Bladder health

Urge urinary incontinence

What it is, what causes it, and how it is treated.

What is the pelvic floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. Three openings run through it: the urethra, the vagina, and the rectum. Its functions include:

• Supporting the pelvic organs, specifically the uterus, the bladder, and the rectum
• Helping provide sphincter control for the bladder and bowel
• Withstanding increases in abdominal pressure such as coughing, sneezing, laughing, straining, and lifting
• Enhancing the sexual response

What is urge urinary incontinence?

Urge urinary incontinence is the involuntary release of urine following a sudden, strong urge to urinate.

Urine is composed of water, electrolytes, and other waste material filtered out of the blood by your kidneys. It travels through the ureters to your bladder, where it is stored. Once the bladder is full, the muscles in its wall contract, forcing urine through the urethra and out of your body. Sphincter muscles and pelvic floor muscles keep the urethra closed to avoid leakage, and they relax at the same time the bladder contracts so urine can exit.

Signs and symptoms include a strong urge to urinate followed by leakage of urine. Many women also experience triggers, which are anything that increases the urge to urinate, such as running water, cold, or the thought of urinating.

What causes it?

Alcohol and caffeine

Alcoholic drinks and caffeine cause your bladder to fill more quickly and can trigger a strong, uncontrollable urge to urinate.

Bladder irritants

Carbonated drinks, citrus juices, artificial sweeteners, tea, and coffee can irritate your bladder and worsen urge incontinence. Even teas and coffees without caffeine are irritants. Nicotine is also a bladder irritant.

Dehydration

When you are dehydrated, your urine becomes very concentrated, which can irritate your bladder and worsen urge incontinence.

Urinary tract infection

Bacteria can irritate your bladder, causing strong urges to urinate, increased frequency, and incontinence.

Constipation

The bladder and rectum share a nerve supply. Compacted stool in the rectum over-activates these nerves, increasing urinary urgency and frequency.

Overactive bladder

Nerves send signals to the bladder at the wrong time, causing it to contract inappropriately and leading to incontinence.

Aging

As you age, the capacity of your bladder to store urine decreases and overactive bladder symptoms become more frequent. The risk also increases with various blood vessel disorders, which are more common in the elderly.

Interstitial cystitis

A painful condition involving inflammation and scarring of the bladder wall. Symptoms include painful, frequent urination as well as urinary incontinence.

Hysterectomy and other surgery

The bladder and uterus are very close together and share supporting ligaments and muscles. Removing the uterus risks damage to the structures that support the bladder. If they are damaged, a prolapse or cystocele is likely, and its symptoms include urinary incontinence. Surgery may also damage the nerves that supply the bladder.

Bladder cancer or bladder stones

Symptoms include urinary incontinence, urgency, frequency, and painful urination. Other symptoms include blood in the urine and pelvic pain.

Neurological damage

Disorders such as multiple sclerosis, Parkinson’s disease, or stroke can cause urinary incontinence by interfering with the nerve signals that control the bladder. Damage to the nerves that supply the bladder or pelvic floor muscles may also result in incontinence.

How is it treated?

Treatment is tailored to your individual problem. The following should be considered:

Pelvic floor muscle strengthening

Strengthening the supporting muscles of your bladder is very effective. Biofeedback, the use of special computer equipment to measure muscle activity, can help improve muscle control. Electrical stimulation can also assist in strengthening the pelvic floor muscles.

Bladder training

Bladder training involves learning to delay the urge to urinate. You breathe deeply, relax, and distract yourself with another activity when you feel the urge. The initial goal is to delay urination by 10 minutes, increased in intervals until trips to the toilet are reduced to once every 2 to 4 hours. It may also involve learning to completely empty the bladder, often with double voiding: urinating, waiting a minute, and then urinating again.

Urethral inserts

A urethral insert is a small tampon-like device placed in the urethra to avoid leakage. It is removed in order to urinate. It is not used for everyday activity but may help people who leak urine during sports.

Surgery

For severe cystoceles, or bladder prolapses, surgery is needed to correct the position of the bladder. Other surgeries for incontinence involve repositioning your urethra and bladder neck.

Sacral nerve stimulation

If neurological damage is the cause, implantation of a small device that electrically stimulates the nerves controlling the bladder and pelvic floor can help.

Prevention

• Routine pelvic floor muscle strengthening exercises
• Not smoking
• Avoiding or correcting obesity and chronic cough
• Increasing your daily fiber and fluid to prevent constipation, a risk factor for urinary incontinence
• Avoiding bladder irritants such as alcohol and caffeine
• Staying physically active, since active people are less likely to develop urinary incontinence
• Discussing the possibilities and risks of estrogen replacement therapy with your physician

Coping with urge urinary incontinence

It can cause embarrassment, fear, anxiety, and social isolation. For these reasons it is important to take steps to address the problem. Seeking treatment can not only help with the problem, but also improve self-esteem and restore confidence. These everyday tips can also help:

• Take a change of clothes and clean-up supplies with you when you leave the house
• Use the restroom before you leave the house
• Locate public restrooms before you need them
• Wear a pad or disposable undergarments
• If odor is a problem, use a powder or deodorant
• If skin becomes irritated, consider a barrier cream