Overactive Bladder

Urinary urgency is the very strong desire to pass urine and empty your bladder that cannot be deferred. When unable to reach the toilet on time and/or unable to hold on after the desire to pass urine, this leakage is urge incontinence (otherwise know as overactive bladder). Triggers that may create more urgency include running water and approaching the front door.

Urge incontinence can also be associated with needing to void frequently and nocturia, which is waking more than once overnight to void. Overactive bladder refers to this combination of symptoms. During urodynamic evaluation involuntary bladder contractions may be seen at the time of experiencing urgency.

Although the majority of patients with overactive bladder are idiopathic ie will not have an underlying cause, the below conditions can contribute to the symptoms and will be excluded during the evaluation process as is appropriate for each patient.

Causes of urgency

Causes of urgency include:

  • Acute urinary tract infection – an irritated bladder with cause urgency and frequency.
  • Constipation
  • Bladder irritants such as caffeine (coffee, soft drinks, tea)
  • Small bladder capacity
  • Prostate enlargement
  • Bladder tumour
  • Foreign body e.g. bladder stone, mesh erosion
  • Spinal cord injury
  • Stroke, Dementia, Parkinson’s disease

Management of urge incontinence

  • Managing fluids – this ensures you are drinking adequate fluids and avoiding fluids that cause bladder irritation such as coffee and alcohol.
  • Bladder retraining – this uses techniques to help increase bladder control without leakage and without the urgent need to pass urine.
  • Medications such as anticholinergics reduce bladder contractility thereby reduce urgency.
  • Botulinum toxin into the bladder – helps reduce bladder contractility where medications have failed.
  • Sacral neuromodulation – this is offered to manage intractable urinary incontinence and non obstructive urinary retention when conservative treatments have failed.
  • The use of appropriate containments aids – pads for male and female and condom drainage for males.

Mixed incontinence

Mixed incontinence is a combination of both stress and urge incontinence (as above). The symptoms experienced are a combination of both and the management of this will depend on which symptom is most debilitating to the patient.