Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 14, 2026
What is urge incontinence?
Urge incontinence is a type of bladder control problem. You feel a sudden, intense urge to urinate and then leak before you can reach a bathroom. Unlike stress incontinence (which happens with coughing or exercise), urge incontinence happens because your bladder muscle squeezes on its own when it shouldn’t.
About 17% of women have overactive bladder symptoms, and that number rises to over 30% in women 65 and older. I see this condition often in my practice, and it responds well to treatment.
How it feels
Women with urge incontinence often describe:
- A sudden, overwhelming need to urinate that comes out of nowhere
- Leaking on the way to the bathroom, sometimes a few drops, sometimes more
- Common triggers like hearing running water, putting a key in the door (“latchkey incontinence”), cold temperatures, or anxiety
- Needing to urinate more than 7 or 8 times a day
- Waking up multiple times at night to urinate
Urge incontinence can feel unpredictable. You might be fine one moment and suddenly desperate the next. This isn’t a weakness. It’s a medical condition caused by involuntary bladder muscle activity, and it’s very treatable.
What causes it
The bladder muscle (called the detrusor) normally stays relaxed while the bladder fills. It contracts only when you choose to urinate. In urge incontinence, this muscle contracts on its own at the wrong times. In about 90% of cases, this is “idiopathic,” meaning we don’t find a specific cause. Possible contributing factors include:
- Changes in the nerves that control bladder signaling
- Bladder irritation from infections, diet, or medications
- Changes in pelvic floor muscle coordination
- Hormonal changes after menopause
- Previous pelvic surgery
- Neurological conditions like Parkinson’s disease or multiple sclerosis (less common)
Even when no specific cause is found, treatment still works well.
Treatment options
I work with each patient to find the right treatment based on your symptoms, your goals, and what matters most to you. AUA guidelines don’t require you to try treatments in a set order, though your insurance may have requirements.
- Bladder training: you gradually increase the time between bathroom trips to retrain your bladder. Urgency suppression techniques (like pelvic floor contractions, distraction, or deep breathing) can help you get through the urge.
- Pelvic floor therapy: this goes beyond Kegels. A pelvic floor physical therapist works on strength, relaxation, coordination, endurance, and surrounding structures like hips, core, and thighs. We have in-office pelvic floor PTs, which makes it easy to get started. A pelvic floor contraction can actually quiet the bladder muscle through a reflex pathway.
- Dietary changes: reducing caffeine, alcohol, and other bladder irritants can make a real difference.
- Medications: two main types are available. Beta-3 agonists (like mirabegron or vibegron) relax the bladder muscle with fewer side effects. Anticholinergics (like solifenacin or tolterodine) block the nerve signals that cause the bladder to squeeze. For older women, we generally prefer beta-3 agonists because anticholinergics may increase the risk of memory problems with long-term use. Only about 18% of patients stay on anticholinergics past 6 months due to side effects like dry mouth.
- Botox injections: onabotulinumtoxinA is injected into the bladder muscle through a cystoscope in the office, using local anesthesia. In one major trial, 27% of women had complete resolution of leaking with Botox compared to 13% with oral medication. The effect lasts about 6 to 9 months, and repeat injections remain effective without wearing out over time. The main risks are urinary tract infections (about 33%) and a small chance of needing to temporarily catheterize (about 5%).
- Tibial nerve stimulation (PTNS): a small needle near your ankle delivers gentle electrical stimulation to the nerve that connects to your bladder. Treatments are weekly for 12 weeks, then about once a month for maintenance. In clinical trials, about 55% of women reported improvement compared to 21% with a sham treatment. It’s the least invasive of the advanced options with very few side effects.
- Sacral neuromodulation: a small device (like a bladder pacemaker) is implanted to regulate the nerve signals to your bladder. It’s done in two stages: first a test phase to see if it helps, then the permanent implant if it does. Newer rechargeable batteries last 10 to 15 years. In long-term studies, sacral neuromodulation and Botox showed equal results by 2 years, but sacral neuromodulation has a lower risk of UTIs.
References
- Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592-1604. doi:10.1001/jama.2017.12137
- Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol. 2019;202(3):558-563. doi:10.1097/JU.0000000000000309
- Visco AG, Brubaker L, Richter HE, et al. Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence. N Engl J Med. 2012;367(19):1803-1813. doi:10.1056/NEJMoa1208872
- Amundsen CL, Komesu YM, Chermansky C, et al. Two-year outcomes of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: a randomized trial. Eur Urol. 2018;74(1):66-73. doi:10.1016/j.eururo.2018.02.011
- Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438-1443. doi:10.1016/j.juro.2009.12.036
- Sanses TVD, Zillioux J, High RA, et al. Evidence-informed, interdisciplinary, multidimensional action plan to advance overactive bladder research and treatment initiatives. Urogynecology. 2023;29(3):252-262. doi:10.1097/SPV.0000000000001274
- ACOG Committee on Practice Bulletins. Urinary incontinence in women (ACOG Practice Bulletin No. 155). Obstet Gynecol. 2015;126(5):e66-e81. doi:10.1097/AOG.0000000000001148
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