Urge Incontinence: uncontrollable urine loss

Urge incontinence

Urge incontinence is a type of urinary incontinence characterized by involuntary and uncontrollable urine loss. This urgency can be so strong that you may only have a few minutes -or even seconds- to reach a bathroom after first feeling the need to urinate. As a matter of fact, it can even wake you up in the middle of the night. Few things give you that sinking feeling that it is already too late like urge incontinence. To put it bluntly, this condition takes place when the bladder muscles are out of whack. For example, most average bladders have a capacity of 350-550ml of urine; usually the first urge to urinate is felt at the 200ml mark.

However, in urge incontinence the muscles that contract and relax in order to empty the bladder may do so regardless of the quantity of urine stored. Furthermore, neurological problems may interfere with the area of the brain that can prevent bladder muscle contractions so that urination can be postponed until the person is ready to go. Aside from children who have yet to learn to control their bladders, urge incontinence is more common in women and seniors, though changes caused by benign prostatic hyperplasia -such as an obstruction of the bladder outlet- can lead to uncontrollable urine loss in adult men.

Other causes include:

  • Bladder inflammation.
  • Bladder cancer.
  • Infection.
  • Bladder stones.
  • Nervous system diseases like multiple sclerosis, diabetes, or Parkinson’s.
  • Nervous system injuries like spinal cord injury or stroke.
  • Bladder irritation.

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In addition to women and elderly people, other risk urge incontinence risk groups are:

  • Pregnant women.
  • Women who have just had a child.
  • Women who have undergone a C-section or other pelvic surgical procedure.
  • Overweight people.
  • People with a urinary tract infection.

Given the variety of potential causes, it’s not surprising that there is also a diversity of tests used to diagnose this condition, including:

  • Cystoscopy.
  • Ultrasound of the pelvis or abdomen.
  • Post-void residual volume measurement.
  • Urinalysis.
  • Urinary stress test.
  • Urodynamic studies.
  • X-ray imaging with contrast dye.
  • Myogram (rare).

Once a diagnosis has been established, and depending on the severity of the symptoms, a course of treatment will be agreed on. Like most conditions, medication and surgery are urge incontinence treatment options.




Oxybutynin, tolterodine, darifenacin, trospium, Solifenacin.

Once-daily formulas that help relax bladder muscles.

Such as augmentation cystoplasty to increase storage space and decrease pressure; only for severely affected patients who have too many contractions or are unable to store much urine.


Also known as Urispas.

Calms spasms; not always effective.


Tricyclic antidepressants

Imipramine, doxepin.

Immobilize smooth bladder muscle.


Physical complications of urge incontinence are rare; complications of treatment, not so much. Medications have potential side effects like blurry vision, dizziness, dry mouth, fatigue, insomnia, nausea, and constipation. Surgery, on the other hand, may lead to complications like blood clots, bowel obstruction, infection, and pneumonia. When settling on a treatment, doctor and patient must weigh the benefits and disadvantages against the possible social and psychological ramifications of uncontrollable urine loss.

Fortunately there is yet another treatment alternative based on behavioral techniques, bladder retraining, and exercise.

Bladder retraining


Behavioral techniques

·         Patient relearns to control bladder by becoming aware of their incontinence episode patterns.

·         Patient charts urination and leakage to provide biofeedback.

·         Toilet trips are scheduled every 1 -1 ½ hours. Patient tracks urination and leakage.

·         Patient holds urine in between toilet trips.

·         Kegel exercises are usually recommended for stress incontinence, but may help strengthen pelvic floor muscles to prevent urge incontinence as well.

·         A sensor in the vagina or anus can help determine if the corrects muscles are being exercised.

·         Alternately, low voltage electric stimulation can be applied to the targeted muscle group.

·         Weighted vaginal cones may also be used to strengthen the pelvic floor muscles.

Monitoring liquid intake so that the bladder doesn’t have to handle too much urine at any given time.

Abstaining from large quantities of liquids with meals (less than 8oz at a time), instead sipping small amounts between meals.

Ceasing fluid intake at least two hours before going to bed.

Avoiding carbonated beverages, caffeine, alcohol, highly acidic foods, and spicy foods.


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