Urge Incontinence

Urge incontinence is characterized by a sudden uncontrollable urge to urinate and frequent urination. It is often necessary to use a bathroom as frequently as every 2 hours, and bed-wetting is common.

With urge incontinence, the bladder contracts and squeezes out urine involuntarily. Sometimes a large amount of urine is released. Accidental urination can be triggered by

• sudden change in position or activity,

• hearing or touching running water, and

• drinking a small amount of liquid.

Two bladder abnormalities commonly cause urge incontinence.

The most common is a neurogenic bladder (overactive type), which is caused by brain or spinal cord injury or disease that interrupts nerve conduction above the sacrum and results in loss of bladder sensation and motor control. There are several neurological diseases and disorders associated with a neurogenic bladder, including the following:

• Alzheimer's disease

• Diabetes mellitus

• Multiple sclerosis

• Parkinson's disease

• Ruptured intervertebral disk

• Stroke

• Syphilis

• Traumatic brain or upper spinal-cord injury

• Tumors located in the brain or spinal cord

Chronic urinary tract infection, bladder stones, and polyps can irritate the bladder and cause detrusor muscle instability, leading to urge incontinence. Detrusor muscle instability without a known cause is also common. It has been suggested that, in these cases, an unidentified dysfunction in muscle or nerve tissue is responsible.

Diuretics increase the amount of urine released from the body. They are commonly used to treat high blood pressure (hypertension) and fluid build-up in the body (edema). Rapid-acting diuretics increase the urgency and frequency of urination in some people, especially the elderly and bedridden. Modifying dosage may alleviate symptoms.

Surgical Treatment of Urge Incontinence

Surgery is recommended only after other treatment options have proven unsuccessful.

Bladder Augmentation - This procedure increases the capacity of a small, hyperactive, or nonresilient bladder by adding bowel (intestine) segments or by reducing the muscle-squeezing ability of the bladder (autoaugmentation). Patients who are unable to perform self-catheterization (i.e., placement of a urinary catheter by the patient) or who have a kidney disorder, bowel disease, or urethral disease are not candidates for bladder augmentation.

Segments from the last part of the small intestine (ileum), the first part of the large intestine (cecum), or the juction between the small and large intestines (ileocecum) can be used to enlarge the bladder. The bladder is opened at the dome and cut on right angles on each side. The bowel segment is joined to the bladder with sutures.

In autoaugmentation, the smooth muscle that contracts the bladder to expel urine (detrusor) is cut out of the dome of the bladder, leaving the mucous membrane intact. This results in reduced muscle contraction and improved function in an overactive bladder.

Postoperative complications include urine leakage, continued incontinence, and kidney problems. Long-term risks include bladder stones, bladder cancer, and incontinence during and after pregnancy.

InterStim® therapy is a reversible treatment for people with urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medication.

InterStim is an implanted neurostimulation system that sends mild electrical pulses to the sacral nerve, the nerve near the tailbone that influences bladder control muscles. Stimulation of this nerve may relieve the symptoms related to urge incontinence.

Prior to implantation, the effectiveness of the therapy is tested on a outpatient basis with an external InterStim device.

For a period of 3 to 5 days, the patient records voiding patterns that occur with stimulation. The record is compared to recorded voiding patterns without stimulation. The comparison demonstrates whether the device effectively reduces symptoms. If the test is successful, the patient may choose to have the device implanted.

The procedure requires general anesthesia. A lead (a special wire with electrical contacts) is placed near the sacral nerve and is passed under the skin to a neurostimulator, which is about the size of a stopwatch. The neurostimulator is placed under the skin in the upper buttock.

Adjustments can be made at the doctor’s office with a programming device that sends a radio signal through the skin to the neurostimulator. Another programming device is given to the patient to further adjust the level of stimulation, if necessary. The system can be turned off at any time.

