What You Need to Know About Urge Incontinence

Urge incontinence is when you have a strong and sudden sense you need to urinate. As in, you need to go RIGHT NOW. Followed by a spasm or squeezing in the bladder, it can cause unexpected urination. Sometimes it’s a little, sometimes it’s a lot. Either way, it’s embarrassing and inconvenient.

The most common type of incontinence for older individuals is urge incontinence, which commonly occurs at night. It can occur at any hour of the day too by certain cues, such as hearing running water or opening the door when returning home.

In many cases, people experiencing urge incontinence have what’s called an overactive bladder (OAB). An OAB causes the muscles in your bladder to randomly squeeze, creating the sensation that your bladder is full and needs to be emptied. The squeezing also causes the muscles in your urethra (the tube that transports urine from your bladder and out of your body) to relax, allowing urine to leak out.

Urge incontinence affects both men and women but occurs more frequently in women.

Other common risk factors include:

- Diabetes

- Menopause

- Certain medications, most notably those for high blood pressure and depression

- Obesity

- Kidney stones

- Pelvic surgery, including hysterectomies

- Smoking

- Pregnancy and childbirth

- Prostate issues

- Urinary tract infections

- Certain neurological disorders, including Alzheimer’s, Parkinson’s, and multiple sclerosis

The good news is that, very often, urge incontinence is caused by a minor medical condition, such as infection, which can be treated with antibiotics. However, there are other more serious potential causes which make getting an accurate diagnosis important.  

The first step in diagnosing any type of urinary incontinence (and there are several) is confirming what type of incontinence you have. Typically, your doctor will review your symptoms, medical history, and perform an exam.

In addition, you will be asked to provide a urine sample for analysis and to keep a “bladder journal” for a few days. Important things to note include, how often you urinate, the amount you produce, and any signs of leakage.

In some cases, your doctor may perform a post-void residual measurement by using a catheter or ultrasound. This can determine how much, if any, urine remains in your bladder after you go to the bathroom. A large amount of urine left in the bladder may indicate an obstruction in your urinary tract or a more serious problem with your bladder’s nerves or muscles.

Once you’ve determined the cause of your condition, your doctor can recommend a specific treatment plan. Options range from medication, bladder training, and fluid management to pelvic floor exercises, medical devices, and, in extreme cases, surgery.

Because urge incontinence can indicate larger medical issues, it is important to seek medical attention when you find yourself racing to the bathroom more frequently or leaking urine.

Anthony Donaldson, MD, is a board-certified urologist at Southwestern Vermont Medical Center.