ChristianaCare

Urogynecology

Urge Incontinence and Overactive Bladder

As your bladder fills up, your brain sends a signal to tighten the muscles of the pelvic floor and urethra. These muscle contractions close the urethra to help hold urine in the bladder. Once your bladder feels full, it sends a signal back to the brain. If you are ready to go to the bathroom, the brain responds with a signal that releases the muscles and allows urine to flow from the bladder, through the urethra and out of the body.

Your brain, bladder and muscles in the urinary system are supposed to work together to control the flow of urine. When you have urge incontinence or an overactive bladder, some part of this circuit breaks down.

An overactive bladder is when strong urges prompt you to go the bathroom more often than normal. Urge incontinence is when the urges associated with an overactive bladder prevent you from holding back urine before you get to the bathroom.

If you find that you are going to the bathroom frequently, your bladder muscles might be contracting before your brain is ready to allow it. Or your brain might be sending signals at the right time, but your muscles might be too weak or uncoordinated to function properly. If you just have a strong urge to urinate, there might be a problem with the nerves that your brain uses to transmit the signals.

A small percentage of people with neurological conditions, such as Parkinson’s disease or a history of strokes, are prone to these conditions. Certain medications also can cause overactive bladder.

These conditions get progressively worse as you age. About 10 percent of women in their 20s experience them. As many as 40 percent of women in their 80s have overactive bladder.

What are the symptoms of urge incontinence and overactive bladder?

Urge incontinence and overactive bladder can occur at any time and often without warning. You might have one or both of these conditions if you:

  • Have the urge to urinate so severely that you leak before you reach the bathroom.
  • Go to the bathroom frequently to avoid leaks.
  • Feel the urge to urinate while washing dishes, putting your key in the door, pulling into your driveway or having sex.
  • Get up frequently from sleeping to urinate.
  • Make sure you know the location of bathrooms during your daily activities.
  • Limit activities out of concern about leaks or an inability to find a bathroom when you need one.
  • Avoid going to the beach or wearing light-colored clothing because of leaks or fear of leaks.
  • Feel afraid or ashamed to discuss this problem.

How are urge incontinence and overactive bladder treated?

There are many options for managing urge incontinence and overactive bladder. They include:

  • Doing nothing. These conditions are not emergencies, and there are no long-term complications that would shorten your life. Patients should make their own treatment decisions based on the severity of their problem.
  • Medication. There are numerous medications available to treat overactive bladder, regardless of whether you experience leaks. They help you hold urine longer by relaxing the bladder muscle. Typically, they can improve symptoms by about 70 percent. Side effects also are mild and include dry mouth, constipation and blurry vision. Dosing is convenient.
  • Strengthening the pelvic-floor muscles. Special exercises can strengthen the pelvic floor and urethral muscles in a way that helps suppress the urge to urinate. This type of physical therapy can correct mild symptoms and significantly improve severe bladder overactivity. Learning the correct techniques from our center can help maximize results.
  • Managing behavior. Sometimes, changing simple things can improve symptoms. For example, caffeine, artificial sweeteners and alcohol can irritate the bladder; reducing or eliminating them can reduce urgency. Modifying your diet or taking medications at certain times also can improve overactive bladder.
  • Training your bladder. This method helps you set and reach goals for lengthening the amount of time between bathroom trips. First, you chart how frequently you urinate. Next, you learn special exercises that strengthen the pelvic floor muscles and help you suppress the urge to go to the bathroom. Then you set a goal to delay urination and use the techniques to suppress the urges. The goal increases with each success. This approach can take several weeks but is harmless and effective.
  • Stimulating the bladder nerve. This is accomplished with the placement of an implant that is similar to a pacemaker. The procedure, called sacral neuromodulation, involves putting a generator in the buttocks and connecting it to a wire resting near the sacral nerve that comes from the bladder. The generator sends electrical impulses that slow down the signals causing frequent urination. This outpatient procedure is an appealing option for patients whose condition has not improved using conventional treatments.
  • Stimulating the tibial nerve. This procedure is similar to sacral neuromodulation but without surgery or an implant. Instead, a physician places an acupuncture needle just above the inside of the ankle near the tibial nerve, which runs through the leg and connects to other nerves returning from the bladder. The needle is connected to a generator that delivers an electrical stimulus to the tibial nerve for 30 minutes. The tibial nerve then communicates with the nerves returning from the bladder to help reduce frequent urination. Patients typically undergo the procedure once a week for 12 weeks.
  • Surgery. If none of the above treatments are successful, other surgical options are available. The center’s physicians will offer all options available to treat your condition.

ChristianaCare Center for Urogynecology and Pelvic Surgery

Christiana Hospital
Medical Arts Pavilion 2
4735 Ogletown-Stanton Road, Suite 1208, Newark, DE 19713 directions
302-623-4055
fax 302-623-4056

ChristianaCare Concord Health Center
161 Wilmington-West Chester Pike, Chadds Ford, PA 19317 directions
610-361-1030, option 9

Smyrna Health & Wellness Center
100 S. Main Street, Suite 215
Smyrna, DE 19977 directions
302-623-4055

Wilmington Hospital
501 West 14th Street
Gateway Building, 2nd Floor
Wilmington, DE 19801
302-623-4055