Urge incontinence

Alternative names:

detrusor instability; irritable bladder; spasmodic bladder; unstable bladder; urgency incontinence

Symptoms:

• sudden and urgent need to urinate (urinary urgency)
• frequent urination, in the daytime and at night
• abdominal distention or discomfort
• involuntary loss of urine (urinary incontinence)

Signs and tests:

Physical examination will include exam of the abdomen, rectal exam, genital exam in men, and pelvic exam in women.

Tests include:

• post void residual (PVR) to measure amount of urine left after urination
• urinalysis/urine culture to rule out urinary tract infection
• urinary stress test (the patient is asked to stand with a full bladder, and then cough)
• pad test (after placement of a pre-weighed sanitary pad, patient asked to exercise; following exercise, the pad is re-weighed to determine the degree of urine loss)
• a pelvic or abdominal ultrasound
• X-rays with contrast dye
• cystoscopy (inspection of the inside of the bladder)
• urodynamic studies (tests to measure pressure and urine flow)
• rarely, an EMG (myogram) in performed

Further tests will be performed to rule out other types of incontinence. These tests may include the measurement of the change in the angle of the urethra when it is at rest and when it is straining (Q-tip test). An angle change of greater than 30 degrees often indicates significant weakness of the muscles and tendons that support the bladder, as in stress incontinence.