Urge incontinence is defined as urinary leakage that occurs prior to arriving at the toilet when experiencing an intense sensation of needing to void.
Urge incontinence often is associated with urinary frequency and is termed “overactive bladder wet”. When urge incontinence is associated with stress incontinence the term mixed incontinence is used to describe the condition. This form of bladder leakage is often much more bothersome to a patient than stress incontinence as every need to urinate is associated with leakage. Urge incontinence can be seen in all ages and sexes and is found in patients that are neurologically normal and in those patients who have neurologic disease such as a stroke or spinal cord injury (neurogenic bladder). The cause of the urge-based bladder leakage is thought to occur with an abnormal contraction in the bladder during filling or with inappropriate sequencing of neurologic events during the filling phase. Why these events occur is the subject of current research and is debated in the literature.
A thorough history is important in the evaluation of urge incontinence. Certainly the symptoms associated with bladder leakage should be clearly defined to be certain the leakage is associated with urgency. Often the urge incontinence is associated with stress incontinence. It is important to assess which symptoms cause more bother for the patient. The coexistence of urinary frequency and nocturia with urge incontinence is common and questions should be asked to determine severity of the overactivity of the bladder. The duration of symptoms should be discussed as sudden onset of bladder leakage may be secondary to a bladder or urethral infection. Questions regarding pad usage can help determine severity of the bladder leakage. Previous medication use and hormone status can impact the incontinence issues.
The physical examination in women can yield occasional clues as to the cause of urge incontinence. Presence of prolapse in the vaginal wall, in particular anterior vaginal wall, can impact voiding function. Narrowing of the urethra can be found on vaginal examination. Tenderness and spasm of the muscles in the vagina and pelvis (levator muscles) is often seen in patients with urge incontinence and voiding dysfunction. The male physical examination can reveal prostate enlargement or abnormalities that can lead to urinary difficulties.
As infection in the bladder can lead to sudden onset of urge incontinence, a urinalysis and urine culture is important during evaluation. Evaluation of the bladder for post-void residual with a bladder scanner can confirm complete bladder emptying. A urodynamic evaluation is performed in patients with urge incontinence to assess bladder dysfunction and suggest further therapy. Occasionally, cystoscopy is performed to rule out cancer or bladder stones.