Urge Incontinence

What is urge incontinence?

Urge incontinence is a type of urinary incontinence that causes a sudden, urgent need to pee. You may accidentally leak urine (pee) before you make it to the bathroom. Some people pee more than eight times a day, as well as several times during the night.

How common is urge incontinence?

Approximately 40% of people assigned female at birth (AFAB) and 30% of people assigned male at birth (AMAB) experience urge incontinence at some point.

What are the types of urinary incontinence?

There are different types of urinary incontinence. All of them cause you to leak urine.

• Stress incontinence causes urine to leak because of pressure on the bladder from coughing, laughing or physical activity.
• Mixed incontinence occurs when you have both urge and stress incontinence. More than half of women with urge incontinence also have stress incontinence.
• Overflow incontinence causes you to leak urine because your bladder is too full or you can’t completely empty it.

What causes urge incontinence?

Most people with urge incontinence have overactive bladders. Your bladder is the organ in your urinary system that holds urine.

An overactive bladder causes your muscles in your bladder to squeeze (contract) more often than they should. This makes you feel like you have to pee before your bladder is actually full.

The squeezed bladder also causes your sphincter muscle inside your urethra (the tube that carries urine out of your body) to relax. When this muscle opens, it lets urine leak out.

What are the risk factors for urge incontinence?

Women are twice as likely as men to develop urinary incontinence. Although the problem becomes more common with age, healthcare providers don’t consider incontinence a normal part of aging. That means you may be able to find ways to treat it.

Risk factors for urge incontinence include:

• Diabetes.
• Hysterectomy or other pelvic surgery.
• Medications, including antidepressants, diuretics and blood pressure medicine.
• Menopause.
• Neurological disorders like Alzheimer’s disease, Parkinson’s disease and multiple sclerosis (MS).
• Obesity.
• Smoking.
• Stroke.
• Urinary tract infections (UTIs).
• Pregnancy and childbirth (particularly vaginal birth).
• Prior radiation therapy to the pelvis for any reason.
• Prostate problems like prostate cancer or an enlarged prostate (benign prostatic hyperplasia).

What are urge incontinence symptoms?

An urgent, uncontrollable need to pee is the top sign of urge incontinence. You may or may not leak urine. If you do have urine leaks, the amount tends to be larger than with other types of urinary incontinence.

Other signs of urge incontinence include:

• Frequent urination (more than eight times a day) or nocturia (peeing more than twice at night).
• Leaking urine before you can make it to the bathroom or just after you peed.
• Wetting the bed (enuresis) at night.

Why have I suddenly become incontinent?

It’s possible you’ve had mild symptoms for a while. Over time, symptoms from an overactive bladder can get worse and become more noticeable. If your incontinence came on after a recent medical procedure, injury or the start of a new medication, contact your healthcare provider. A nerve injury or another problem may be causing the incontinence.

How is urge incontinence diagnosed?

You’ll get a physical exam, which may include a pelvic exam or a rectal prostate exam. To help your healthcare provider make an accurate diagnosis, you might keep a bladder diary for two to three days, where you write down your fluid intake, bathroom use and urine leakage, including what you were doing when the leaks occurred.

Tests for urge incontinence include:

• Urinalysis to rule out infections, blood in your urine (hematuria) and other problems.
• Abdominal ultrasound to view your bladder, kidneys and other organs.
• Cystoscopy to examine your urinary tract.
• Urodynamic testing, including a postvoid residual urine test, to show how well your urinary system holds and releases urine.

Can pelvic floor exercises (Kegels) treat urge incontinence?

Yes, pelvic floor exercises (Kegels) can strengthen your muscles that support your urinary system. These exercises can improve symptoms.

It’s important to target and use the correct muscles (which is more difficult than you might think). A physical therapist who specializes in pelvic floor disorders can teach you the proper technique. This healthcare provider may use biofeedback to ensure you get the most benefit from the exercises. It can take four to six weeks to see improvements.

While some people need to strengthen the pelvic floor muscles, others have spasm or excess tension in the pelvic floor muscles that can make their overactive bladder worse. In this case, you can work with a pelvic floor physical therapist on relaxing and coordinating these muscles.

How else can you treat urge incontinence naturally?

Other steps you can take to ease urge incontinence:

• Ask your healthcare provider for help quitting smoking.
• Drink less caffeinated and carbonated beverages and alcohol. These substances can irritate an overactive bladder.
• Lose weight, if needed.
• Prevent constipation (which worsens incontinence) by eating high-fiber foods and staying hydrated.
• Manage conditions like diabetes.
• Use the restroom at set times (bladder training or timed voiding).

What are urge incontinence treatments?

If pelvic floor exercises and other techniques don’t help, your healthcare provider may recommend one of these treatments:

• Medications or bladder botulin toxin injections (Botox®) to relax your bladder muscle so it can hold more urine.
• Nerve stimulation using a device that sends electrical pulses to your nerves. These impulses act as a bladder pacemaker to relax and regulate overactive bladder squeezes. Your healthcare provider may recommend a surgical procedure to place a sacral nerve stimulation device. Or you may have an in-office procedure for percutaneous tibial nerve stimulation (PTNS).
• Augmentation cystoplasty surgery to enlarge your bladder using tissue taken from your intestine.
• Urinary diversion surgery to redirect your ureters (tubes that carry urine from your kidneys) to a urine drainage bag outside of your body instead of into your bladder.

What are the complications of urge incontinence?

Urge incontinence can affect your mental health. Some people with severe urge incontinence may be afraid to go out in public. They may worry about being too far from a restroom for fear of an accident. These worries may increase your risk of anxiety and depression.

Because urge incontinence causes you to leak a lot of urine, you may want to wear adult diapers or absorbent urinary pads until treatments take effect. Unfortunately, constant exposure to urine can lead to skin rashes and sores.

How can I reduce my risk of urge incontinence?

The same natural steps that treat urge incontinence can also help prevent it. For instance:

• Achieve a healthy weight.
• Do regular pelvic floor exercises.
• Prevent constipation.
• Stop smoking.
• Drink less caffeinated and carbonated beverages and alcohol. These substances can irritate an overactive bladder.
• Urinate regularly (timed voiding or bladder training) to keep your bladder emptier.

What is the outlook for someone with urge incontinence?

At-home therapies like pelvic floor exercises can help reduce urge incontinence. Usually, people who receive needed treatments like medications or nerve stimulation get symptom relief.

What should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What type of urinary incontinence do I have?
• What is causing my urge incontinence?
• What did my test results show?
• Are there treatments I can try at home?
• What are my other treatment options?
• Is nerve stimulation or surgery right for me?
• What are the risks of nerve stimulation or surgery?

Can urge incontinence get worse?

Without treatment and other changes, urge continence can get worse. You may find yourself going to the bathroom even more often or leaking larger amounts of urine. These problems are more likely if you gain a lot of weight, smoke or don’t change dietary habits.

What is the difference between urge incontinence and stress incontinence?

Urge incontinence and stress incontinence have different causes and symptoms.

• Stress incontinence is due to abdominal pressure on your bladder. It causes you to leak small amounts of urine.
• Urge incontinence results from an overactive bladder. It causes you to leak a lot of urine.

A note from Cleveland Clinic

Leaking urine for any reason isn’t an unavoidable part of aging, so don’t be embarrassed to talk to your healthcare provider. Treatments can help. You can learn pelvic floor exercises and use biofeedback to improve urge incontinence symptoms. If needed, you can try medications or nerve stimulation, too. With proper therapies, you can treat urge incontinence, regain the ability to regulate your bladder and enjoy life more.