Urge Incontinence
The primary symptom of urge incontinence (also called hyperactive, irritable, or overactive bladder (OAB)) is the need to urinate frequently (more than 8 times over 24 hours, including 2 or more times a night) with subsequent leakage. However, most people (60%) with overactive bladder experience only urgency and frequency. In some people, it occurs only at night (called nocturnal enuresis).
All cases of urge incontinence involve an over-active bladder. In such cases, the detrusor muscle, which surrounds the bladder, contracts inappropriately during the filling stage. When this occurs, the urge to urinate cannot be voluntarily suppressed, even temporarily. There is usually one of two types:
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Idiopathic Detrusor Overactivity (formerly called Detrusor Instability). In this type, the nerves serving the bladder have signaled the brain appropriately that the bladder is full, but the detrusor muscles are unable to be suppressed. The actual cause, however, is not known.
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Neurogenic Detrusor Overactivity (formerly called Detrusor Hyperreflexia). With this type, a known neurologic abnormality impairs the signaling systems between the bladder and the central nervous system, and the brain is unable to inhibit the detrusor muscles controlling urination.
Very often, the cause of detrusor instability and bladder hyperactivity is unknown. Some conditions that can produce the disorders leading to urge incontinence include the following:
- Benign prostatic hyperplasia (BPH). Detrusor instability occurs in about 75% of men with BPH and causes frequency, urgency, and urination during the night (although incontinence itself occurs only in very severe cases). Urge incontinence only at night can be a sign of severe obstruction in the urinary tract.
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| Benign prostatic hypertrophy (BPH) is a non-cancerous enlargement of the prostate gland, commonly found in men over the age of 50. |
- Prostate surgical procedures. Either prostatectomy for prostate cancer or transurethral resection of the prostate (TURP) for BPH can cause detrusor instability. As with stress incontinence, prostatectomy poses a much higher rate than with TURP, which is very low.
- Hysterectomy. Complications of this operation, which removes the uterus, are associated with a higher risk for urge incontinence. In one study, for example, incontinence developed or worsened after hysterectomy in about 16% of women who had only mild or no incontinence before surgery. It should be noted, however, that hysterectomies can also significantly improve urinary incontinence in many women who have an existing condition before the procedure. In the same study mentioned above, 30% of women had severe urinary incontinence before hysterectomy, which declined to 20% afterward and was sustained for at least two years.
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Click the icon to see an image about hysterectomy. |
- Damage to the central nervous system. Certain neurologic disorders or injuries can disrupt the passage of nerve messages between the urinary tract and central nervous system. Among the many conditions that cause this are stroke, multiple sclerosis, spinal cord or disk injury, and Parkinsons disease.
- Infections.
- The aging process.
- Emotional disorders. Anxiety and possibly even depression have been associated with urge incontinence.
- Medications, including certain sleeping agents.
- Genetic factors. Genetic factors may play a role in some cases. For example, a 2001 study identified genetic abnormalities in a family that had a strong history of urge incontinence and leakage at night.
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