Ask Dr. Pat · Health

Urinary Urge Incontinence

Dr. Richard Lee Responds

Up to 43 percent of women, young and old, experience symptoms of overactive bladder, or OAB. It represents one of the most commonly seen urologic conditions in women. OAB is defined as urinary urgency, usually accompanied by frequency and nocturia, in the absence of urinary tract infection or other obvious pathology. As the definition implies, the cause is often idiopathic, or unknown. It can be accompanied by urinary incontinence, as the you have described. We often need to distinguish between the types of incontinence, i.e. typically stress incontinence vs. urge incontinence (and sometimes overflow incontinence). The former refers to leakage that may occur with coughing, laughing or sneezing. The latter is most often accompanied by a sudden urge to urinate that one cannot control before getting to the bathroom. Overflow incontinence occurs when the bladder no longer empties completely, causing a patient to feel as if they need to urinate frequently.

In regards to treating OAB, we typically recommend a history and physical with your physician. We often discuss conservative measures, like reducing caffeine and alcohol intake, restricting fluid in the evening, and reducing carbonated beverages. Pelvic floor muscle therapy can be helpful. If these conservative measures fail, we can often empirically treat with oral medications, of which there are two main classes: the anticholinergics (these medications interrupt the neuromuscular signals to the bladder, akin to taking your foot off the gas pedal of a car) and the beta-3 agonists (these medications interrupt the neuromuscular signals to the bladder, akin to pressing the brake of your car). Both types of medications help to calm the overactive bladder, although patients can experience side effects, particularly with the anticholinergics. There are also second- and third-line treatments, like Botox injection for the bladder (Botox functions by chemically relaxing the bladder muscle), peripheral neuromodulation, and sacral neuromodulation (both neuromodulation technologies send an electrical impulse to the nerves that control your bladder, thereby calming it down), which your physician can discuss with you further. Diagnostic procedures, like cystoscopy or urodynamics, may occasionally be used to further evaluate the urinary tract but are not typically first-line tests that are utilized.

Dr. Richard Lee

 

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  • hillsmom January 9, 2017 at 11:33 am

    What about Kegel exercises, and how to do them…or is it too late? I hope she tries another urologist, too. Good luck.

    Reply
  • Mary Kelly Selover January 9, 2017 at 10:33 am

    Welcome aboard, Dr. Lee! Great post.

    Reply