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Also known as
Urgency urinary incontinence (UUI), bladder instability, overactive bladder with incontinence, bladder urgency, spasmodic bladder, involuntary urination, urgency incontinence
Definition
Urge incontinence, also known as urgency urinary incontinence (UUI), is a type of urinary incontinence characterized by a sudden, compelling urge to void that is difficult to delay, often followed by involuntary leakage of urine.1 It occurs primarily as a result of detrusor muscle overactivity, resulting in uninhibited or involuntary muscle contractions of the bladder.2 Patients with urge incontinence typically describe a sudden desire to urinate that is difficult to defer, resulting in leakage of urine. These episodes may occur at various times during the day or night.3 The condition significantly affects a person’s quality of life and carries a social stigma, leading to underreporting.4 Urge incontinence is a common cause of incontinence in elderly people, though it can affect individuals of any age.
Clinical Context
Urge incontinence is clinically relevant in various scenarios, particularly in elderly populations where prevalence increases with age.1 It is diagnosed through a thorough clinical evaluation, including a detailed history and physical examination, urinalysis, and sometimes urodynamic studies.2
Patient selection criteria for treatment typically involve assessing the severity of symptoms, impact on quality of life, and ruling out reversible causes (using the mnemonic DIAPPERS: delirium, infection, atrophic urethritis, pharmaceuticals, psychological factors, excessive urine output, restricted mobility, and stool impaction).3
Treatment follows a stepwise approach:
- First-line treatments include behavioral therapies such as bladder training, toileting habits, lifestyle modifications, avoiding bladder irritants (caffeine, alcohol), pelvic floor muscle training, and biofeedback.4
- Second-line treatments include pharmacotherapy with antimuscarinic agents (e.g., oxybutynin, tolterodine, fesoterodine) or beta-3 adrenoreceptor agonists (e.g., mirabegron).4
- Third-line treatments for refractory cases include percutaneous tibial nerve stimulation, intravesical onabotulinumtoxin A injections, and sacral neuromodulation.4
Expected outcomes vary based on treatment approach, with combination therapy (behavioral plus pharmacological) often yielding better results than monotherapy. Successful treatment can significantly improve quality of life and reduce complications such as skin conditions, urinary tract infections, and social isolation.4