Some people suffer from an excruciating, precipitous urge to urinate, forcing them to quickly visit a restroom. Sometimes this can result in urge incontinence, an involuntary leakage of urine.
What is urge incontinence?
Urge incontinence, or urge incontinence, is the medical term for an abrupt onset of urge to urinate that is difficult to control and may be accompanied by involuntary leakage of urine. This form of incontinence is triggered by a sensitive, overactive bladder. There are two main forms of urge incontinence:
- In sensory urge incontinence, the bladder reacts with an urge to urinate even at low levels.
- In motor urge incontinence, there is a disorder of the nerves responsible for emptying the bladder, which causes the bladder sphincter to contract in spasm.
In both cases, it is not a disorder of the sphincter, but a malfunction of the bladder muscle, in which even a low bladder filling level triggers extreme bladder pressure.
Causes
The most common causes include inflammation of the lower urinary tract, especially in sensory urge incontinence. It can be caused by frequent bladder infections or bladder stones. The sensors that transmit the level of the bladder to the brain are sensitive. The brain reacts by reflexively contracting the bladder muscles. When the bladder is not properly filled, this results in frequent excretion of small amounts of urine. In motor urge incontinence, the signals between the bladder and the brain do not function properly. Urine leakage that cannot be controlled occurs when the muscle responsible for emptying the bladder contracts and the pressure in the bladder increases. Sufferers feel a strong urge to go to the toilet quickly. Neurological diseases such as stroke, multiple sclerosis, diabetes, Parkinson’s and Alzheimer’s can also lead to urge incontinence. Sometimes a cup of coffee or other beverage is enough to trigger the urge to urinate. During menopause, it can also be due to pelvic floor weakness.
Symptoms, complaints and signs
The main symptom of urge incontinence is a sudden, agonizing urge to urinate that usually cannot be suppressed. The urge can be so intense that sufferers sometimes fail to reach a toilet in time. Involuntary urination may occur, and in addition, shorter intervals of bladder emptying may occur. Those suffering from urinary incontinence are e constantly on the lookout for the nearest toilet. Those affected usually have to urinate more than eight times a day, usually also at night. The pressure increases even more during excitement or psychological stress. Cold can also promote the urge to urinate, or a sound of water. A lack of estrogen, as occurs during menopause, exacerbates the symptoms.
Diagnosis and course of the disease
At the doctor’s office, a detailed medical history is first taken about the symptoms, whether there is involuntary loss of urine. This is followed by a physical examination, usually a gynecological one in women, to determine whether there is a lowering of the uterus or vagina, whether there is an estrogen deficiency, and what the condition of the pelvic floor is. To rule out cystitis, the urine is examined. A cystoscopy is also usually performed to detect bladder tumors, bladder stones or an enlarged prostate. An ultrasound examination can be used to assess the filling capacity and degree of filling of the bladder. A special transducer can be used to examine the bladder and urethra from the vagina, including whether coughing or pressing causes a change in position. Changes between periods of rest and periods of exertion can also be recorded. It is useful to measure bladder pressure to find out the causes of involuntary urine leakage. Due to the good technical possibilities of ultrasound examinations, X-ray examinations are rarely performed. A micturition protocol can be a valuable supplement.
Complications
Urge incontinence usually has a very negative impact on everyday life and on the life of the affected person. Patients suffer from very frequent urination and are unable to hold water in the bladder in many situations.In children, urge incontinence can also lead to bullying or teasing, so that patients also suffer from psychological complaints or depression. Furthermore, these complaints can also occur in adults. Those affected feel uncomfortable with it and in many cases are ashamed of the symptoms of urge incontinence. This can also lead to reduced self-esteem or strong inferiority complexes. If urge incontinence is not treated, the condition can continue to lead to urinary toxicity. In the worst case, the affected person may die from this. The kidneys are also damaged in the course of the disease, so that renal insufficiency can also occur. Those affected are then dependent on a donor kidney or dialysis. The risk of prostate cancer increases significantly as a result of the disease. Treatment always depends on the cause, but proceeds without complications. The symptoms cannot be completely alleviated in every case. It is also possible that the disease limits the life expectancy of the patient.
