Patient education: Treatments for urgency incontinence in females (The Basics)

What is urgency incontinence? — "Incontinence" is the medical term for leaking urine or losing control of your bladder. People with urgency incontinence feel a strong need or "urge" to urinate all of a sudden. Often, it is so strong that they can't make it to the bathroom in time. "Overactive bladder" is another term for having a sudden, frequent urge to urinate. People with overactive bladder might or might not actually leak urine.

Urgency incontinence is common, especially in females. But there are treatments that can help. There are also things that you can do on your own to stop or reduce urine leakage. You don't have to "just live with it."

Is there anything I can do on my own to prevent urgency incontinence? — Yes. To help reduce urine leaks or urges, you can:

●Cut down on any foods or drinks that make your symptoms worse. Alcohol, caffeine, spicy or acidic foods, or artificial sweeteners make some people urinate more often or cause sudden urges.

●Try not to drink too much right before bed.

●Prevent constipation – Constipation is a common problem that makes it hard to have bowel movements. It can make urgency incontinence worse.

To help with bladder control, you can try:

●Bladder retraining – Bladder retraining helps your bladder hold more urine so that you can urinate less often. During bladder retraining, you go to the bathroom at scheduled times. For example, you might decide to go every hour. Make yourself go every hour, even if you don't think that you need to. If you need to go sooner, try to wait until the whole hour has passed. After you get used to waiting 1 hour, you can try waiting longer between bathroom visits. Over time, you might be able to "retrain" your bladder to wait 3 or 4 hours between bathroom visits.

●Relaxation can help manage the urge to go. When you get an urge, stand still or sit down. Take a deep breath, squeeze your pelvic muscles, and let the "wave" of needing to go pass. Then, walk slowly to the bathroom to urinate.

●Pelvic floor muscle training – This involves learning exercises to strengthen and relax your pelvic muscles. These include the muscles that control the flow of urine and bowel movements. These exercises can help, but people often do them wrong. Ask your doctor or nurse how to do them correctly. They might suggest working with a physical therapist who has special training in these exercises.

How do doctors treat urgency incontinence? — In addition to bladder retraining, relaxation, and pelvic muscle exercises, treatment might include medicines and sometimes procedures. These include:

●Medicines to relax the bladder – These can help control symptoms. Medicines include oxybutynin (brand name: Ditropan), tolterodine (brand name: Detrol), fesoterodine (brand name: Toviaz), solifenacin (brand name: VESIcare), darifenacin (brand name: Enablex), and mirabegron (brand name: Mirbetriq). They come in pills that you take by mouth, and patches or gels that you put on your skin.

Medicines for urgency incontinence can cause side effects, including:

•Very dry mouth

•Constipation

•Heartburn

•Trouble thinking and remembering things

•Blurry vision

•Fast heart rate

•Sleepiness

If you are older, ask your doctor if it is safe to take these medicines. If you have any trouble thinking or remembering things, some of these medicines could make these issues worse.

If you take medicine to help with urgency incontinence or overactive bladder, you might need to try several different medicines before you find a treatment that works for you.

●Vaginal estrogen – If medicines that relax your bladder do not work for you or cause too many side effects, talk to your doctor about other treatments. For some people who have vaginal dryness after menopause, vaginal estrogen can help with this as well as your bladder problems.

●Procedures to help relax the bladder – If medicines don't help your symptoms or you can't take medicines, your doctor might suggest a procedure such as:

•An injection (shot) of botulinum toxin (Botox) into the bladder to help it relax – The injection needs to be given about once or twice a year. These injections can cause trouble urinating in about 1 out of 4 people who get them.

•Treatment with electrical nerve stimulation – This is done with a device that goes under the skin, like a pacemaker. Electrical stimulation sends mild electrical signals to nerves that affect the bladder. The signals do not hurt. This treatment can reduce sudden urges or the need to urinate often. You might need follow-up procedures after getting the device put in.

How well do treatments for urgency incontinence work? — That depends on your symptoms and the cause of your urgency incontinence. For example, if you have another medical condition, such as diabetes, treating that condition might help.

Most people need to try several treatments and might use more than 1 at a time. For example, your doctor might suggest bladder retraining, medicine to relax your bladder, and vaginal estrogen. It can take a month or longer to know if a treatment is working. Try not to get discouraged if it feels like treatment is not working quickly enough.

What will my life be like? — Most people with urgency incontinence need some kind of treatment for a long time, or for life. Treatment for urgency incontinence can help symptoms, but does not cure the cause of the incontinence.

Even if treatment doesn't stop urgency incontinence completely, it can make life easier and help you feel a lot better.

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