Urge incontinence
Alternative names:
detrusor instability; irritable bladder; spasmodic bladder; unstable bladder; urgency incontinence
Treatment:
There are several different approaches that may be used in managing and treating urge incontinence. Kegel exercises (tightening the pelvic floor musculature 150 to 200 times per day) may be beneficial self-care. If evidence of infection is found in urine culture, antibiotics will be prescribed. Bladder retraining exercises can be used, having the individual urinate on a predetermined schedule or gradually increasing the interval between urinations. Biofeedback techniques may prove useful. Medications that relax the bladder muscles such as anticholinergics, bladder muscle relaxants or antispasmodic medications.
The choice and location of a specific treatment will depend on the severity of the symptoms and the extent that the symptoms interfere with your life style. There are three major categories of treatment for urge incontinence; bladder retraining therapy, medications to relax bladder contractions, and surgery.
MEDICATIONS:
Medications used to treat urge incontinence are aimed at relaxing the involuntary contraction of the bladder and improving bladder function. There are several types of medication that may be used, including anticholinergic agents, oxybutynin, tricyclic antidepressants, calcium channel blocking agents, flavoxate and terbutaline. Medications may be used alone or in a combination.
Propantheline and dicyclomine are anticholinergic medications that block the inappropriate contractions in the bladder. These medications has been widely used to treat urge incontinence because they are relatively inexpensive yet effective. Dicyclomine also has the ability to function as a bladder muscle relaxant. Side effects, including dry mouth, dizziness, drowsiness, increased heart rate, and difficulty urinating, are reported in about half of the people who are taking these medications.
Oxybutynin is an antispasmodic medication that also relaxes the smooth muscle of the bladder. Side effects are similar to those of propantheline, with the most commonly occurring side effect being dry mouth.
Tricyclic antidepressants, such as imipramine or doxepin, have been used to treat urge incontinence because of their ability to inhibit or "paralyze" the bladder smooth muscle. Possible side effects include fatigue, dry mouth, dizziness, blurred vision, nausea, and insomnia.
Flavoxate is a widely used medication to treat urge incontinence. This medication may have the ability to relax the smooth muscle of the bladder. Studies have shown inconsistent benefit in controlling symptoms of urge incontinence.
Calcium channel blocking agents may be used to treat urge incontinence because they prevent contraction of the bladder muscle by blocking the influx of calcium, which is required for muscle contraction. However, these medications are commonly used to treat elevated blood pressure, and therefore may have some dangerous side effects. Also, there is inconsistent reports of actual benefit in controlling urge incontinence.
Terbutaline, a beta-adrenergic agonist, may be used to treat urge incontinence because of it's ability to increase the bladder capacity. Potential side effects include heart palpitations, insomnia, and elevated blood pressure. People taking this medication should have their pulse and blood pressure frequently checked.
SURGERY:
Urge incontinence may result from inappropriate bladder contraction or decreased ability of the bladder to store urine. Surgery may be advised for people who have an unstable bladder (severe inappropriate contraction) and poor ability to store urine. Thus, the goal of any surgery to treat urge incontinence is aimed at increasing the storage ability of the bladder, while decreasing the pressure within the bladder.
Augmentation cystoplasty is the most frequently performed surgical procedure for severe urge incontinence. This is basically a reconstructive surgery in which a segment of the bowel is removed and used to replace a portion of the diseased bladder.
Possible complications include the usual complications resulting from a major abdominal surgery, bowel obstruction, blood clots, infection, and pneumonia. Also, there is a risk of developing urinary fistulae (abnormal tubelike passage from , urinary tract infection, difficulty urinating, and a rare possibility of increased risk of developing tumors.
DIET:
Some experts recommend a regimen of controlled fluid intake as a supplement to other therapies in the management of urge incontinence. The goal of this program is to distribute the intake of fluids throughout the course of the day so that the bladder does not need to handle a large volume of urine at one time. Do not drink large quantities of fluids with meals, limit your intake to less than 8 ounces at one time. Sip small amounts of fluids between meals. Stop drinking fluids approximately two hours before going to bed.
Additionally, it may be helpful to eliminate your intake of foods that may irritate the bladder, such as caffeine, spiced foods, carbonated drinks, and highly acidic foods.
BLADDER RETRAINING:
People with urge incontinence are initially managed with a program of bladder retraining. Occassionally, electrical stimulation and biofeedback therapy may be used in conjunction with bladder retraining. A program of bladder retraining involves becoming aware of patterns of incontinence episodes, and relearning skills necessary for storage and proper emptying of the bladder. Bladder retraining alone was successful in 75% of people treated for urge incontinence.
Bladder retraining consists of developing a schedule of times when you should try to urinate, while trying to consciously delay urination in between these times. One method is to force yourself to try to urinate every 1 to 11/2 hours , despite any leakage or urge to urinate in between these times. As you become skilled at waiting this long between urination episodes, gradually increase the time intervals by 1/2 hour until you are urinating every 3 to 4 hours.
KEGEL EXERCISES:
Pelvic muscle training exercises called Kegel exercises are primarily used to treat people with stress incontinence. However, these exercises may also be beneficial in relieving the symptoms of urge incontinence. The principle behind Kegel exercises is to strengthen the muscles of the pelvic floor, thereby improving the urethral sphincter function. The success of Kegel exercises depends on proper technique and adherence to a regular exercise program.
Some women may use vaginal cones to strengthen the muscles of pelvic floor. A vaginal cone is a weighted device that is inserted into the vagina. The women should then try to contract the pelvic floor muscles in an effort to hold the device the place. The contraction should be held for up to 15 minutes. This procedure should be performed twice daily. Within 4 to 6 weeks, about 70% of the women had some improvement in their symptoms.
BIOFEEDBACK AND ELECTRICAL STIMULATION:
For those people who are unsure if they are performing the procedure correctly, biofeedback and electrical stimulation may be used to help you identify the correct muscle group to work. Biofeedback is a method of positive reinforcement. Electrodes are placed on your abdomen and along the anal area. Some therapists place a sensor in the vagina in women or anus in men, to monitor contraction of the pelvic floor muscles. An monitor will display a graph showing which muscles are contracting and which are at rest. The therapist can help you identify the correct muscles for performing Kegel exercises. Of the people who used biofeedback to enhance performance of Kegel exercises, about 75% have reported improvement of their symptoms, and 15% were cured.
Electrical stimulation involves using low-voltage electric current to stimulate the correct group of muscles. The current may be delivered using an anal or vaginal probe. The electrical stimulation therapy may be performed in the clinic or at home. Treatment sessions usually last 20 minutes and may be performed every 1 to 4 days. Some clinical studies have shown promising results in treating urge incontinence with electrical stimulation.
ACTIVITY:
People who have urge incontinence may find it helpful to avoid activities that irritate the bladder and thus worsen symptoms. One such activity is bubble baths and use of some caustic soaps, as they may have a potentially irritant effect on the urethra or bladder.
MONITORING:
Urinary incontinence is a chronic (long-term) problem. Although some people may be cured by various treatments, you should continue to see your health care provider to evaluate the progress of your symptoms and monitor for possible complications of treatment.
Expectations (prognosis):
Symptoms can usually be alleviated with accurate diagnosis and adequate treatment regimens.
Complications:
Physical complications are rare, but psychosocial problems may arise, particularly if incontinence results from an inability to get to the bathroom when urgency arises.
Calling your health care provider:
If symptoms are moderate or severe (incontinence occurs more often than rare occasions, or if pelvic discomfort or burning with urination occurs), or if symptoms occur daily, call for an appointment with your health care provider.
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