When should one go to the doctor?
The affected person should always see a doctor immediately in case of urge incontinence, as it is a serious disease that can significantly reduce the quality of life of the affected person. There can be no independent cure, so the patient should contact a medical professional at the first symptoms and signs of urge incontinence. The earlier the disease is diagnosed, the better is usually the further course. A doctor should be consulted if the patient suffers from incontinence during severe physical or mental stress. Small amounts of urine leak out, which can also be only small droplets. The affected person does not always recognize this dripping. In many cases, severe pain in the area of the bladder or ureters can also indicate urinary incontinence and should also be examined by a doctor. In this case, the complaints do not have to be permanent. In the case of this disease, a urologist should be consulted. However, since the disease can also lead to psychological upsets or depression, a visit to a psychologist is also usually necessary.
Treatment and therapy
Since urge incontinence is not caused by organic problems in most cases, treatment is primarily aimed at improving the symptoms. Initially, targeted bladder training is designed to improve bladder control and increase the intervals between voidings. It is best to keep a micturition diary, which provides information about when the urge to urinate occurs, how quickly the affected person gives in to it, whether there is involuntary leakage of urine, and how much is drunk. In most cases of urge incontinence, targeted pelvic floor training is also useful to strengthen the muscles. In addition to bladder training, medication is usually prescribed to relax the bladder muscles and enable them to store a greater volume of urine again. In most cases, anticholinergics are administered. However, they can cause dry mouth, gastrointestinal problems, and dry skin. In milder cases, herbal remedies with pumpkin can also relieve the irritation. Antibiotics are prescribed only in cases of infection. Surgical procedures tend not to be indicated for urge incontinence because the closing apparatus of the bladder is intact. Bladder stones are an exception because they must be removed.
Prevention
One of the most important preventive measures is regular pelvic floor exercises. Those who suffer from excess weight should reduce it, because the excess kilos strain the pelvic floor. Regular exercise is good. A balanced, healthy diet can help prevent constipation, which in turn puts a strain on the pelvic floor. Sufficient drinking ensures that the bladder’s capacity is exercised. In addition to bladder training, it is useful to learn relaxation techniques.
Aftercare
Aftercare for urge incontinence is necessary if the symptoms are permanent and cannot be treated causally. Affected individuals need to experience adequate support in their daily lives. The effects of the complaints should burden life as little as possible. To this end, the doctor and patient agree on an appointment to discuss the effectiveness of the measures.In practice, medication, bladder training and psychotherapy promise promising treatment success. The last aspect in particular is an important component. In severe cases, uncontrolled urination can restrict everyday life. Many patients hardly dare to leave their homes. The patient’s medical history plays an important role in the scheduled follow-up examinations. In addition, neurological approaches can also be pursued. Basically, doctors try to eliminate the causes of urge incontinence. Unfortunately, according to a statistical survey, this succeeds in only 20 percent of all cases. Since the elimination of the triggers means that there are no longer any symptoms, there is no longer any need for close follow-up checks, as is the case with tumor diseases. After complete healing, a recurrence is not to be expected. To date, no effective preventive measures are known to prevent recurrence of urge incontinence.
What you can do yourself
Urge or urge incontinence is treated with medication and physical therapy. Any organic disorders must be identified and corrected. Targeted bladder and toilet training can be used as a means of self-help. The results are recorded in a micturition diary so that the patient and doctor can treat the condition in a targeted manner. This is supplemented by pelvic floor training under medical supervision, which is supported at home by physiotherapy, yoga and other strengthening measures. Parallel to this, treatment with medication is necessary. The most important self-help measure here is to take the prescribed medication properly. If unusual side effects occur, such as dry mouth or gastrointestinal disturbances, the treatment must be discontinued and the doctor informed. Urge incontinence also requires preventive measures. Many patients wear adult diapers or special panty liners. A change in daily routine creates room for relaxed visits to the toilet. The diet should be changed. Diuretic foods and spicy or potassium-containing foods should be avoided. To create an adapted diet, those affected are best advised to sit down with a nutritionist. The association Inkontinenz Selbsthilfe e. V. provides further advice and contacts for those affected.