You may have heard urge urinary incontinence referred to as an unstable or overactive bladder. You have possibly even heard the phrase “detrusor instability”. However, many people are not educated on the underlying causes of urge incontinence and the common symptoms.
Urge incontinence is the second most common variety of incontinence after stress incontinence. Recent studies suggest that the number of people worldwide suffering from urge incontinence is between 50 and 100 million, therefore if you have urge incontinence you are most definitely not alone. Urge incontinence can cause a great amount of stress and disruption to anyone suffering from the ailment, therefore it is important to be educated and aware of the condition to the greatest extent possible.
What is Urge Incontinence?
The easiest way to understand urge incontinence is through comparing the condition to a normally functioning bladder. In a bladder that is functioning normally, the muscle in the bladder called the Detrusor remains relaxed as the bladder gradually fills up. You should feel the first urge to urinate when there is a bit less than 1 cup of urine in your bladder. Most people are able to hold more than 2 cups of urine in their bladder. Once you have felt the need to go and urinate, you should find yourself with enough time to reach the toilet before urinating.
However, if you suffer from urge incontinence, this process is not straight forward. The communication between the brain and the bladder does not quite function correctly. If you have urge urinary incontinence, you will feel the need to empty your bladder straight away although your bladder may not be particularly full. This leaves you with little or no time to get to the bathroom, and you are often at risk of leaking urine at inappropriate times. For instance, you may leak urine in public or while you are sleeping.
People who suffer from urinary incontinence often feel like they cannot seem to empty their bladder and feel the need to urinate frequently.
If you feel like you may have urge incontinence, it is advisable to check whether you have any of the following main symptoms of the condition:
1.Having the inability to control when you pass urine
2. Needing to urinate often during the day and night
3.Feeling like you will urinate suddenly without having time to reach the bathroom
What are the causes of urge urinary incontinence?
Urge urinary incontinence occurs due to abnormal bladder contractions. If you have urge incontinence, you will experience bladder contractions at inappropriate times, leaving you with little or no time to go to the bathroom. People with diseases that affect the nerves that are linked to the bladder such as Multiple Sclerosis and Parkinson’s disease can be prone to urge incontinence. It is also common for people who have suffered a stroke to develop urge incontinence, and people with a urinary tract infection are at particular risk of urge incontinence. Another common reason why urge incontinence may develop is that the part of the brain that controls urination may undergo changes that will result in the brain sending incorrect messages to your body.
Who is at the greatest risk of urge incontinence?
While urge incontinence is a common problem and can affect anyone, women and older adults are at a higher risk of developing urge urinary incontinence. Factors such as pregnancy, childbirth, menopause due to lack of oestrogen and the normal female anatomy account for this difference. Women who have had a C-section or other pelvic surgery are at particular risk of developing urge incontinence. A pelvic organ prolapse may also contribute to the development of urge incontinence.
Additionally, there is increasing interest in urge incontinence in older people as being a reflection of alteration of central control as much as an end-organ disease. Functional PET scanning in young, healthy volunteers shows that the periaqueductal grey matter (PAG), pons and ventral and dorsal portions of the pontine tegmentum are active during bladder filling. Functional MRI studies in older people suggest that failure of activation in areas of the brain relating to continence, such as the orbitofrontal regions and the insula may lessen the ability to suppress urgency. There is a known association between vascular risk factors and lower urinary tract infections. The presence of white matter hyperdensities within periventricular and subcortical regions of the brain is associated with functional and cognitive impairment. As a consequence, elderly people may find it harder to retain bladder control due to alterations in the functioning of the brain.
How Is Urge Incontinence Treated?
The treatment option you choose for your urge incontinence will normally depend on the severity of your condition and the quantity of urine you leak each day. As urge incontinence is often the result of another underlying condition, that underlying condition needs to be correctly identified and treated. If left untreated, urge incontinence can easily create anxiety and get in the way of everyday social life and events. It is therefore hugely important that you see a doctor if you feel that you may have urge urinary incontinence.
Some useful treatment methods that are suitable for trying at home include doing pelvic floor exercises, which help strengthen the muscle tissue surrounding your bladder. To find out more about how to do these pelvic floor exercises, read our blog page on incontinence treatment here. You may also want to ensure that you make the route to the toilet in your home as easily accessible as possible, and consider some relaxation techniques such as meditation in order to reduce anxiety symptoms.
However, a method which is fairly new and has seen a transformation in the treatment for urge incontinence is Pelvic Physical Therapy. Also referred to as Pelvic PT, Pelvic Physical Therapy involves restoring function, improving muscular support around the pelvis and improving behavioural/dietary habits. The treatment also involves re-training body movements to allow for optimal organ and structural function.
The impact of the treatment has been confirmed in many case studies and research plans. For example, a case study conducted in 2013 by the Pelvic Health and Rehab Center followed a 44-year-old female with a 14-year history of urge incontinence, who was named Joan for confidential reasons. Urge incontinence greatly affected Joan’s functioning and quality of life. She was unable to sit through meetings at work and avoided social activities and long walks due to fear of leaking. The patient’s initial goals for pelvic floor PT were first to eliminate leaking on the way to the bathroom, and secondly, to decrease her urinary frequency from twice per hour to once every two hours.
Joan’s inner thighs, abdomen, pelvic floor, hips and low back were evaluated. It was discovered that there were trigger points in her bilateral adductor muscles, urogenital diaphragm and some tightness in her pelvic floor. She was also experiencing constant fear and worry about experiencing leakages, which affected her day to day life.
Joan was provided with intense muscular support training, bladder retraining and guidance on the changing of behavioural habits. Her fear and anxiety of leaking on the way to the bathroom were particularly examined and improved upon. After two months of pelvic floor PT consisting of both the above mentioned myofascial work and the bladder retraining program, the patient was reported to be leak-free. A long-term brain retraining programme was provided in order to keep Joan healthy and worry-free.
If you suffer from urge urinary incontinence and would be interested in trying Physical Pelvic Therapy, you can find a Physical Pelvic Therapist on the Pelvic Rehabilitation Institute website here.