Urge incontinence is a form of urinary incontinence characterized by a sudden urge to urinate, resulting in involuntary leakage of urine. The condition is caused by sensory or motor dysfunction. It is typically idiopathic but can also result from neurologic conditions such as spinal cord injury and stroke. The prevalence of urge incontinence increases with age, with more women affected than men. The condition is usually diagnosed via a detailed medical history and urodynamic studies. Treatment is conservative and involves the administration of anticholinergics. Surgical options should be considered only as a last resort.
- Idiopathic (most common)
- Neurological conditions: lesions above the brain stem, spinal cord injury, stroke, Parkinson disease, dementia, and multiple sclerosis
- Genitourinary conditions: bladder cancer, inflammation, or renal stones
- Risk factors include:
- See also “Etiology” of .
- Urinary urgency: sudden urge to urinate
- Loss of urine without exertion, with urinary tenesmus; → frequent episodes, with variable volumes of urine voided each time
See for general diagnostic measures.
Urinary stress test
- Used to rule out concomitant stress incontinence
- Negative in individuals who only have urge incontinence (no leakage of urine)
- Used to quantify urine leakage over a 1–24-hour period
- Patients are asked to wear a preweighed sanitary pad, perform certain activities, and drink a certain volume of liquid. The pad is then weighed again to measure urinary leakage.
Conservative measures should first be attempted before considering medical treatment.
- Nonpharmacological treatment: behavioral therapies, exercises, lifestyle modifications (see )
- First-line are anticholinergics, including oxybutynin, tolterodine, solifenacin, trospium, and darifenacin
- Alternatives or combined administration
Oxybutynin treats Overactive bladder.
- Endoscopic injection of botulinum toxin at different points in the bladder wall
- Sacral nerve stimulation
- Augmentation cystoplasty