Incontinence & Overactive Bladder Health Center
Related to Incontinence & Overactive Bladder (OAB)
Urge Incontinence
Treatments for Incontinence & Overactive Bladder (OAB)
Copyright © 2010 Woodbury Health Products All rights reserved.

1-800-777-1111
Monday - Friday 9:00am - 5:00pm EST
What is Urge Incontinence?

While stress urinary incontinence (SUI) is the most common type of incontinence causing leakage with pressure from straining from coughing, laughing or sneezing - urge incontinence happens when the urge to pass urine becomes overwhelming and the bladder lets go before a toilet can be reached. This will often happen at inappropriate times such as in public or while you are sleeping.
What Causes Urge Incontinence?
Urge incontinence is caused by the bladder sending a message to the brain that it's full, often too early and the bladder muscle starts to contract too early (also called bladder instability). These abnormal bladder contractions cause a force strong enough to override the sphincter muscles of the urethra (urine tube) and allow urine to pass out of the bladder. The bladder may experience abnormal contractions for the following reasons:

  • The bladder may not be functioning properly because its nerves are damaged by various diseases such as stroke, dementia, multiple sclerosis, or Parkinson's disease.
  • Spinal cord may be damaged.
  • The bladder may contract in reaction to certain stimuli, such as running water, putting a key in the door.once you arrive home.

In many cases, the cause of urge incontinence cannot be identified.

How is Urge Incontinence is Treated?
Treatment for urge incontinence is behavioral. Pelvic floor biofeedback is a therapy that helps you learn how your body is behaving and can define whether your bladder is overactive.


When a person suffers from both stress and urge
incontinence they have "mixed" urinary incontinence.
URGE SUPPRESSION: 
Learning how to ignore the first
urge to go to the toilet

Urge Suppression is basically behavioral therapy for those who have urinary urgency or frequency. If you squeeze the pelvic floor muscles, you can suppress the "gotta-go when you gotta-go" feeling. This behavioral therapy will retrain the bladder that has been conditioned to empty more frequently than necessary. If you've fallen into the habit of going to the toilet 'just in case', your bladder has gotten use to holding less and less urine, which results in an even more overactive bladder as it's sending the 'full' signal earlier each time.

Behavioral Therapy can help both
urge and mixed urinary incontinence

What does Behavioral Therapy do?
  • Bladder retraining helps your bladder tolerate being stretched as it fills, and gets you back into a normal pattern of passing urine (less than six visits to the toilet per day). The less often you pass urine, the less often you will need to go.
  • Urge suppression teaches you to ignore the first urge to go to the toilet.
  • Helps your bladder hold more urine, so you don’t need to go to the toilet as frequently.
  • Helps you control the urge to go to the toilet, so you don’t have to rush to pass water.

How does Behavioral Therapy work?

1.  Keep a Bladder Diary
First, you must learn how to keep a bladder diary. This will help you set goals for increasing the length of time between visits to the bathroom. It will also be a good tool for measuring your progress. The bladder diary will keep record of:
  • how often you go to the toilet
  • how much urine you pass on average per visit.

The longer the time between visits, the more urine your bladder is holding,
so the more urine you'll pass at each visit to the toilet.

Be sure that you are drinking enough liquids for the bladder retraining to work.

2.  Retrain your bladder
Now that you've kept an accurate bladder diary, you now know how often you go to the toilet. The second step is to start with 'scheduled toileting'. An example of this would be if, on average, you go to the toilet every hour and a half, go every hour and a half.

Once you're have accomplished managing a new schedule while staying dry, add another fifteen minutes between visits.

Please note: This process may take a week or more to adapt to. If you have severe urgency, it may take several weeks.

Continue this process until you reach an interval of three to four hours between visits to the bathroom to empty your bladder. Keep in mind, you should pass urine at the set interval, even if you don’t have the urge to go.

3. Urge Suppression
While you're trying to retrain your bladder by extending the time between visits to the toilet, you may feel an urge to go to the toilet. That 'gotta-go' feeling is the urge. This feeling is triggered by signals that your bladder sends to the brain. It does not mean that you have to go right away. Rather, it simply means that your bladder is in a filling mode.

Urge suppression methods will help you hang on, or delay passing urine until your scheduled time. Here are some techniques to help you do this:

  • Sit on a hard seat or a tightly rolled towel. This puts pressure on your pelvic floor muscles.
  • Do five quick squeezes of your pelvic floor muscles. We call these "quick flicks", which makes your external sphincter contract so you won’t leak, and also sends a message to your bladder to stop it contracting.
  • Try relaxation techniques. Slow, deep breathing can help you calm down and stop you getting stressed and rushing to the toilet.
  • Try distraction techniques. Instead of thinking about wanting to go to the toilet, start counting backwards from 50.

Other Treatments for Urge Incontinence
If behavioral treatment doesn't work your healthcare provider may suggest other medical or surgical treatments, which include:

  • Electrical stimulation (E-stim): this treatment uses a low-voltage electric current to stimulate your pelvic floor muscles passively. Sessions are 15-20 mins. every 1-5 days.
  • Medications: there are several medications used to treat urge incontinence. There are two prescription medications formulated to treat urge incontinence. They are -- oxybutynin (Ditropan, Ditropan XL, Oxytrol, Gelnique) and tolterodine (Detrol, Detrol LA). Several other medications can be taken to control bladder spasms.
  • Percutaneous Tibial Nerve Stimulation: this therapy delivers an electric current to the tibial nerve the patient's ankle. This nerve is thought to affect bladder contraction specifically.