• Clinical science

Urge incontinence (Overactive bladder incontinence)

Abstract


Urge incontinence is a form of urinary incontinence characterized by a sudden urge to urinate, resulting in involuntary leakage of urine. The condition is caused by sensory or motor dysfunction. It is typically idiopathic but can also result from neurologic conditions such as spinal cord injury and stroke. The prevalence of urge incontinence increases with age, with more women affected than men. The condition is usually diagnosed via a detailed medical history and urodynamic studies. Treatment is conservative and involves the administration of anticholinergics. Surgical options should be considered only as a last resort.

Definition

References:[1]

Epidemiology

References:[2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[3]

Clinical features

  • Urinary urgency: sudden urge to urinate
  • Loss of urine without exertion, with urinary tenesmus; frequent episodes, with variable volumes of urine voided each time

Diagnostics

  • See diagnostics for urinary incontinence for general diagnostic measures.
  • Urinary stress test; : no leakage of urine in pure urge incontinence
  • Pad test:
    • Used to quantify urine leakage over a 1–24-hour period
    • Patients are asked to wear a preweighed sanitary pad, perform certain activities, and drink a certain volume of liquid. The pad is then weighed again to measure urinary leakage.

References:[4]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

Conservative measures

Conservative measures should first be attempted before considering medical treatment.

Nonpharmacological treatment

Medical treatment

Second-line treatment

  • Endoscopic injection of botulinum toxin at different points in the bladder wall
  • Sacral nerve stimulation
  • Last resort
    • Augmentation cystoplasty
    • In severe cases that show no response to other modes of therapy: diversion of urinal flow

References:[2][3]