Overactive Bladder (Urge Urinary Incontinence)
Overview
You are not alone.
More than 50% of women who are at least 65 years old have urinary incontinence.*
The current national estimates are that more than 20 million women have urinary incontinence or have experienced it at some point in their lives.
Urge urinary incontinence is when a woman feels an urge to go to the bathroom and leaks at the time of the urge or right after the urge. Sometimes these leaks are small and sometimes they can be quite large. When this happens, women frequently feel like their bladder is in control of them; this can cause women to limit their activities.
*According to a recent report from the CDC.
Causes
This type of leakage happens because the bladder actually begins to contract before the woman has given it permission to empty. When the bladder system is functioning normally, the bladder should only empty when the patient is sitting on the toilet. With urge urinary incontinence, the void contraction happens before the patient is ready.
Symptoms
How is urge urinary incontinence diagnosed?
Urgency incontinence can frequently be diagnosed based on symptoms. Women will complete a voiding diary that will tell us how frequently voids occur and how frequently leakage occurs. If there are questions, urodynamics can be done. Urodynamics is a test that evaluates bladder function. A small catheter is placed in the bladder during this test. Sterile water is infused into the bladder. A second catheter is placed in the vagina. The catheters measure the pressure in the bladder and urethra as the bladder fills up and as it empties. This test helps evaluate how the bladder functions, how the urethra functions, and what is causing the leaks. If the bladder is noted to have uncontrolled contractions during this test, the patient has detrusor overactivity, or urge incontinence. This can be caused by a neurologic reason (such as multiple sclerosis or stroke) but most commonly is idiopathic, or for unknown reasons.
Sometimes poor bladder function can be the first sign of a neurological disease. It is more common, however, for the patient to have a known neurological condition. If you have neurologic symptoms, it will be thoroughly investigated.
Treatments
What treatment options are available?
The first line of treatment for urge urinary incontinence is conservative. Many behaviors can make this type of leakage worse and it is important to thoroughly review your fluid intake, diet and habits that might be impacting your bladder. There are also urge suppression techniques and pelvic floor exercises that can help. Some women can be easily taught these exercises in the office. Others benefit from physical therapy or supplemental devices.
Medications
Medications are frequently the next line of therapy. Most of the medications that are commonly used to help urge urinary incontinence are in a family of medications called anticholinergics. They allow the bladder to store more urine. They can cause dry eyes, dry mouth and constipation but they are frequently quite beneficial. Recent data suggests that long-term use may negatively affect memory. This should be addressed with your provider if memory issues occur.
These medications include:
All of these medication are oral medications except Oxytrol and Gelnique- they are topical. Oxytrol is available over the counter.
Myrbetriq is another medication that helps the bladder store more urine. It is a beta-3 adrenergic agonist and works by a different mechanism than the other medications. It is not an anticholinergic
Additional Treatments
Some women improve with behavioral changes and medications. Other require additional treatment.
- Percutaneous Nerve Stimulation:
- OnabotuliniumtoxinA, commonly known as Botox®, can also be used to treat urge urinary incontinence. Botox® is injected into the bladder muscle and temporarily paralyzes the muscle. This reduces the urgency and frequency and can eliminate the associated leaks by blocking the random bladder contractions. Botox® has been shown to be an effective and safe treatment, and typically lasts 6-9 months.
- Interstim® is a form of sacral nerve stimulation. In this procedure, a small electrical lead is placed by the sacral nerves in your back to modify the neurological messages that the bladder is getting. A test procedure is done first to see how well this therapy will work. If it is at least 50% effective, then a permanent implant can be placed along with a generator like a pace-maker. Interstim has also been shown to be safe and effective.
Resources
Everyday Freedom - This website is a helpful resource for patients who are considering sacral neuromodulation as a bladder control treatment option, as well as those who are undergoing the evaluation or have moved on to the implant.
American Urogynecologic Society - This website promotes patient care for pelvic medicine and reconstructive surgery through education, research and advocacy.
Percutaneous Tibial Nerve Stimulation (PTNS) - More information on this treatment option.
Botox® - Detailed information regarding Botox® as a treatment option.