Bladder spasms and contractions
Urge Incontinence is when you have any sudden, intense urges to urinate often followed by loss of urine. Urge incontinence is caused by a bladder that contracts when it should not. Urge incontinence is also known as Overactive Bladder (OAB), detrusor instability, or irritable bladder.
Symptoms & Causes
Causes: Urge incontinence, or overactive bladder (OAB), occurs when a person cannot hold their urine long enough to get to the toilet in time. It’s often found in elderly people or in those who have diabetes, stroke, Alzheimer’s disease, Parkinson’s or multiple sclerosis.
Symptoms: With urge incontinence, you’ll have an immediate, strong urge to urinate followed by an involuntary loss of urine. You may need to urinate often throughout the day and night.
Risk Factors & Complications
Urge incontinence is more common among older women, but gender and age are not the only factors. According to the Urology Care Foundation, risk factors of getting urinary incontinence include:
- Overweight or obesity
- Hormonal changes
Some people with an overactive bladder also have bowel control problems. Contact your doctor if this problem also affects you.
Many people think urinary incontinence is just part of getting older. It’s not. And it can be treated, or even cured.
Urge incontinence can affect a person’s emotional, psychological and social life – it is not just a medical issue. Those who have urinary incontinence are hesitant to do daily activities, not wanting to stray too far from a toilet.
Below are the best ways to treat urge incontinence.
Absorbent Pads & Catheters
Absorbent products may be used to manage any form of incontinence. However, incontinence products are NOT a TREATMENT for incontinence; for some individuals, urinary incontinence products are a temporary strategy until they address and resolve the underlying cause of their incontinence. Most people find the use of pads, diapers and bladder supports to be extremely inconvenient, expensive and impacts their quality of life.
According to WebMD, absorbent products, such as adult diapers, plastic-coated underwear, pads or panty liners that attach to underwear can be used if:
- Your incontinence is not a significant disruption in your life
- You are waiting for another treatment for incontinence to take effect
- Your incontinence cannot be treated by other means
- You prefer to use absorbent products rather than medicines or surgery
Risks when using absorbent products include irritation around the groin area and an increased risk of urinary tract infections.
Product options include:
- Depends® Adult Underwear
- Tena Serenity®
- Poise® Pads
- Always Discreet®
While not strongly recommended for urge incontinence, your doctor may request you try these treatments first to help strengthen and train your pelvic floor and bladder.
- Bladder Training: Training the bladder to hold out for longer and longer periods between bathroom visits.
- Fluid Management: Having a reasonable fluid intake, drinking less, avoiding coffee, tea, caffeinated sodas and alcohol.
- Double Voiding: Urinating twice – once you urinate you wait a few minutes and urinate again to release any residual urine.
- Scheduled Trips to the Restroom: Urinating every two to four hours instead of waiting for the urge to go to the bathroom.
Patients typically attend in-office appointments 2-3 times per week for a duration of 12 weeks. Therapists will often utilize bladder training, biofeedback, pelvic floor muscle exercises and electrical muscle stimulation.
In urgency urinary incontinence, a strong pelvic floor created by muscle training prevents leaking induced by the involuntary contractions of the detrusor muscle.
Pelvic Floor Muscle Exercises (Kegel Exercises)
Many physicians recommend Pelvic Floor Exercises as a first line treatment for Stress and Urge bladder leakage. The goal of pelvic floor muscle training is to strengthen weak urinary sphincter and pelvic floor muscles – the muscles that control urination and defecation.
The Problem with Kegel Exercises
Research has shown that over half of women who attempt Kegel exercises do them incorrectly by overusing their abdominal, buttock or leg muscles resulting in no improvement in pelvic floor muscle strength—remember, you have to contract these muscles in isolation in order to be effective! In addition, if you already have very weak pelvic floor muscles, you may not be able to contract them effectively.
There are devices available including over-the-counter devices (no prescription required) to assist you in identifying the correct muscles and providing active resistance.
Biofeedback is a technique that provides you with real-time information about activity in the bladder and pelvic muscles to help you learn to contract these muscles properly. Sensors are placed internally and/or externally within or around the vagina or rectum. Many trained specialists, such as physical therapists, occupational therapists, and nurses provide these services. Patients typically require 2-3 in-office visits per week to learn how to isolate and contract the pelvic floor muscles while using biofeedback to guide performance.
Women who wish to avoid surgery, botulinum toxin injections, and daily oral medications, particularly those who are highly motivated, are ideal candidates for these over-the-counter automatic neuromuscular pelvic exercising devices.
Medical devices help build and strengthen pelvic floor muscles, treating incontinence at the source instead of just managing the result. According to the Mayo Clinic, “gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need multiple treatments over several months.”
Electrical Muscle Stimulation
The use of electrical muscle stimulation for urinary and fecal incontinence spans a 30 year period and has gained popularity as it is an effective, safe, non-invasive treatment for treating stress, urge, mixed urinary incontinence and fecal incontinence.
