Urge Incontinence

Urgency urinary incontinence (UUI) happens when there is an involuntary loss of urine accompanied by or immediately following a sudden and intense urge to urinate.

Urgency is the complaint of a sudden overwhelming desire to pass urine which is difficult to postpone.

Frequency is the complaint by someone who considers that he/she passes urine too often in the daytime. A person is considered to have frequent urination if he/she passes urine more than eight times in 24H. However other factors like number of voids per litre of intake, the amount of urine per void and level of urgency pre void should also be taken in account to decide if a person is actually passing too frequently.

Nocturia is the complaint of being woken from sleep at night to void.

Causes
Urge incontinence can be caused by urinary tract infections, bladder stones or other bladder irritants. It can also result from a stroke, Parkinson’s disease, spinal cord problems and various other nerve related disease like multiple sclerosis.

In some instances, there is no known cause. This is then attributed to an Overactive Bladder (OAB).

Overactive Bladder
OAB is a symptom complex defined by frequent urination, urgent urination and/ or urge urinary incontinence where no actual cause has been detected.
Urgency urinary incontinence or OAB is a diagnosis of exclusion. A systematic evaluation is usually performed by the doctor to exclude other causes including infection, tumours, and medical illnesses like diabetes mellitus and stroke.

A full assessment would include a history, physical examination, and basic tests such as urine tests for infection and blood and xrays to look for stones.

Your urologist may ask you to keep a bladder diary to record your drinking and voiding habits.

Treatment

In certain instances, treatment of the underlying condition like urinary tract infection or bladder stones will cure the incontinence.

If the patient has an irreversible cause like a stroke, Parkinsonism or other nerve related problems or in patients where there is no discernible cause, the following measures will help:

Behavioral modification

• Modifying intake: Spacing out one’s daily fluid intake, minimize intake of bladder stimulants like caffeine, alcohol, acidic and spicy foods.
• Bladder training: Using timed voids and urge suppression strategies to gradually train the bladder to hold more urine per void and have longer intervoid intervals. Bladder training is usually done under supervision of a urologist or trained continence nurse advisor.

Medications

• Medications like Oxybutynin (Dithropan), Tolterodine (Detrusitol), Solifenacin (Vesicare) , Trospium (Mictornorm) all act to slow down the bladder’s contractile activity. This usually results in less leakage and an average of 2 less visits to the washroom a day. They generally allow the bladder to hold slightly more urine per void and longer time between voids.

Surgery and Invasive treatments

• Botulinum toxin A injection to the bladder muscle. In suitable cases , the urologist may suggest Botox injections to further weaken muscle contractions and stop leakage. The effect is temporary and may need to be repeated at intervals.
• Sacral neuromodulation: modifies the voiding reflex
• Bladder Augmentation : This is performed as a last resort for patients with severe intractable symptoms. A short length of bowel patched onto the divided bladder.

Continence aids

• In the frail, bedridden or in patients with dementia who have not responded to treatment, simple collection devices like absorbent pads and condom or indwelling catheters will aid care givers. With proper care and guidance, these help prevent skin infections , accidents and falls.