Urge incontinence

Urge incontinence is a need to urinate that is so strong that you can't get to the toilet in time. It can occur when the bladder contains only a small amount of urine. Some people have no warning before they accidentally leak urine. Others may leak when they drink water or hear running water.

If you have urge incontinence, you may feel a sudden urge to urinate and the need to urinate often. The urge is so strong that you can't reach the toilet in time. With this bladder problem, you may leak a large amount of urine that can soak your clothes or run down your legs.

Urge incontinence is often first treated with:

• Bladder training. This helps you slowly increase how long you can wait before you have to urinate.
• Pelvic floor muscle exercises (Kegels). They help strengthen some of the muscles that control the flow of urine. Biofeedback can also help with this.

Your doctor may talk to you about making changes in your diet and lifestyle. For example, limit caffeine, carbonated drinks, and alcohol. They make you urinate more.

Medicines may also be used. These include:

• Medicines like darifenacin and mirabegron that reduce the urge to urinate and how often you urinate.
• A type of antidepressant that may help with bladder control.
• Estrogen cream used in the vagina.
• Alpha-blockers and other medicines that help relax the muscles in the prostate and bladder.

For urge incontinence that hasn't been controlled by exercises or medicine, treatments include:

• Botulinum toxin injections. You may need to get bladder injections every 3 to 12 months.
• Electrical stimulation. Small electrodes send a mild electric current to nerves in the lower back or the pelvic muscles that are involved in urination.
• Surgery to treat an enlarged prostate, to make the bladder bigger (augmentation cystoplasty), or to make another way to store and pass urine (urinary diversion).

• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• Limit caffeine, fizzy drinks, and alcohol. They make you urinate more.
• Keep a bladder diary. This can help with bladder training. You can find bladder diary forms and instructions for bladder training online. Or ask your doctor for them.
• Try pelvic floor (Kegel) exercises. These tighten and strengthen pelvic muscles. (If doing these exercises causes pain, stop doing them and talk with your doctor.) To do Kegel exercises:
  • Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
  • Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
  • Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
  • Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.
• Wear pads that absorb the leaks. This may help for a while. Pads designed to absorb urine work best.
• Keep skin in the genital area dry. Petroleum jelly (like Vaseline) spread on the area may help protect your skin.