Urinary incontinence, or the involuntary loss of urine, is a common yet largely misunderstood condition that affects an enormous number of people. In fact, by some estimates, well over 10 million Americans experience it to some degree or another.

In this article, we will address one of the most common types of incontinence—and one of the most troublesome—urge incontinence. Whether you're personally affected by urge incontinence, caring for a loved one who is, or simply seeking to learn more about this condition, this guide is designed to provide valuable insights, support, and empowerment.

What Is Urge Incontinence?

Urge incontinence is a condition characterized by a sudden and strong urge to urinate, which may lead to involuntary urine leakage. Some common symptoms of urge incontinence include:

• Sudden urge to urinate: You may experience a strong, sudden urge to urinate that is difficult to control.
• Frequent urination: You might need to urinate more frequently than usual.
• Urge to urinate at night: You may wake up frequently during the night to urinate.
• Bladder leaks: You may experience episodes of involuntary urine leakage associated with the urge to urinate, even if you try to reach the bathroom quickly.
• Incomplete bladder emptying: After urinating, you might feel like your bladder is not completely empty.

Urge Incontinence & the Urinary System

Overview of urinary system (with graphic if possible) including kidneys, ureters, bladder, and urethra

In order to understand what urge incontinence is and why it develops, it’s important to have a basic understanding of the urinary system. The urinary system is made up of the following interconnected organs and structures, each of which fulfills a specific function:

• The kidneys filter your blood and remove waste via urine
• The ureters (narrow tubes) carry urine from your kidneys to your bladder
• The bladder stores urine until it is voided from the body
• The urethra is a tube that carries urine from the bladder to the outside of the body (and for men, a passage for for semen during ejaculation)

Normally, when your bladder is full, the detrusor muscle–the main muscle in the bladder wall–squeezes, pushing urine out through the urethra. This is what happens when you go to the bathroom. Then, when your bladder is empty, the detrusor muscle relaxes, allowing your bladder to fill up again.

With urge incontinence, the bladder's detrusor muscle becomes overactive, causing the unexpected and involuntary release of urine. This often happens suddenly and without the usual warning signs that you need to urinate.

Symptoms of Urge Incontinence

Urge incontinence can have an enormous impact on women’s day-to-day life. The frequent need to urinate and the fear of bladder leaks often disrupts their daily activities and social life, and sometimes even their sleep. Not surprisingly, many women suffering from urge incontinence report that it takes an emotional toll, leaving them feeling lonely, anxious, and/or depressed and diminishing their overall quality of life. (1)

Overactive bladder syndrome, or OAB, has a lot in common with urge incontinence. Its symptoms are very similar and include sudden, intense urges to urinate as well as frequent urination, typically both during the daytime and at night. Interestingly, however, less than half of women with overactive bladder actually experience incontinence.

Because they are unpredictable, symptoms of urge incontinence and overactive bladder are extremely challenging to navigate.

What causes urge incontinence?

Urge incontinence can have a variety of underlying causes.

Dysfunction of the bladder muscle. One of the primary causes of urge incontinence is dysfunction in the detrusor muscle, which controls the bladder's contraction and relaxation. When the detrusor muscle becomes overactive, it can squeeze involuntarily, leading to a sudden and strong urge to urinate.

Nerve damage. Damage to the nerves that control bladder function can disrupt the signals between the bladder and the brain, leading to overactive bladder symptoms. Nerve damage can result from a number of different conditions including diabetes, multiple sclerosis, or stroke.

Urinary tract infections. Bladder infections can lead to irritation of the bladder lining and cause symptoms of urgency and frequency.

Bladder irritants. For some people, things like caffeine and smoking can cause bladder irritation and contribute to urge incontinence.

Medications. Some medications, including diuretics and antidepressants, can affect bladder function and contribute to urge incontinence as a side effect. (2)

Bladder microbiome. The bladder microbiome, or “urobiome”, is the collection of microorganisms (such as fungi, bacteria and viruses) that exists in the bladder. There is growing evidence that the microbiome influences bladder function and may contribute to symptoms of overactive bladder and urge incontinence. (3)

Pelvic radiation. The bladder muscle may lose some of its elasticity in women who have undergone radiation to the pelvic area. When this occurs, women often experience discomfort as their bladders fill.

