Urge Incontinence Guide

What Is Urge Incontinence?

Urge incontinence is described as the inability to properly control your bladder or bowel, usually meaning you rush to the toilet. This condition can occur for the bladder, the bowels, or for both, causing single or double incontinence. The condition can cause a lot of stress and discomfort in your day-to-day life, but there are options available to manage the symptoms of urge incontinence.

Urinary Urge Incontinence

Urinary urge incontinence is a common complaint. It's characterized by a sudden, uncontrollable need to go to the bathroom. This can be a result of bladder contractions that happen too fast, or not at all.
There are two types of urge incontinence:

● Overactive bladder

● Stress urinary incontinence.

Overactive bladder is the complaint of urine leakage associated with a sudden, persuasive desire to void that is difficult to defer.

Stress urinary incontinence is chronic incontinence usually involves the bladder more directly whereby the detrusor muscle malfunctionshad . This leads to premature release of urine, or complete incontinence whereby the entire bladder empties. Learn more about stress incontinence in women

The causes of urinary urge incontinence are poorly understood, but urgency can be worsened by bladder irritation from cystitis (a bacterial infection), atrophic tissue due to hormone depletion, or bladder tumors or stones (small growths). Further disturbances in nerves, smooth muscle and urothelium have been described to cause this condition. Read more about urge incontinence here >>

Bowel Urge Incontinence

When you're suffering from bowel incontinence, it can feel like your body is betraying you. But it's not—the problem is that the muscles in your pelvic floor and around your anus aren't working well together.

The anal sphincter complex is made up of two muscles: the internal and external sphincter. The internal sphincter is circular muscle that runs along the rectal wall and controls whether or not stool can pass through. It's controlled by the autonomic nervous system, which means it works automatically and we can't control it consciously. The external sphincter is a continuation of the pelvic floor muscle, which we do have some control over—we can squeeze it voluntarily when we want to stop stool from coming out.

When you're healthy, everything works together smoothly: stool enters the rectum and doesn't come out until you're ready for it to go; when you are ready for it to go, your pelvic floor tightens around your anus and holds everything in place until you're done defecating. But if something goes wrong with this process—if there's too much pressure on one side or another—then things start getting messy!

Once again, the causes are less well known, yet majorly the weakening of the sphincter which leads to bowel urge incontinence is due to damage of to the pelvic floor sustained during childbirth. Faecal incontinence may also occur after spinal injury, stroke, in Multiple Sclerosis and in long-term diabetes. Sometimes, it may be as simple as your diet that requires changing to prevent incontinence (The IBS Network, n.d).

What Are the Symptoms of Urge Incontinence?

As with the causes of urge incontinence, symptoms differ from person to person. Some may experience small leakages with minor problems, yet others may display full incontinence with complete loss of control of their bladder or bowels (Age UK, 2017).

Symptoms of urge urinary incontinence

The symptoms vary in degree and type between individuals.

The Following Symptoms Are Generally The Most Common:

• Sudden urge to urinate followed by an involuntary loss of urine.


• Need to urinate often, including throughout the night.


• Feeling that the bladder doesn’t empty completely.

Symptoms of urge urinary incontinence

The symptoms vary in degree and type between individuals.

The Following Symptoms Are Generally The Most Common:

• Leaking from the bowel.


• Urgent need to open bowels followed by an involuntary loss of faeces
  
  

Conservative Behavioural Treatment

Many people with bladder problems have found biofeedback to be an effective treatment. Biofeedback is a type of conservative behavioural treatment and is the practise that helps individuals learn how the body behaves and such can work out when it isn’t functioning properly. It can help recognise when it the bladder or bowels are overactive.

Two techniques include

• Timed voiding involves using a chart to record the times that you pass urine/faeces and also when you leak involuntarily. This technique works by understanding your leakage patterns, therefore avoiding leakage in future by visiting the bathroom at those times


• With bladder training, the intervals which you go to the bathroom are elongated, waiting a little longer before each time. You follow a certain pattern, for example, every hour for a prolonged period of time. This interval is then increased, such that the interval is increased by up to four hours in the long term. This can aid in training the bladder and ‘teaching’ it when to pass urine, restoring normal bladder activity (Faiena, I., et al, 2005).

Pelvic floor exercises can help strengthen the muscles that support the bladder, uterus and bowels. Strengthening these muscles can aid in reducing or preventing problems such as urine or faeces incontinence. To practice these exercises, you pretend you are trying to stop the flow of urine or preventing the release of gas, causing the contraction of the pelvic floor muscles. Usually it is recommended that these should be done every day, roughly five times each day. These exercises can improve your ability to hold urine until you get to a bathroom, avoiding accidental leakage (NHS, 2017).

Medication Treatments

If behavioural therapies are not an effective treatment for urge incontinence, your medical professional may prescribe medication called antimuscarinics. They are often used in primary care in combination with behavioural and lifestyle changes (McDonnell, B. and Birder, L.A., 2017). There are many subtypes of this medication, but common types include oxybutynin, tolterodine and darifenacin. Usually, patients are prescribed at a low dose to avoid any possible side effects, and doses can be increased until the medication proves effective. Reassessment occurs after approximately 4 weeks, and then every 6 to 12 months thereafter if the medication continues to help (NHS, 2017).

Mirabegron is an alternative medication if antimuscarinics are unsuitable, ineffective or if they cause unpleasant side effects. This treatment usually causes the bladder muscle to relax, which helps with the filling up of the bladder and storage of urine. Studies have shown that this drug causes improved bladder compliance, increased bladder capacity, reduced urinary frequency, and reduced incontinence (McDonnell, B. and Birder, L.A., 2017).

Treatment Summary

Invasive Treatments

Occasionally, usually in more severe cases, behavioural therapies and medications do not directly work in preventing urge incontinence. Therefore, more invasive treatments are required to prevent the condition. These treatments should be discussed in detail with a specialist, providing an outline of the benefits and risks associated with the treatment. Other options include (NHS, 2017 and WebMD 2005):

They Can Aid With The Continuation Of Normal Life And Products May Include:

• Botulinum toxin A (Botox) injection into the bladder, increasing its storage capacity and reducing leakage episodes.


• Hormone therapies for women, using oestrogen alone or in combination with progesterone


• Sacral nerve stimulation which delivers an electrical signal which controls the amount of abnormal contractions.


• Surgical procedures:


• Augmentation cytoplasty involves making your bladder bigger by adding a section of intestinal tissue to the bladder wall. This is usually accompanied by the use of a catheter.


• Urinary diversion involves redirecting the ureters (from the kidney to the bladder) to outside of your body, bypassing the bladder.

Summary

It's easy to laugh off incontinence as an embarrassing problem, but it can take a serious toll on sufferers. Urge incontinence is a common and uncomfortable condition that can have a severe impact on sufferers, particularly the elderly or nursing care patients. Fortunately, the condition is easily treatable and manageable with the right products and support. MoliCare assist with that support, supplying high quality and personalised pads, pants and incontinence care products in order to maximise your comfort.

If you or a loved one is facing urge incontinence, don't hesitate to reach out to your doctor or another medical specialist. You'll be thankful you did.

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