Electrical stimulation resolves incontinence by treating the underlying problem – it strengthens weak pelvic floor muscles and can calm an over-active detrusor muscle without the use of medications or surgery. Muscle stimulation is a first-line treatment option that should be used prior to more invasive options.
Muscle stimulation causes a contraction of the pelvic floor muscles to strengthen them (resolving stress incontinence) and can also calm an overactive detrusor muscle (resolving urge incontinence). This therapy is very valuable when a person is too weak to contract their muscles on their own and also helps you to isolate the pelvic floor muscles.
Electrical muscle stimulation can be done in your doctor or therapist’s office or in the privacy of your home with an over-the-counter (no prescription necessary) muscle stimulation device.
Tibial Nerve Stimulation
Tibial nerve stimulation delivers specific electrical impulses to the tibial nerve. During treatment, a needle electrode is inserted near the ankle. The needle electrode is then connected to the battery-powered stimulator. During a 30-minute treatment, mild impulses from the stimulator travel through the needle electrode, along the leg and to the nerves in the pelvis (sacral plexus) that control bladder function.
Typically you will need 12 in-office treatments and your physician will determine the necessity of ongoing treatments thereafter. This type of therapy treats OAB only, not stress incontinence.
Note: Tibial nerve stimulation does nothing to strengthen the pelvic floor muscles.
Sacral Nerve Stimulation
The sacral nerves control the bladder and the muscles related to urinary function. If the brain and sacral nerves don’t communicate correctly, the nerves cannot tell the bladder to function properly. This communication problem may lead to symptoms of OAB. Neuromodulation targets these symptoms by stimulating the sacral nerves.
An electronic pacemaker-like device is implanted into your buttock area and a thin wire with an electrode tip is placed near the sacral nerve to deliver electrical impulses. Sacral Nerve Stimulation is an invasive, surgical procedure.
Note: Sacral nerve stimulation does nothing to strengthen the pelvic floor muscles.
MARKET LEADING MEDICAL DEVICES
InControl Medical InTone and ApexM
A recent clinical study shows a 90% improvement in daily incontinence occurrences over a 12-week period. ApexM treats the underlying causes of incontinence – weak pelvic floor muscles and an overactive detrusor muscle through gentle muscle stimulation surrounding the muscles that allow you to squeeze your urethra, stopping any unwanted leakage. The device is used intravaginally and can be done in the privacy of your own home. Learn more about InControl Medical ApexM here.
InterStim was developed by Medtronic. According to a clinical study sponsored by Medtronic, 59% of patients with urge incontinence who received and completed follow-up with their physicians had at least 50% fewer leaks per day compared to the number of leaks before therapy. Learn more about Medtronic InterStim here.
For urge incontinence, drug treatment has an ACP recommendation only if bladder training is unsuccessful. All pharmacologic therapy should be individualized based on the patient’s preference and medical comorbidities and the drug’s tolerability, cost, and ease of use.
For urge incontinence, physicians often prescribe anticholinergic/antimuscarinics medications to block the nerves that trigger contraction in the bladder muscle and prevent bladder spasms. The most common side effects include dry mouth and constipation.
- Medications include: Detrol, Ditropan XL, Enablex, Oxytrol, Urispas, Vesicare, Sanctura, Toviaz
- According to the Cleveland Clinic, the benefit of these medications is small, with fewer than 200 patients achieving continence per 1,000 treated.
Mirabegron (Myrbetriq®) is another medication used to treat incontinence by relaxing the bladder muscle and increasing the amount of urine the bladder may hold. Most common side effects include increased blood pressure, common cold symptoms, headache and urinary tract infection.
In men with urge or overflow incontinence, alpha blockers help to relax bladder neck muscles and muscle fibers found in the prostate to make it easier to empty the bladder.
Note: Medications do nothing to strengthen the pelvic floor muscles.
Neurotoxin Injection (Botox)
Neurotoxin (Botox®) is used for urge incontinence. Toxin is injected into the detrusor muscle (the muscle that surrounds the bladder) to limit the muscle’s ability to contract, thus diminishing the symptoms of urgency for a period of time. Injections must be completed with regularity, as the effects of the injection diminish.
Common side effects:
- Urinary retention (not being able to empty the bladder completely) which may require catheterization
- Urinary tract infection
- Hematuria (blood in the urine)
- Fatigue (extreme tiredness)
- Insomnia (difficulty getting to sleep and or staying asleep)
Note: Does not strengthen the pelvic floor muscles.
According to the Cleveland Clinic, approximately 11 percent of patients seeking treatment for urinary incontinence will undergo surgery.
Sling surgery is often done as an outpatient procedure. One option is to place the bladder in a “sling” – a piece of tissue or synthetic material is used to create a sling around the bladder neck and urethra in order to provide support to keep the urethra closed in order to prevent leaks. As with any surgical procedure, please discuss thoroughly with your physician the benefits and possible complications that may exist.
Note: Does nothing to strengthen the pelvic floor muscles.
Bladder neck suspension
This procedure will support your bladder neck and urethra. The bladder neck is an area of muscle where the bladder connects to the urethra. The surgery involves an abdominal incision, so it can be done during general or spinal anesthesia.