Is urge incontinence curable?

Whether or not urge incontinence can be cured depends largely on what is causing it. If, for instance, the underlying problem is a urinary tract infection, antibiotics will likely clear it up completely. However, if the issue is nerve damage caused by diabetes, minimizing and managing symptoms – rather than eliminating them – will likely need to be the goal.

Managing Symptoms: Medical & Physical Approaches

Bladder and Pelvic Floor Muscle Training Techniques

Bladder training. Bladder training, a behavioral therapy technique, offers an effective way to regain control over bladder urges and reduce leakage episodes. It involves learning to gradually increase the amount of time between bathroom trips and retraining your bladder to hold urine for longer periods.

Pelvic Floor Muscle Exercises (Kegels). Kegel exercises involve squeezing, holding, and then relaxing the pelvic muscles. Regularly performing them strengthens the muscles that support the bladder and urethra and doing eight or 10 repetitions of them three or four times a day can go a long way in preventing bladder leakage.

Bladder Training: 3 Proven Methods

Lifestyle Approaches

Fluid management. Stay hydrated but pace yourself. Drink plenty of fluids throughout the day to maintain adequate hydration, but be mindful of consuming excessive amounts all at once. Remember, as the bladder starts to fill up, it can cause the bladder muscle to contract and trigger the urge to urinate.

Avoid bladder irritants. For some people, caffeine and alcohol can irritate the bladder and exacerbate urge incontinence. While you probably don’t have to eliminate them altogether, if you have urge incontinence, you might want to try cutting back on caffeine and alcohol and see if your symptoms improve. Smoking is something else to avoid. Not only is it terrible for your overall health, it has been clearly linked to overactive bladder and incontinence. (4)

Medical Approaches

There are several medications that can be helpful in managing symptoms of urge incontinence, including urinary urgency and frequency.

• Antimuscarinic medications (also called anticholinergic medications) work by blocking the signals that cause the bladder muscles to contract uncontrollably. Examples include oxybutynin, tolterodine, solifenacin, and darifenacin. Unfortunately, side effects related to these medications often cause people to stop using them. Potential side effects include dry mouth, blurry vision, rapid heart rate, and constipation; in some people anticholinergic medications can cause urinary retention.
• Beta-3 Adrenergic Agonist medications (e.g. mirabegron, vibegron) work by relaxing the bladder muscle and increasing bladder capacity. This type of medication tends to have fewer side effects than antimuscarinic drugs. In fact, they are sometimes used in individuals who try and do not tolerate the side effects of antimuscarinics.
• Individuals whose symptoms of urge incontinence do not improve with behavioral approaches and medication can be considered for a range of other treatments, including:
• Tibial Nerve Stimulation. The tibial nerve is a nerve in the leg, near the ankle; it's connected to the nerves that control the bladder. Tibial nerve stimulation involves inserting a thin needle into the skin near the ankle, where the tibial nerve is located. Gentle electrical signals are then delivered through the needle; these signals travel up the leg to the spine and then to the bladder. By regulating signals to the bladder this way, tibial nerve stimulation can help alleviate urge incontinence symptoms. Sometimes electrical signals are delivered using special pads applied to the skin overlying the tibial nerve and no needle is necessary. Also, several implantable neurostimulation devices are currently available; they are surgically implanted underneath the skin near the tibial nerve and deliver electrical signals using a battery.
• Sacral Nerve Stimulation. The sacral nerve is a nerve in the lower back that controls bladder function. A sacral nerve stimulator is a small device, similar to a pacemaker, that is implanted under the skin near the buttocks. The device sends electrical pulses to the sacral nerve and helps regulate the signals going to your bladder, reducing the urge to urinate suddenly and helping prevent accidents.
• Botox Injections. Botulinum toxin (Botox) injections directly into the bladder muscle can help relax overactive bladder muscles and reduce urinary urgency and leakage.
• Surgery. In rare cases when other treatments have failed, surgical interventions may be considered for urge incontinence. Options include bladder augmentation (increasing bladder size), urinary diversion (a surgical procedure that involves rerouting the flow of urine from the bladder to a new exit point on the body), or placement of a suprapubic catheter (a type of urinary catheter that is inserted through the lower abdomen into the bladder).

