Urge Incontinence

Urge incontinence (also called urge incontinence) is a sudden, involuntary urge to urinate which can hardly be held back and therefore leads involuntarily to urine leakage. The urge incontinence is caused by a motor or sensory component, mixed forms also exist. Motor urge incontinence is caused by hyperactivity of the muscle that empties the bladder – the detrusor vesicae muscle.

This muscle is also called “urinary expectorant” in German and contracts the muscles in the bladder. A contraction of the bladder always results in a reduction in volume and thus an outflow of urine from the bladder into the urethra. The pressure is so high that even if the pelvic floor muscles are intact, they are no longer able to hold back the urine – urine is discharged.

This hyperactivity of the bladder wall muscles cannot be influenced deliberately and can probably be described most vividly as “muscle twitching“, or “muscle spasm”. Accordingly, so-called spasmolytics – i.e. spasmolytic drugs – are administered therapeutically, which can effectively combat the hyperactivity of the bladder wall muscles. However, the effect of these spasmolytics is unfortunately also bought with a number of side effects, such as dry mouth, palpitations, and glaucoma.

These side effects can – but do not have to – occur.Urge or urge incontinence can also be triggered by its sensory component: The bladder muscles themselves are not hypersensitive, but rather the leading nerve tracts. The “switching center” which orders the bladder muscles to empty is hypersensitive in this form of urinary incontinence. It sends out too many impulses too often.

Since the muscles cannot decide whether constant contraction (and thus emptying of the bladder) really makes sense, they bluntly follow the commands of the hypersensitive control center and contract. In contrast to motor urge incontinence, it is not the hyperactivity of the bladder muscles that is to blame, but the hypersensitivity of the coordinating control center. In the end, the result is the same and relatively insignificant for the patient, but it is important for the treating physician to know the exact cause of the urge incontinence.

There is no difference in the drug therapy. First choice means are also spasmolytics. If the side effects are too strong or if it is not possible to take spasmolytics for other reasons, an injection of botulinum toxin (trade name Botox, BTX) into the bladder muscles can also be carried out in the second instance.

Botox inhibits the neuronal transmission between the nerve and muscle cells and leads to a slackening of the muscles. Therefore, it is often used during cosmetic surgery to fight wrinkles. The slackening of the bladder muscles reduces the permanent contraction of the bladder and improves urinary incontinence. However, it is important to find the right dose of Botox here, as too little application will have no effect, while too high a dose can lead to urinary retention. In any case, the application must be repeated after 2-6 months, as the Botox is slowly broken down and thus loses its effect.