Urge incontinence is characterized by a sudden uncontrollable sensation of urination and frequent urination. These patients often need to use the bathroom, even every 2 hours, and bedwetting occurs frequently at night.
Urge incontinence is caused by involuntary bladder contractions resulting in the extrusion of urine, which can sometimes expel large amounts of urine.
Incidental urination can be triggered by.
(1) Sudden change of position or activity
(2) Hearing or touching running water
(3) When drinking small amounts of water
Etiology
Two types of bladder abnormalities can cause urge incontinence. The most common cause is neurogenic bladder (overactive type), which is caused by a brain or spinal cord injury or disease that interrupts nerve conduction pathways above the sacrum, resulting in loss of bladder sensory and motor function. There are several neurological disorders and abnormalities associated with neurogenic bladder, including:
(1) Alzheimer’s disease (senile dementia)
(2) Diabetes mellitus
(3) Multiple sclerosis
(4) Parkinson’s disease
(5) disc rupture
(6) Stroke
(7) Syphilis
(8) Brain trauma or spinal cord injury
(9) Tumors of the brain or spinal cord
Chronic urinary tract infections, bladder stones or polyps can also irritate the bladder and cause urge incontinence by causing instability of the detrusor muscle. Unexplained instability of the detrusor muscle is also common. It is thought that these cases are related to abnormalities in the function of muscle or nerve tissue.
Diuretics can increase urine output and are commonly used to treat hypertension and edema. Rapid diuretics can increase the urgency of urination and frequency of urination in some patients, especially in elderly and bedridden patients. Dose modifications can improve symptoms.
Treatments commonly used to treat urge incontinence are biofeedback and electrical stimulation, timed voiding bladder training, and surgery.
Timed voiding bladder training
This treatment is used for both urge and overflow incontinence. Patients are required to keep an ongoing voiding diary of voiding and leakage, which the physician analyzes and determines the type of voiding the patient is experiencing. The patient uses this schedule to plan when to empty the bladder to avoid leaking urine. During bladder training, biofeedback and Kegel training are useful to help patients reduce the sensation of urgency and can delay voiding and follow a schedule.
Medications
For some patients, medications such as anticholinergic and alpha-1 adrenergic receptor blockers have been shown to be effective. Anticholinergic agents relax smooth muscle tissue and have an antispasmodic effect on an overactive bladder.
Anticholinergic agents
Propantelene, which blocks bladder muscle contractions (overactive bladder). Standard dose is 7.5-30 mg 3-4 times a day before meals.
Oxybutynin hydrochloride, relaxes bladder smooth muscle. For the treatment of urge incontinence due to overactive bladder.
Oxybutynin skin patch, a light, soft, transparent film, is applied to the skin of the abdomen or buttocks twice a week to treat overactive bladder. This treatment allows oxybutynin to continue to enter the bloodstream through the skin, relieving symptoms for up to 4 days. It should not be applied in patients with urinary or gastric retention, uncontrolled closed-angle glaucoma, and in patients with allergy to oxybutynin.
Scopolamine sulfate, an antitussive drug, is used to treat urge incontinence due to overactive bladder or neurogenic bladder. The standard dose is 1-2 tablets every 12 hours. This drug is not indicated in patients with urinary tract obstruction (e.g. prostatic hyperplasia), glaucoma (increased intraocular pressure) or severe colitis (ulcerative colitis).
Tricyclic antidepressants, which have anticholinergic effects, can reduce nocturnal incontinence and help control urge incontinence.
Drug side effects
Side effects associated with anticholinergic effects include
(1) dizziness
(2) constipation
(3) Drowsiness
(4) Dry mouth
(5) Headache
(6) Nausea
(7) Nervousness
(8) Tachycardia
(9) Urinary retention
(10) Blurred vision