Tips for Maintaining Your Quality of Life When Living With Urge Incontinence

Keep supplies on hand. Always carry extra absorbent pads, liners, or protective underwear with you when you're away from home. Having these supplies on hand can provide a sense of security and help manage any unexpected leakage.

Plan ahead. Before leaving the house, plan your bathroom breaks and identify restrooms along your route or at your destination. Knowing where the nearest restroom is can help alleviate anxiety and ensure that you have easy access when needed.

Stay calm. If you do experience a bladder leak in public, try to stay calm and composed. Remember that urinary incontinence is a common condition, and most people are understanding and sympathetic.

Dress strategically. Wear dark-colored or patterned clothing that can help camouflage any potential leaks. Consider layering with dark-colored clothing or wearing clothes with forgiving fabrics that dry quickly, such as cotton or moisture-wicking materials.

Use absorbent products. Consider using absorbent pads, liners, or protective underwear to manage any leakage and provide peace of mind when you're out and about. Choose products specifically designed for your level of incontinence and activity level.

Practice good hygiene. Practice good hygiene by keeping the genital area clean and dry. Pat the skin dry instead of rubbing to prevent irritation.

Talk to family and friends. Push feelings of embarrassment aside and remember that the most important people in your life want to be there to support you. Also, consider seeking out local or online support groups for people with urge incontinence. Many people find it helpful to talk to others who are going through the same thing.

Seek medical support. Don't hesitate to talk to your healthcare provider about your incontinence symptoms. They can offer personalized advice, recommend appropriate treatments, and provide support to help you manage your condition effectively.

How to Choose the Right Incontinence Products for Daily Use

Choosing the right incontinence products for daily use is crucial for managing symptoms effectively and maintaining comfort and dignity. Here are some steps to help you select the most suitable products:

Assess your needs. Begin by assessing your individual needs and preferences. Consider factors such as the severity of your incontinence, the frequency of leakage episodes, your activity level, and any specific features you require in an incontinence product.

Understand the types of products available. There are various types of incontinence products available.

• Disposable pads and liners are thin and discreet and are designed to absorb only light to moderate urinary leakage.
• Disposable briefs provide more coverage and absorbency than disposable pads; they are suitable for moderate to heavy urinary incontinence. 
• Disposable underpads (AKA "bed pads") protect your bed and other furniture from leaks.
• Washable absorbent underwear are a cost-effective, environmentally alternative to disposable briefs.
• Portable urinals, designed for use at home or on the go. Boom Home Medical offers two options: Loona portable female urinal and Tanker portable urinal for males. 
• Personal wipes help you feel clean and fresh wherever life takes you.

Find the right absorbency levels. Choose an incontinence product that is absorbent enough to keep you protected. Products are typically labeled with absorbency levels ranging from light to maximum, allowing you to find the right level of protection for your needs.

Consider comfort and fit. It’s unlikely you’ll use any product that’s not comfortable. Also, find products that can be worn discreetly under clothing. Chances are you won’t use a product if it leaves unsightly panty lines or makes a rustling sound when you walk or move.

Eco-friendly? If environmental sustainability is important to you, explore eco-friendly options such as reusable cloth pads or underwear. While these options may require more frequent washing, they can reduce waste and leave a smaller environmental footprint.

REFERENCES

1. Veroese N et al. Maturitas. Vol 160, June 2022, pages 11-15. https://www.sciencedirect.com/science/article/abs/pii/S0378512222000226
2. Somaz V et al. Int Neurourol J. 2017 Mar; 21(1): 62–67. Published online 2017 Mar 24. doi: 10.5213/inj.1732652.326
3. Bae S et al. Int Neurourol J. 2022 Sep; 26(3): 190–200. Published online 2022 Apr 22. doi: 10.5213/inj.2244016.008
4. Kawahara T. Int J Urol. 2020 Dec; 27(12): 1078–1086. Published online 2020 Sep 1. doi: 10.1111/iju.14357