Possible adverse effects include the following:

• Change in bowel function

• Infection

• Lead movement

• Pain at implant sites

• Unpleasant stimulation or sensation

Nonsurgical Treatment of Urge Incontinence

Treatments most commonly used for urge urinary incontinence are biofeedback electrical stimulation, bladder training with timed voiding, and surgery.

• Bladder Training with Timed Voiding

  • This treatment is used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.

• Medication

  • Anticholinergic and alpha-1-adrenergic blocking agents have proven to be effective in some patients with urge incontinence.

  • Anticholinergic agents relax smooth muscle tissue and have an antispasmodic effect on overactive bladder.

  • Anticholinergic Agents

    • Propantheline bromide (Pro-Banthine®) is prescribed to stop bladder muscle contractions (overactive bladder). Typical dosage is 7.5 to 30 mg taken without food three to five times per day.

    • Oxybutynin chloride (Ditropan®XL) relaxes bladder smooth muscle. It is prescribed to treat urge incontinence caused by overactive bladder.

    • The oxybutynin transdermal system (Oxytrol™) is a thin, flexible, clear patch that is applied to the skin of the abdomen or hip, twice weekly, to treat overactive bladder. This treatment delivers oxybutynin continuously through the skin into the bloodstream and relieves symptoms for up to 4 days.

    • Patients who have urinary or gastric retention, uncontrolled narrow-angle glaucoma, and those with hypersensitivity to oxybutynin should not use the oxybutynin transdermal system.

    • Hyoscyamine sulfate (Levbid®, Cytospaz®) is an antispasmodic prescribed for urge incontinence caused by overactive or neurogenic bladder. Typical dosage is one or two 0.375 mg tablets taken every 12 hours. This drug should not be taken by patients with obstructive urinary tract disorders (e.g., enlarged prostate), glaucoma (i.e., eye disease characterized by increased intraocular pressure), or severe inflammation of the large intestine (ulcerative colitis).

    • Tricyclic antidepressants (TCAs) have anticholinergic effects that reduce nighttime incontinence and help manage urge incontinence. TCAs include doxepin hydrochloride (Sinequan®), desipramine hydrochloride (Norpramin®), nortryptyline hydrochloride (Pamelor®), and imipramine pamoate (Tofranil-PM®). The usual dose of Tofranil is 10 to 25 mg taken one to three times per day for a total of 25 to 75 mg daily.

  • Side effects associated with anticholinergics include the following:

    • Confusion

    • Constipation

    • Dizziness

    • Drowsiness

    • Dry mouth

    • Headache

    • Nausea

    • Nervousness

    • Rapid heart rate (tachycardia)

    • Urinary retention

    • Visual blurring

  • Alpha-1-adrenergic blocking agents

    • These agents are used to treat benign prostatic hyperplasia (BPH), which compresses the male urethra and obstructs urine flow resulting in overflow and urge incontinence.

    • Alpha blockers relax striated and smooth muscle, decreasing urethral resistance and relieving symptoms.

    • Three drugs commonly prescribed for treatment of BPH and associated incontinence include the following:

      • Doxazosin mesylate (Cardura®), 1-8 mg, once daily

      • Tamulosin hydrochloride (Flomax®), 0.4-0.8 mg, once daily

      • Terazosin hycrochloride (Hytrin®), 1-10 mg, once daily

  • Side effects commonly experienced with these drugs include

    • dizziness,

    • fatigue, and

    • headache.

  • Muscarinic receptor antagonist

    • Tolterodine tartrate (DetrolLA®) blocks nerve receptors that control bladder contraction and reduces urinary frequency and urgency in overactive bladder and urge incontinence.

    • The typical dose is 2-4 mg, twice daily.

    • Patients who have an adverse reaction to the drug or who have the following conditions should not use this medication.

      • Urinary retention

      • Gastric retention

      • Narrow-angle glaucoma

The above opinionated views and information serves to educated and informed consumer .  The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation.A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions