This is Part Two of a two-part series about different types of urine leakage (incontinence)
In the first post of this series, we began by discussing urine leakage (incontinence) in general and then moved on to talk about one specific type of urinary incontinence, stress incontinence. Stress leakage generally occurs with activities or actions that increase abdominal pressure (think coughing, sneezing or exercising), essentially forcing the urine out past the muscles that normally keep you dry. Today, we turn our attention to urinary incontinence that may seem more sudden or random. Urgency incontinence is urinary leakage that occurs along with a need to urinate that is difficult or impossible to postpone. For many people, this common form of incontinence can result in really large volumes of urine leakage that can be quite distressing, even debilitating.
Urinary incontinence associated with urgency can be a side effect of many bladder issues. This would include neurologic issues that can affect more than just the bladder including multiple sclerosis, stroke or diabetic neuropathy. Patients with spinal cord injuries or diseases may suffer from urgency incontinence. The bladder may be irritated from urinary tract infections or pelvic radiation. Patients may have blockage of the bladder outlet or involvement of the bladder from a prior incontinence surgery such as a mid-urethral sling. These are just a few of the numerous causes of frequent urination or urgency that results in incontinence. However, the most common cause of these symptoms is Overactive Bladder (often abbreviated OAB). OAB is defined as having urinary urgency, with or without urinary leakage.
If the cause of urgency incontinence is something other than Overactive Bladder, it is important to identify and treat the underlying condition. But for most patients with urgency incontinence, those with OAB, there is no cure for the symptoms. Rather, the focus is on moderating and treating the symptoms.
For most people, treatment should begin with identifying lifestyle modifications that may help the problem. This might include moderating intake of irritating foods or beverages such as those containing caffeine or acids or artificial sweeteners (see the previous posts about how what you drink affects your bladder). Pelvic floor exercises (often termed Kegel exercises) can help to reduce incontinence and may play a role in controlling the urgency to urinate. Urinating on a fixed schedule that gradually increases (Bladder Training) may help to reduce the frequency of urination over time.
For those that are not seeing enough benefit from these changes or who have more severe symptoms, treatment with medications is often appropriate. Most OAB medications are taken by mouth and act on the bladder to partially block the bladder receptors that are overactive. This may reduce the severity of the urgency to urinate, increase the time between the first urge to urinate and severe urgency, decrease the total number of trips to the bathroom and reduce the number or leakage episodes. Common side effects include dry mouth or dry eyes, with constipation occurring in some patients. For a few people, particularly those who are older, some OAB medications can affect thinking or memory so this should be considered in choosing a medication. I think it is important to note that most medications work better as additions to rather than instead of lifestyle changes. I always encourage my patients to continue the behavior changes we started with.
Even after lifestyle/behavior changes and medications, there are those patients who still have bothersome symptoms or may not be able to take OAB medications. The symptoms of OAB can be quite severe and it may be appropriate to pursue more invasive therapies if medications are ineffective or result in intolerable side effects. We often call the next steps in OAB therapy “third-line therapies” meaning we are trying them after behavioral therapy (first-line) and medication therapy (second-line). These third-line therapies include injection of Botox into the bladder and stimulation of nerves either in the lower leg or the sacrum (Sacral Neuromodulation). It may require seeing someone who specializes in OAB to have these third-line therapies done.