Urge Urinary Incontinence and Overactive Bladder
Urge and Stress Incontinence are quite different although they can often occur together.
What is it?
Urge Incontinence is a symptom of Overactive Bladder (OAB) which is the overly frequent contractions of the detrusor muscle which forms the muscular wall of the bladder. This occurs even when the bladder is not full and can be in response to certain triggers, for example warm water, getting home from an outing (key-in-the-door syndrome), and different foods. It can also make you feel like you need to go to the washroom every 20 minutes but when you do, there's not a whole lot to empty.
OAB does not always cause leaking, however it can lead to urge incontinence if you are unable to make it to the washroom on time. Particularly if you do not have adequate pelvic floor muscle strength. While it sounds annoying at the most, it can have a significant impact on your lifestyle as you are constantly worried about where the closest bathroom is. When it becomes more severe, activities such as golfing or hiking are dreaded and almost out of the question.
Ideal frequency for voiding (passing urine) is every 3-4 hours during the day and 0-1 times waking during the night. This can obviously vary depending on fluid intake but if you are emptying your bladder less than every 2 hours then you may have some overactivity of the bladder or are putting yourself at risk of this condition.
Differential Diagnosis: Urinary tract or bladder infections can also cause a strong urge and frequent urination, however this is often associated with burning pain and can be detected by a urine sample ordered by your family doctor.
What are the symptoms?
Frequent trips to the washroom, less than every 2 hours
You know where every washroom is in the mall
Sudden urge to urinate, with or without involuntary leaking
Strong urge to urinate but only passing a small amount or even a few drops in the toilet
Key-in-the-door syndrome - getting home from an outing and experiencing a strong urge and possible leaking when you go to put the key in the door
What are the causes?
Frequent trips to the washroom, less than every 2 hours - this can train the bladder to only hold small amounts and therefore will need to empty more frequently
Irritation of the bladder from dietary triggers eg: caffeine, acidic foods, carbonated drinks, tyrosine (eg. bananas)
Lack of water/dehydration which leads to concentrated urine in the bladder
Idiopathic or unknown
Trigger points in the pelvic floor muscles or surrounding abdominal muscles that can refer to the bladder
Bladder prolapse (cystocele) - incomplete emptying due to sagging of part of the bladder can lead to a pocket of concentrated urine which constantly stimulates the detrusor muscle to contract
Anxiety about incontinence or feeling unable to 'hold on'
Prostate conditions or surgery for men
Some neurological conditions
What can be done about it?
Prevention: Avoid going to the washroom 'just in case' or too frequently if you do not need to go. Please remember not voiding for more than 4 hours is also detrimental to your pelvic health and can over-stretch the bladder.
Pelvic Health Physiotherapy: Education, urge suppression and emptying techniques, as well as behavioural training can be effective in managing urge incontinence. Assessment of the pelvic floor and surrounding muscles can allow for the release spasm or trigger points referring to the bladder. Strengthening and optimising the function of your pelvic floor muscles is also key in helping suppress urgency and preventing unwanted leaking.
Medication: There are some anti-cholinergic drugs, such as Vesicare and Detrusitol, that can help to suppress the contractions of the detrusor muscle. However all medications have side effects and should only be prescribed by a physician.
Injection: Botox injections can help to inhibit the contraction of the detrusor muscle. However it is not a permanent fix and would have to be repeated every 4-9 months. Prior to being considered for the procedure, you would be taught how to self-catherise in case you are unable to empty your bladder after the injection.
See previous post for more info about Stress Urinary Incontinence.
If you have any questions, please feel free to leave a comment or use the form on the contact page!