Urge incontinence

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Urge incontinence
Classification and external resources
Illu bladder.jpg
Urinary bladder (Detrusor labeled at top)
ICD-10 N39.4
ICD-9 788.31
MedlinePlus 001270
MeSH D053202

Urge incontinence is a form of urinary incontinence characterized by the involuntary loss of urine occurring for no apparent reason while feeling urinary urgency, a sudden need or urge to urinate.

Causes[edit]

The most common cause of urge incontinence is involuntary and inappropriate detrusor muscle contractions.[1] Idiopathic Detrusor Overactivity – Local or surrounding infection, inflammation or irritation of the bladder. Neurogenic Detrusor Overactivity – Defective CNS inhibitory response.

Presentation and pathophysiology[edit]

Medical professionals describe such a bladder as "unstable", "spastic", or "overactive". Urge incontinence may also be called "reflex incontinence" if it results from overactive nerves controlling the bladder.

Patients with urge incontinence can suffer incontinence during sleep, after drinking a small amount of water, or when they touch water or hear it running (as when washing dishes or hearing someone else taking a shower).[2]

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's Disease, stroke, spina bifida[3] and injury—including injury that occurs during surgery—can all harm bladder nerves or muscles.

Treatment[edit]

Timed voiding or bladder training[edit]

Timed voiding (urinating) is a form of bladder training that uses biofeedback to reduce the frequency of accidents resulting from poor bladder control. This method is aimed at improving the patient’s control over the time, place and frequency of urination.

Timed voiding programs involve establishing a schedule for urination. To do this a patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak. Some individuals find it helpful to use a vibrating reminder watch to help them remember to use the bathroom. Vibrating watches can be set to go off at certain intervals or at specific times throughout the day, depending on the watch.[4] Through this bladder training exercise, the patient can alter their bladder’s schedule for storing and emptying urine.[5]

Surgery[edit]

Urodynamic testing seems to confirm that surgical restoration of vault prolapse[clarification needed] can cure motor urge incontinence.[6]

Behavior[edit]

Behavior techniques for incontinence include retraining the bladder to hold more urine. The goal is to lengthen the time between periods of urination. This includes relaxation techniques and learning how to cope with urges to urinate. Fluid management is the cornerstone of all urinary incontinence. Techniques include not drinking lots of fluids and avoiding certain foods and beverages which stimulate or irritate the bladder, for example alcohol, caffeine and acidic foods.[7]

A randomized controlled trial in men of behavioral therapy versus the anticholinergic medication oxybutynin (no control group) found similar effectiveness.[8] The behavioral treatment included:

  • Pelvic floor muscle training
    • "Contract and relax pelvic floor muscles while keeping abdominal muscles relaxed"
    • "Contract their muscles for 2- to 10-second periods separated by 2 to 10 seconds of relaxation.
      • "Initial contraction duration was based on the ability demonstrated by each participant in the training session.”
    • "Daily practice included 45 exercises”
      • "Divided into manageable sessions”
      • "Usually three sessions of 15 exercises each”
    • "Duration was increased gradually to a maximum of 10 seconds"
  • Urge suppression techniques when awakened at night with the urge to void
    • "Remain still in bed and attempt to diminish the urgency with repeated pelvic floor muscle contractions.
    • "If successful, they could go back to sleep; if not, they could void and return to bed."
  • Fluid restriction (after 6:00 p.m.)

Medications[edit]

See also[edit]

References[edit]

  1. ^ "Incontinence - Causes". HealthExpress. Retrieved 2013-08-20. 
  2. ^ "Urinary Incontinence in Women". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Retrieved 2013-08-20. 
  3. ^ "Spina Bifida (Urinary Tract Concerns)". Pedisurg.com. Retrieved 2012-12-28. 
  4. ^ Pham, Nancy. "Get Control Over Your Bladder with a Vibrating Reminder". National Incontinence. Retrieved 10 October 2012. 
  5. ^ Mercer, Renee. "Strategies to Control Incontinence". National Incontinence. Retrieved 28 September 2012. 
  6. ^ Can motor urge incontinence be surgically cured? K. Goeschen Pelviperineology N.26.1.2007 [1]
  7. ^ 10 worst foods for your bladder
  8. ^ Burgio KL, Goode PS, Johnson TM, Hammontree L, Ouslander JG, Markland AD et al. (2011). "Behavioral Versus Drug Treatment for Overactive Bladder in Men: The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial.". J Am Geriatr Soc 59 (12): 2209–16. doi:10.1111/j.1532-5415.2011.03724.x. PMID 22092152. 
  9. ^ a b c d e f Waller et al, Medical Pharmacology and Therapeutics, third edition, 2010, Elsevier Saunders
  10. ^ Sacco E, Bientinesi R. Mirabegron: a review of recent data and its prospects in the management of overactive bladder. Ther Adv Urol. 2012 Dec;4(6):315-24. doi: 10.1177/1756287212457114.
  11. ^ Sacco E, et al. Botulinum toxin in the treatment of overactive bladder] Urologia. 2008 January–March;75(1):4-13.
  12. ^ Sacco E, et al. Emerging pharmacological targets in overactive bladder therapy: experimental and clinical evidences. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Apr;19(4):583-98. doi: 10.1007/s00192-007-0529-z.
  13. ^ Sacco E, Bientinesi R. Future perspectives in pharmacological treatments options for overactive bladder syndrome. Eur Urol Review 2012;7(2):120-126
  14. ^ Sacco E, et al. Investigational drug therapies for overactive bladder syndrome: the potential alternatives to anticolinergics. Urologia. 2009 July–September;76(3):161-177