor (Kegel) exercises - Considered to have the greatest success rate at treating urge incontinence, pelvic floor exercises are part of any treatment plan. Strengthen your pelvic floor over a 12 week programme, followed by weekly maintenance exercises, to better support your bladder and give you better control over your urethra. You will also benefit from an improved sex life and better bowel movements.
- Biofeedback behaviour training - Using skin electrodes or a vaginal probe, your GP can confirm that you are competing your pelvic floor exercises correctly, or how you can change them to make them more effective. This can be an invaluable addition to your pelvic floor exercise routine as many women do not correctly contract their muscles; leading to pelvic pain at worse, and a waste of their time at best.
- Lifestyle changes - For a lasting treatment for urinary incontinence, you will need to amend your lifestyle. This includes maintaining a healthy weight (BMI less than 30), avoiding constipation, and avoiding foods which increase urine production such as caffeine and spicy curry's (diuretics).
- Medication - You may be inclined to discuss what prescription drugs are available with your doctor as your first line of treatment, with the hope of a quick resolution with minimal effort. However studies show that due to the nature of follow-up appointments and incontinence recurrence, drugs cannot be considered as a fool proof treatment for urge incontinence. The prescription drugs that are available aim to reduce the contractions of the detrusor muscle.
Surgery - Surgery is reserved for those that are unable to treat their urge incontinence through the methods above. Usually as the damage to their muscles, bladder and/or urethra is irreversible.
- Bladder enlargement - Also known as augmentation cystoplasty, during this procedure the capacity of the bladder is increased by inserting a section of the bowel.
- Urinary diversion - During this procedure, the normal flow of urine out the body is rerouted from the kidneys into an external drainage pouch or an artificial internal reservoir. It can be done temporarily (several days or weeks) to reduce pressure whilst a blockage is treated, or permanently if there is irreversible damage to the bladder.
- Percutaneous implanted sacral neuromodulation - This form of sacral nerve stimulation is used to resolve issues with bladder function. It involves having an electric device permanently implanted under the skin, when you are under local anaesthesia.
- Injections of botox (botulinum toxin) - In the same way as prescription drugs, botox injections aim to decrease the involuntary contractions of the detrusor muscle. Their affects weaken over time however, and therefore need to be repeated often.
To read about the other treatments available for general urinary incontinence, and the potential complications associated with surgical treatments, visit our incontinence treatment page.
Bladder and Bowel Support Community (2018). Urgency And Urge Incontinence. [online] Bladder and Bowel Community, 2018. [viewed 24/04/18] Available from: https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/urgency-and-urge-incontinence/
Blok, B. F. M. (2018). European Urology. Sacral Neuromodulation and OnabotulinumtoxinA for Refractory Urge Urinary Incontinence Offer Similar Success During 2-Year Follow-up. [online] Article in press [viewed 24/08/18]. Available from: http://www.europeanurology.com/article/S0302-2838(18)30197-0/pdf
Burgio, K. L. Goode, P. S. Locher, J. L. Umlauf, M. G. Roth, D. L. Richter, H. E. Varner, R. E. Lloyd, L. K. (2002). JAMA. Behavioral Training With and Without Biofeedback in the Treatment of Urge Incontinence in Older Women: A Randomized Controlled Trial. [online] 288(18), p2293-2299. [viewed 25/04/18] Available from: https://jamanetwork.com/journals/jama/fullarticle/195505
Burgio, K. L. Locher, J. L. Goode, P. S. Hardin, J. M. McDowell, B. J. Dombrowski, M. Candib, D. (1998). JAMA. Behavioral vs Drug Treatment for Urge Urinary Incontinence in Older Women: A Randomized Controlled Trial. [online] 280(23), p1995-2000. [viewed 25/04/18]. Available from: https://jamanetwork.com/journals/jama/fullarticle/188273
Çetinel, B. Kocjancic, E. Demirdağ, Ç. (2016). Investigative and Clinical Urology. Augmentation cystoplasty in neurogenic bladder. [online] 57(5), p316-323. [viewed 24/04/18] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017553/
Khandelwal, C. Kistler, C. (2013). American Family Physician. Diagnosis of Urinary Incontinence. [online] 87(8), p543-550. [viewed 23/04/18] Available from: https://www.aafp.org/afp/2013/0415/p543.html
NHS Trust (2015). Bladder Stones: Causes [online] NHS Trust, 2015. [viewed 25/04/18]. Available from: https://www.nhs.uk/conditions/bladder-stones/causes/
NICE. (2013). Urinary incontinence in women: management. National Institute for Health and Care Excellence, 2015. [viewed 18/04/18] Available from: https://www.nice.org.uk/guidance/cg171/resources/urinary-incontinence-in-women-management-pdf-35109747194821
NIH. (2013). Urinary Diversion. [online] National Institute of Diabetes and Digestive and Kidney Diseases, 2013. [viewed 18/04/18] Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-diversion
Rao, P. K. Iverson, A. J. Sabanegh, E. S. (2016). Augmentation Cystoplasty. [online] Medscape, 2016. [viewed 18/04/18] Available from: https://emedicine.medscape.com/article/443916-overview
Spinelli, M. Giardiello, G. Arduini, A. van den Hombergh, U. (2003). European Urology. New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results. [online] 43(1), p70-74. [viewed 24/04/18]. Available from: http://www.europeanurology.com/article/S0302-2838(02)00442-6/pdf
Tidy, C. (2016). Urge Incontinence. [online] Patient, 2016. [viewed 15/04/18]. Available from: https://patient.info/health/lower-urinary-tract-symptoms-in-women-luts/urge-incontinence#nav-2
Veeratterapillay, R. Thorpe, A. C. Harding, C. (2013). Indian Journal of Urology. Augmentation cystoplasty: Contemporary indications, techniques and complications. [online] 29(4), p322-327. [viewed 24/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822349/